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Objective:To analyze the clinical features, treatment efficacy and prognosis of cavernous lymphangioma.Methods:The clinical manifestations, laboratory findings, imaging examinations and treatment of 8 patients with pathology-diagnosed cavernous lymphangioma admitted in Peking Union Medical College Hospital from January 1990 to July 2020 were retrospectively analyzed.Results:All the patients were female. The onset age ranged from 0 to 58 years, with a course of 24 (5,78) months. There were 2 cases of abdominal mass, 2 cases of axillary mass, 1 case of neck mass, 1 case of inguinal mass, 1 case of mandibular mass and 1 case of pleural and peritoneal effusion. Seven cases had adult onset and 1 case had congenital onset. Two patients had had history of surgery adjacent to lesion sites. Contrast-enhanced CT scan showed a low-density round mass with no significant enhancement in 5 patients. Seven patients underwent complete resection of the mass, 1 patient received partial resection and intervention with medium-chain fatty-acid diet. During the follow-up, 4 patients were stable after 3.5 (1.3-17.8) years, while 2 patients relapsed 1 and 13 year after surgery, respectively. Additionally, one patient was diagnosed with Bowen disease.Conclusion:Cavernous lymphangioma can be congenital or acquired and usually occurs in female. The body mass is the common clinical manifestation; and surgery is the most common treatment, but it is prone to relapse and requires long-term follow-up.
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Objective To provide helpful continued medical education (CME) for physicians and improve gout treatment,we conducted a questionnaire survey to investigate physicians' knowledge in nine districts of Beijing.Methods A questionnaire survey including ten gout-related questions was conducted among 298 physicians in Beijing.Demographic data and previous gout CME experience were collected.Chi-square test or Student's t test,univariate analysis and logistic regression analysis were used to evaluate the relevant factors of physicians' knowledge level.Results A total of 250 valid copies were collected including 127 from community service centers (CSC),123 from tertiary hospitals.The correct answer rate of gout etiology,pathogenesis and attack symptoms were over 70％ in both groups.45.5％ (56/123) CSC doctors and 57.4％ (66/115) tertiary doctors answered right drugs to control acute gout attack (P=0.067).Only 42.3％ (52/123) in CSC and 53.4％ (63/118) in hospitals chose allopurinol as a urate-lowering drug (ULT),while 46.3％ (57/123) and 32.2％ (38/118) doctors considered colchicine as a ULT drug (P=0.084) respectively.Near half doctors considered that gout patients should take long-term ULT [40.5％ (51/126) vs.57.6％ (68/118)respectively,P=0.007].Univariate analysis showed that CME training could improve gout-related knowledge in CRC doctors.Conclusion Most CSC doctors generally understand basic knowledge of gout,while confusion of treatment is still significant.CME especially including standard gout treatment should be performed by doctors in tertiary hospitals.
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In order to improve the professional competence of in-service general practitioners and improve the effectiveness of standardized residency training, it is necessary to carry out training with the specific problems encountered in the practice. Taking Gaobeidian Community Health Service Center as an example, the characteristics, process and precautions of the general practice case discussion model based on the real scene of the community health institutions are introduced in the article. It would provide reference for improving the teaching effectiveness and efficiency in the training base of general practice.
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Objective@#To survey knowledge of systemic lupus erythematosus (SLE) among general practitioners in Beijing Dongcheng district.@*Methods@#In November 2017, an online questionnaire survey on knowledge of SLE was conducted among 226 general practitioners from 7 community health service centers and 44 community health service stations in Beijing Dongcheng district. The questionnaire included three parts: the basic information of participants, SLE-related knowledge and the demand of continuing education for SLE.@*Results@#Total 225 valid questionnaires were received with a retrieval rate of 99.6%. The overall accuracy rate was 47.0%(1 269/2 700). And the rates of correct answer for SLE diagnosis, treatment and management were 28.3% (191/675), 58.4%(526/900) and 49.0%(551/1 125), respectively. Educational background, professional titles and working years had a certain impact on the level of SLE disease-related knowledge. Higher educational level and longer working years were associated with the higher knowledge level of SLE treatment goals (χ2=6.054, 4.296; P<0.05). Knowledge scores regarding side effects of glucocorticoid were slightly higher in GPs who were working for a longer time and in senior positions (χ2=6.048,5.499;P<0.05). In addition, the study also identified SLE patients in 5 community health centers and 15 community health service stations, who were given medications of glucocorticoids and immunosuppressants. Fewer SLE patients presented to the community health service and lack of learning resources mainly affected the GPs′ perception of SLE, as well as patient management. Besides, 79.6%(179/225) of GPs perceived that community management of SLE patients is necessary and they would be interested in receiving further training on SLE. The most preferred method of training delivery was short courses and lectures.@*Conclusion@#The knowledge and practice of SLE need improvement among GPS, especially early identification and long-term management. Fewer patients and lack of learning resources are the primary barriers. The results of the study are of practical significance for the training of general practitioners in the future.
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Objective To survey knowledge of systemic lupus erythematosus (SLE) among general practitioners in Beijing Dongcheng district.Methods In November 2017,an online questionnaire survey on knowledge of SLE was conducted among 226 general practitioners from 7 community health service centers and 44 community health service stations in Beijing Dongcheng district.The questionnaire included three parts:the basic information of participants,SLE-related knowledge and the demand of continuing education for SLE.Results Total 225 valid questionnaires were received with a retrieval rate of 99.6％.The overall accuracy rate was 47.0％(1 269/2 700).And the rates of correct answer for SLE diagnosis,treatment and management were 28.3％ (191/675),58.4％(526/900) and 49.0％(551/1 125),respectively.Educational background,professional titles and working years had a certain impact on the level of SLE disease-related knowledge.Higher educational level and longer working years were associated with the higher knowledge level of SLE treatment goals (x2=6.054,4.296;P＜0.05).Knowledge scores regarding side effects of glucocorticoid were slightly higher in GPs who were working for a longer time and in senior positions (x2=6.048,5.499;P＜0.05).In addition,the study also identified SLE patients in 5 community health centers and 15 community health service stations,who were given medications of glucocorticoids and immunosuppressants.Fewer SLE patients presented to the community health service and lack of learning resources mainly affected the GPs' perception of SLE,as well as patient management.Besides,79.6％(179/225) of GPs perceived that community management of SLE patients is necessary and they would be interested in receiving further training on SLE.The most preferred method of training delivery was short courses and lectures.Conclusion The knowledge and practice of SLE need improvement among GPS,especially early identification and long-term management.Fewer patients and lack of learning resources are the primary barriers.The results of the study are of practical significance for the training of general practitioners in the future.
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Supervised Teaching Clinic of the General Internal Medicine Department,Peking Union Medical College Hospital,is introduced from three respects including it's organization form,teaching contents,and feedback given by the supervisor.Through the actual cases in these clinics,it is illustrated how to implement the value of general practice during the interviews and how to deliver it to the residents in standardized training program.
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Heart failure is a serious condition with high prevalence and mortality. The application of the novel big data analysis in heart failure can improve the management of this condition,especially in terms of diagnosis,classification,and prognostic prediction. This articles reviews relevant literature and validates the role of big data analysis for heart failure patients.
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Humans , Big Data , Heart Failure , Diagnosis , Therapeutics , PrognosisABSTRACT
A 70-year female patient with a 14-year history of type 2 diabetes mellitus ( T2DM) complains poor blood sugar control and body weight gain after insulin use for 3 years.A patient-centered community management was applied to this patient .The management scheme included defining the purpose of patient visit, completing the relevant medical history and examination , confirming the current major diagnosis, analyzing causes of insulin-induced weight gain , eliminating concerns about insulin use , choosing the type of insulin, determining the insulin treatment plan and the diet plan , as well as giving health education of hypoglycemia accordingly .The general practitioner and the patient worked together on the individualized management plan .After 3 months of treatment, the patient's weight, fasting blood glucose, glycosylated hemoglobin , blood lipids and BMI levels were significantly decreased .
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Objective To investigate the clinical features of adult-onset chronic active Epstein-Barr virus infection (CAEBV). Methods A total of 21 adult patients with CAEBV who were admitted to the department of General Internal Medicine at Peking Union Medical College Hospital from January 2006 to January 2016 were retrospectively analyzed. Demographic data, disease duration, clinical manifestations, laboratory findings, treatments and prognosis were reviewed. Results Eighteen females and 3 males were enrolled with a mean age of 39 years. The most common clinical manifestations included fever in 20 patients, splenomegaly in 20 patients, lymphadenopathy in 18 patients, and hepatomegaly in 10 patients, followed by laryngopharyngeal disorders in 6 patients, pleural effusion and peritoneal effusion each in 5 patients, rash in 4 patients, interstitial lung disease in 3 patients, gastrointestinal hemorrhage in 2 patients, and peripheral neuropathy and pulmonary hypertension each in 1 patient. Six patients were complicated with hemophagocytic lymphohis-tioncytosis(HLH) that developed 5-17 (mean: 9) months following CAEBV onset, all of whom experienced hyperpyrexia, pancytopenia, lymphadenopathy, splenomegaly, and liver dysfunction, 3 with hepatomegaly. Nineteen of the 21 patients had received steroid therapy including 10 combined with immunosuppressive agents, 11 with antiviral therapy, and 8 with intravenous immunoglobulin. Thirteen patients died, including 10 of multiple organ failure, (including 6 of HLH) 2 of severe pulmonary infection, and 1 of lymphoma. Six patients remained on follow-up, yet 2 were missing. Conclusions CAEBV is expected with severe condition and poor prognosis, which is likely to be complicated with HLH. Clinical physicians should pay attention to adult patients with fever, hepatosplenomegaly and lymphadenopathy, which suggests possible CAEBV.
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Comprehensive geriatric assessment (CGA) is widely used for creating tailored individual care plans for seniors who usually are suffering from multiple diseases,frailty,disability and cognition decline.Skilled communicators are of importance for high-quality clinical data collection.Communication skills used in CGA are summarized in this article by reviewing related references and combining practical experiences in the process of applying international resident assessment instruments (interRAI).
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Objective To review the feedback from trainees and trainers of interactive clinical skill training workshop for general practice.Methods An interactive clinical training workshop was held on October,2014,medical staff from 17 provinces or municipalities attended the workshop.Feedback from 86 trainees was collected by questionnaire survey,while the feedback from 12 trainers was collected by focus group.Results Total 86 questionnaires were collected from trainees with a response rate of 100％.The average working year of trainees was 15.6 ; 38.4％ of them were general practitioners in community health centers; and most of them had no similar trainings before.Among 86 trainees,70 (81.4％) thought that the training contents were relevant to their daily work,76 (88.4％) thought that workshop was good method for the training.More than 55.0％ trainees told that the training contents met their expectation ; 76 (88.4％) thought that the workshop was well conducted in general,68 (79.1％) were willing to participate similar training workshops in the future.However,the contents probably need similar training advised by the trainers in the questionnaire were not agreed by trainees.The trainers thought the width and depth of training contents should be modified according to the trainees' level.Basic knowledge,basic clinical skill and common diseases should be emphasized ; and the concept of general practice and indications of referral were among the important but difficult parts in the training.For an interactive clinical skill training,teaching materials preparation,lacale control and local teaching facilities were all important.Conclusions Clinical skill training is an important part of general practitioners' training,and workshop is an effective way for training.The training contentd should be more closer to the daily work of general practitioners.
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To explore the population composition and the morbidities and treatment of hypertension and diabetes mellitus among the patients at 4 community healthy service stations at Gaobeidian,Chaoyang District of Beijing during the period of February 2009 to October 2010.A cross-sectional survey was conducted by self-reporting questionnaires.Most patients were above 40 years old,had a lower income level and education status and their treatment costs were mainly covered by social health insurance.Their incidences of hypertension and diabetes mellitus were high.Though most of them could recognize and treat their illnesses,the control rate remained non-satisfactory.Targeting incoming patients,community health service stations should take its advantages of managing chronic diseases and enroll more patients from local communities.
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Objective To evaluate the current situation of two-way referral system by qualitative study.Methods The qualitative study was carried out in Department of General Internal Medicine of Peking Union Hospital and 4 clinics under Beijing Gaobeidian Community Health Center from June to December 2009.In-depth interview was conducted on 6 patients,who were referring from community health center to tertiary hospital and 16 general practitioners in the community.The method of thematic framework was used for data analysis.Results Only 1 of the 6 patients,who made the appointment,completed the two-way referral.From the view of the patients,the interrupt of the two-way referral was due to long-time waiting,inconvenient transportation to the hospital,availability of specialists,unsmooth process of referral and unsatisfied doctors.However,the community health service staff thought that difficulties of the two-way referral originated from the system,doctors,patients,and doctor-patient relationship.Sometimes patients distrusted doctors both in hospital and in community; communications between doctors or between doctors and patients were less efficient; patients had multiple choice for their primary care and they may go to any hospital freely bypass community-based referral system; patients had excessive expectation for medicine and doctors; some patients paid less attention to their own health,and so on.For improvement of the two-way referral system,the community health service staff proposed concrete measures in terms of relevant policy,the hospital,community health service,the doctors and patients; they emphasized the importance of upgrading their own communication ability and professional skills for primary care.Conclusions Many factors may influence successful implement of two-way referral,so it is necessary to improve the relevant policy and procedures and to upgrade medical staff in community.
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A cross-sectional survey on two-way referral using self-report questionnaire was conducted in a sample of 1423 residents living in 4 communities in Caobeidian area, Chaoyang District and 4 communities in Dongcheng District from April to July 2009. Among the residents who responded the questionnaire, 19.7% (88/446) from Gaobeidian and 8.2% ( 80/977 ) from Dongcheng District were referred to hospitals in 2008. And 30.7 % (27/88) in Gaobeidian and 43.8% (35/80) in Dongcheng District referred to hospital based on their own decision rather than doctors' recommendation; 45. 5% (40/ 88) in Gaobeidian and 45. 0% (36/80) in Dongcheng District of referrals were officiary processed by health institutions. The survey also showed that 57.6% and 59.4% of the respondents from the two districts preferred to free referral between community health service centers and hospitals.
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Objective To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. Methods A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. Results A total of 2593 patients were included in our study. It consisted of 1075 men and 1518women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing,the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593)of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89. 2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29. 8%), certain infectious and parasitic diseases(26.3%), and neoplasm (14. 5%)] . The final diagnostic rate of the 928 non-FUO cases was 86. 8%(803/925), with the first three leading causes as musculoskeletal system and connective tissue(24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs(11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. Conclusions During 2004 -2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.
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<p><b>OBJECTIVE</b>To study the effect of interleukin (IL)-27 on INF and IL-4 activities in children with asthma.</p><p><b>METHODS</b>The levels of IFN-gamma and IL-4 in culture supernatants of peripheral blood mononuclear cells (PBMCs) from 23 asthmatic children were measured using ELISA. PBMCs were cultured with recombinant IL-27 (5 ng/mL or 0.5 ng/mL) for 12 hrs in vitro.</p><p><b>RESULTS</b>IFN-gamma levels in both 5 ng/mL and 0.5 ng/mL IL-27 treatment groups (85.9+/-12.2 and 8.9+/-2.3 microg/L, respectively) increased compared with those in the cytokine stimulated control group (P<0.01, P<0.05 respectively). The group treated with 5 ng/mL IL-27 had decreased significantly IL-4 levels compared with the cytokine stimulated control group (15.0+/-1.9 microg/L vs 77.0+/-15.6 microg/L; P<0.01).</p><p><b>CONCLUSIONS</b>IL-27 may be involved in the pathogenesis of asthma. It may affect Th1/Th2 cell activities and might be a new option for the treatment of asthma.</p>
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Child , Child, Preschool , Female , Humans , Infant , Male , Asthma , Allergy and Immunology , Cells, Cultured , Interferon-gamma , Interleukin-17 , Pharmacology , Interleukin-4 , Leukocytes, Mononuclear , Allergy and Immunology , Recombinant Proteins , PharmacologyABSTRACT
International medical community has seen the prevail of outpatient teaching for medical students in recent years. A student-centered and faculty-run teaching clinic was set up based on current outpatient resources in 2008 by Division of General Internal Medicine (DGIM) in Peking Union Medical College Hospital (PUMCH). We concluded that teaching clinic was an effective teaching mode for medical students to improve clinical skills, diagnostic proficiency and health-care professionalism in internal medicine.
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Department of General Internal Medicine (DGIM) in the Peking Union Medical College (PUMC) Hospital is the first academic general internal medicine division in teaching hospitals in China. We attempted to construct DGIM teaching base in 2005, and the teaching reform was conducted in a part of the students. Primary assessment was based on examinations and questionnaires. The results show that the students could not only master the basic medical knowledge, but also improve overall capability. We conclude that DGIM in teaching hospital would become an important teaching base in China.
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<p><b>OBJECTIVE</b>Nephrotic syndrome (NS) is characterized by marked urinary excretion of albumin and other intermediated-size plasma proteins such as transferrin. The aim of this study was to determine the changes of serum iron and transferrin and the relationship between the serum and urinary transferrin.</p><p><b>METHODS</b>The indexes related to iron metabolism, including serum iron, ferritin, transferrin, total iron-binding capacity, transferrin saturation and hematological parameters (Hb, MCV, MCH), and urinary transferrin were measured in 37 children with NS before treatment and at the remission stage. Thirty-five age-matched healthy children served as controls.</p><p><b>RESULTS</b>Serum iron levels (18.8 +/- 3.8 micromol/L) in NS patients before treatment were significantly lower than in the healthy controls (22.2 +/-3.8 micromol/L) and those measured at the remission stage (21.0 +/- 3.5 micromol/L) (P < 0.01). Serum transferrin levels in NS patients before therapy (1.9 +/- 0.3 g/L) also decreased compared with those in the healthy controls (3.1 +/- 0.5 g/L) and those measured at the remission stage (2.9 +/- 0.6 g/L) (P < 0.01). In contrast, serum total iron-binding capacity and transferrin saturation were noticeably higher in NS patients before treatment than those in the healthy controls (total iron-binding capacity 56.4 +/- 9.2 micromol/L vs 50.7 +/- 6.8 micromol, P < 0.01; transferrin saturation 55.7 +/- 9.2 % vs 46.4 +/- 8.2%, P < 0.01) and were also higher than those measured at the remission stage (51.9 +/-7.7 micromol/L and 47.4 +/- 13.3%) (P < 0.01). Serum transferrin positively correlated to serum albumin (r = 0.609, P < 0.01) and negatively correlated to urinary transferrin (r = -0.550, P < 0.01) in NS patients before treatment.</p><p><b>CONCLUSIONS</b>Serum iron and transferrin levels markedly decreased in NS patients, which may be partially related to the urinary loss of transferrin.</p>