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Objective To improve the early diagnosis of congenital heart disease (CHD), investigate the awareness, screening knowledge and screening ability of CHD among health care providers in the rural areas of Yunnan province and discover an effective way to improve the related knowledge and skills of CHD screening. Methods From 2015 September to 2017 April, we set up charity mobile schools and chose eight areas as the investigating and training sites. We designed two questionnaires, and adopted the theoretical training as the main method combined with the training of clinical skills. We investigated and trained a total of 1022 medical staff. The training content include the awareness of CHD,the knowledge and skills of CHD screening. We also evaluated the outcomes of the training. Results A total of 2044 questionnaires were collected. After training, the number of objects which would screen CHD in future increased, and the cognition of the incidence and common clinical manifestations of CHD, Eisenmanger's syndrome,cardiac auscultation, pulse oximetry and the related knowledge of CHD were also improved; 563 took the test on practical skills of CHD detection. The correct rate of auscultation, period of murmurs and characteristics of murmurs was 98.22%(553),30.55%(172) and 28.60%(161). The correct rate of murmurs in ventricular septal defect,atrial septal defect and patent ductus arteriosus was 45.47%(256), 39.79 (224) and 50.80%(286) respectively. Online training was advised by 244 trainees. Increasing investment in congenital heart disease screening was suggested by 652 trainees. Conclusions The awareness of CHD screening in grassroots medical workers of Yunnan province is insufficient. It is an effective way to establish charity mobile school and to train the grassroots medical staff with the theory and practical knowledge to improve the awareness,screening knowledge and screening skills of CHD. The next step suggests that we can improve the early diagnosis of congenital heart disease (CHD).
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Objective To analyze the problems and reasons in the clinical medicine postgraduate cultivation.We stated the competency of clinical medicine postgraduates according to the transition of health demands global medical development and practical requirements for clinical personnel. Me thods Questionnaire surveys combined with interviews were conducted, and statistical analysis was performed. In the first part, we selected the permanent staff with qualifications of medical clinicians, including: chief physicians, associate chief physicians, physicians, residents, accounting for 72％ of the interviewees; And related personnel, including nurses, administrators and patients, were also interviewed, accounting for 28％ of the total. 90 questionnaires were distributed, and 86 valid questionnaires were recovered, with an effective rate of 95.56％. In the second part, graduate students with clinical professional degrees were selected for interviews, 96 questionnaires were distributed, and 92 valid questionnaires were collected, and the effective rate was 95.83％.Re s ults There was a certain gap between the expected goal and the actual situation of the post competency of clinical professional degree graduate students, and the gap had a certain statistical significance. The clinical professional degree graduate students paid more attention to the doctor-patient communication, teamwork. Conclus ions We elaborated the required post competence for clinical medicine postgraduates on the basis of its content and characteristic. We propose to strengthen the cultivation of clinical medicine postgraduates by the reform and support of the government enhanced construction of teachers improved course plan and cultivation process perfected assessment system in order to make the students competent to their posts.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the feasibility, safety and efficiency of extracorporeal cardiac shock wave therapy (CSWT) in patients with ischemic heart failure.</p><p><b>METHODS</b>Fifty patients with ischemic heart failure and left ventricular ejection fraction (LVEF) < 50% were randomized to CSWT (shots/spot at 0.09 mJ/mm(2) for 9 spots, 9 times within 3 month) or control group. Dual isotope simultaneous acquisition single-photon emission computed tomography with (99)Tc(m)-sestamibi/(18)F-fluorodeoxyglucose ((99)Tc(m)-MIBI/(18)F-FDG) was performed before randomization and at 1 month after CSWT/control to locate and evaluate viable myocardium region. Canadian cardiovascular society (CCS) class sores, NYHA, Seattle Angina Questionnaire (SAQ), 6-min walk test (6 MWT), left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and the dosage of nitroglycerin use were compared between two groups at each time point.</p><p><b>RESULTS</b>All patients completed the study protocol without procedural complications. At 1 month, patients in CSWT group experienced improvement in NYHA (P < 0.01), CCS (P < 0.01), SAQ (P = 0.021), 6 MWT (P = 0.012) and dosage of nitroglycerin use (P < 0.01) compared to baseline. LVEF [45.0 (39.0, 48.0) vs. 47.0 (42.0, 50.0) P = 0.001], LVEDD [58.0 (56.0, 59.0) vs. 56.0 (55.0, 58.0) P = 0.002], summed perfused score [23.0 (20.5, 24.5) vs. 20.0 (18.0, 22.0) P < 0.01] and metabolic score [25.0 (23.0, 26.0) vs. 24.0 (21.5, 25.0) P = 0.028] were also improved in CSWT group. All these parameters remained unchanged in control group between baseline and at 1 month. CSWT was independent factor for improved cardiac function, quality of life and echocardiography parameters after adjusting for known factors which might affect outcome.</p><p><b>CONCLUSION</b>CSWT could improve symptom, cardiac function, quality of life and exercise tolerance in patients with ischemic heart failure, CSWT might serve as a new, non-invasive, safe and efficient therapy for these patients.</p>