Strengthening healthcare through family medicine training in the Gambia: The journey so far

According to the World Health Organizations (WHO) family medicine forms the bedrock upon for accessible, affordable and equitable healthcare for any country. The need for family doctors is more acute for low income countries like The Gambia. More so that The Gambian health infrastructure is suboptimal and appropriate health personnel is low. This is worsened by brain drain leading to poor health indices. Despite these challenges and more, the department of Family Medicine was accredited for training in the Gambia with improved infrastructure (at the training centre), with 7 residents. Though there are still challenges there are also opportunities and strengths. There is therefore hope that the right personnel will be produced for an improved Gambian health system.

CHALLENGES IN IMPLEMENTING SMART ENERGY METERS IN INDIA

Introduction: Smart Energy Meter (SEM) is an electronic device used to measure, record and transmit the consumption of electricity, gas or water. The smart energy meter is a vital component of a smart grid, which is an advanced power distribution infrastructure that uses digital communication technology to monitor, control and optimize the ow of electricity between power producers and consumers. India, like other developing countries, faces several challenges in the implementation of smart energy meters. This paper examines the challenges in implementing smart energy meters in India and proposes solutions to overcome these challenges.

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Report on the Toronto International Program to Strengthen Family Medicine and Primary Care / 日本プライマリ・ケア連合学会誌

We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.

Study on the correlation between pterygium and single blood lipid and its ratio / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the serum lipids changes and lipid ratiosin patients with pterygium. <p>METHODS: Based on the retrospective study, 500 pterygium patients who were admitted to the department of ophthalmology and had finished physical examination in the physical examination center of Zhongnan Hospital of Wuhan University from January 2016 to February 2019 were included. As well as 500 people who underwent health examination and were matched in age and gender at the same time. The serum levels of triglycerides(TG), total cholesterol(TC), low density lipoprotein cholesterol(LDL-C), and high-density lipoprotein cholesterol(HDL-C), were measured by professionals in hospital. TG/HDL, TC/HDL, LDL/HDL were calculated and analyzed statistically between the two groups.<p>RESULTS: Among the 500 patients with pterygium, abnormal serum lipid content accounted for 68.2%(341/500). TG, TC, LDL-C level and TG/HDL, TC/HDL and LDL/HDL were higher in pterygium group than control, and with statistically significant differences(<i>P</i><0.001). While serum HDL level was lower than that in control group and with no statistically significant differences(<i>P</i>>0.05). According to Logistic analysis, TG(<i>OR</i>=4.132), TC(<i>OR</i>=2.194), TG/HDL(<i>OR</i>=2.184)and TC/HDL(<i>OR</i>=2.007)were risk factors for pterygium(<i>P</i><0.05). <p>CONCLUSION: Dyslipidemia is an important factor in the pathogenesis of pterygium. It is very necessary for the patients with pterygium to control the level of blood lipids because it has important clinical significance for the attack and treatment of them.

Four Proved Cases by Professor LIAN Jianwei's Differentiation and Treatment on Eructation / 浙江中医药大学学报

[Objective]Analyzing clinical experience and academic view of Pro. LIAN Jianwei for the treatment of eructation in order to completely learn and master his experience.[Method] Analyzing 4 belching cases of Pro. LIAN, and combining his therapeutic experience and view. [Result] According to the view of Pro. LIAN Jianwei, there are 4 common types in clinic, the type of accumulation in stomach and intestine, the type of spleen and stomach deficiency, the type of liver qi stagnation, the type of liver and spleen disharmony. Promoting digestion and harmonizing stomach to treat the type of food accumulation in stomach;benefiting qi and strengthening spleen to treat the type pf spleen and stomach qi deficiency;smoothing liver and regulating qi to treat type of liver and stomach disharmony; regulating liver and spleen to treat type of liver and spleen disharmony;eliminating damp to treat type of spleen deficiency with damp;activating blood to treat stasis caused by prolonged diseases. Prescriptions of Pro. LIANbased on methods which changed with syndromes. He insisted that treatments base on differentiation;prescriptions base on methods, which make effect well. [Conclusion] It is worthy for our students to learn and imitate clinical experience and academic view of Pro. LIAN Jianwei for the treatment of eructation.

Discussion on YANG Jinkun Professor's Clinical Experience of Treatment of Gastric Cancer / 浙江中医药大学学报

[Objective] To summarize Prof. YANG Jinkun gastric cancer clinical experience of diagnosis and treatment, in order to promote clinical application. [Method] Through clinical diagnosis, collecting cases, Prof. YANG Jinkun stomach cancer treatment methods are analyzed and summarized, and enumerated case evidence. [Results] Prof. YANG Jinkun offered to poison pixu(spleen deficiency) for the basic pathogenesis of gastric cancer, on the basis of the spleen and the centralizer, and combined disease according to the nature of different pathogenic toxin, chase respectively eliminating phlegm and stasis fights, qingrejiedu, etc of evil spirits, all applications in the west, comprehensive treatment, the clinical good results have been achieved. For medical record satisfactory curative effect. [Conclusion] Gastric cancer experience of diagnosis and treatment of YANG Jinkun is unique, curative effect is distinct, worthy of clinical application and promotion.

compliance and unhealthy lifestyle of patients with diabetes mellitus / 中国实用护理杂志

Objective To observe and study the influence degree of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus. Methods A total of 64 patients with diabetes mellitus from January 2015 to March 2016 were selected and divided into two groups by the method of random number table,32 patients in control group were taken care with routine nursing of diabetes mellitus,32 patients in observation group were taken care with strengthen training for family members,then the treatment compliance,related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention and at 4th, 8th and 12th week after the intervention were compared. Results The treatment compliance, related knowledge cognition of unhealthy lifestyle and unhealthy lifestyle situation of two groups before the intervention all had no obvious differences (all P>0.05). The treatment compliance at 4th, 8th and 12th week after intervention were (6.26 ± 0.32), (6.95 ± 0.36), (7.28 ± 0.40) scores in observation group, and (5.23 ± 0.29), (6.01 ± 0.30), (6.30 ± 0.33) scores in control group, and the differences were significant (t=8.253, 9.201, 10.257, all P<0.05). The related knowledge cognition of unhealthy lifestyle at 4th, 8th and 12th week after intervention were (80.78±5.90), (89.44±6.02), (93.43±6.20) scores in observation group, and (73.38± 5.73), (77.93±5.84), (82.20±6.01) scores in control group, and the differences were significant (t=11.258,12.563, 13.324, all P<0.05 ). The unhealthy lifestyle situation at 4th, 8th and 12th week after intervention were 75.00%(24/32), 90.63%(29/32), 96.88%(31/32) in observation group, and 59.38%(19/32), 68.75%(22/32),78.13%(25/32) in control group, and the differences were significant (χ2=7.251, 7.468, 9.169, all P<0.05). Conclusions The influence of strengthen training for family members for the treatment compliance and unhealthy lifestyle of patients with diabetes mellitus are more active, so the value of strengthen training for family members of patients with diabetes mellitus is higher.

Professor LIAN Jianwei's Experience in Treating Chronic DIarrhea / 浙江中医药大学学报

[Objective]Summarize the clinical experience of famous veteran doctor LIAN Jianwei in treating chronic diarrhea. [Methods] With the method of following Professor LIAN, analyse and induce his experience in treating chronic diarrhea by collecting cases. [Results] Professor LIAN is good at using classical prescriptions and current prescriptions to treat chronic diarrhea. According to the characteristics of diarrhea, to identify the viscera, cold and heat, asthenia and sthenia and flexible combination of prescriptions. Weakness of the spleen and the stomach using Shenling Baizhu Powder to nourish qi to invigorate spleen;Patients of liver stagnation and spleen deficiency are treated by Tongxieyao Formula to repress liver and supporting spleen;Sishen pill and decoction of four mild drugs treatment of spleen and kidney yang-deficiency by invigorating spleen and kidney;Patients of coldheat complex are treated by Wumei Pill to warm and nourish the stomach. [Conclusion] Professor's experience in treating chronic diarrhea is well worth learning for it always gets outstanding effect.

Prevention and Treatment of Adenomatous Colonic Polyps by Therapy of Supplementing Spleen to Strengthen Lung / 广州中医药大学学报

Objective To observe the effects of therapy of supplementing spleen to strengthen lung on patients with adenomatous colonic polyps (ACP) after endoscopic removal . Methods One hundred ACP patients with spleen deficiency and dampness blended with blood stasis were randomly divided into 2 groups after endoscopic removal, 50 cases in the treatment group and 50 cases in the control group. Both groups were treated with diet and behavioral therapy, and the treatment group was simultaneously given oral use of modified Shen Ling Baizhu Powder plus self-moxibustion of bilateral acupoint Zusanli point. After treatment for 6 months and 1.5 years, all of the patients were asked to do the examination of colonoscopy, body mass, body mass index (BMI), and triglyceride (TG). Results (1) After treatment, the mean overall symptom scores of the two groups were improved (P 0.05). The effect of the treatment group on improving body mass, BMI and TG was better than that of the control group (P < 0.05). Conclusion The therapy of supplementing spleen to strengthen lung is effective on relieving symptoms of ACP patients, and also has an effect on decreasing BMI and TG as well as the recurrence of ACP after endoscopic removal.

Effectiveness analysis on measles supplementary immunization for students of primary and middle schools in Hongkou District of Shanghai / 上海预防医学

Objective] To analyze the effect of enhanced immunization for school-age children in Hongkou District of Shanghai in immunology and epidemiology . [ Methods] One month after completing immunization, the blood antibody titers were measured by ELISA method , and compared with the those of non-enhanced immunization , for epidemiological survey were collected history of measles immunization and close contact with the measles . [ Results] It could not be thought that strengthening immunization im-proved antibody positivity rate , the protection rate , and geometric antibody average concentrations .There was not statistical difference in antibody levels between measles vaccination 2 times and 3 -4 times. [ Conclusion] In the regions where routine immunization rates reach a high level , strengthening immuni-zation done on large scale is a waste of vaccine resources , human resources and financial resources , and leak re-vaccination should be done as a cost-effective preventive measure .

Clinical Observtion to 30 Cases of Mild and Moderate Ovarian Hyperstimulation Syndrome Treated with Resvised Wupi Decoction / 浙江中医药大学学报

[Objective] To observe the clinical effects of resvised wu pi decoction on mild and moderate ovarian hyperstimulation syndrome. [Method]To 30 of such cases ,take resvised wu pi decoction to strengthen spleen and tonify kidney, remove dampness and prevent miscarriage, observe patient chest dis-tress, abdominal distension and liquid intake and output volume of 24 hours etc.;Then estimate the clinical effect,and analyze one typical case.[Result]The marked effective rate was 60.00%, with total effective rate 96.67%. [Conclusion] The clinical application of resvised wu pi decoction treating mild and moderate OHSS by strengthening spleen and tonifying kidney,removing dampness and preventing miscarriage has excellent curative effect.

Application value of MSCT in atypical benign and malignant gastric stromal tumor diagnosis / 中国医学装备

Objective:To discuss the application value of MSCT in atypical benign and malignant gastric stromal tumor diagnosis. Methods:Twenty three patients that had definite pathological diagnosis of gastric stromal tumors image data were chosen in our hospital from January 2009 to January 2013, and patients were divided into highly malignant group (12 cases) and low malignant group (11cases) according to patient’s pathological dianosis. Tumor location, growth pattern, size, shape, boundaries, arterial phase enhancement level, ulceration, necrosis, cystic degeneration, calcification were recorded and the results were analyzed using SPSS17.0 for data processing. Results:Twenty three patients were all atypical gastrointestinal stromal tumors, and there were three cases of pedunculated walk, 8 cases od completely cystic, 7 cases of junction, 5 cases of irregular. There were statistically significant differencesin the tumor diameter, central liquefaction necrosis, the degree of enhancement, tumor morphology, tumor border(x2=15.683,x2=10.145, x2=16.130,x2=19.326,x2=9.224;P<0.05). Conclusion:Application of spiral CT is not typical GIST, according to the image characteristics of benign and malignant tumors of the qualitative analysis and diagnosis, worthy of clinical application.

Archiater Zhang Nianzhi's Experience in Treating Primary Bronchial Lung Cancer with Method of Supporting Essence to Remove Pathogeny / 浙江中医药大学学报

[Objective]To sum up archiater Zhang Nianzhi's experience in treating lung cancer by supporting essence to remove pahtogeny. [Method] By analysing the causa morbi and mechanism of primary bronchial lung cancer, it expounds Zhang Nianzhi's treating primary bronchial lung cancer by insist-ing on the general rule of strengthening body resistance to eliminate pathogenic factors, applying revised self-made Feiji-1 to the disease, exampled with cases. [Result] Mr Zhang's method centers on nourishing Yin and clearing Qi and removing sputum and stasis, smartly applying Feiji-1 decoction on the disease, with good result. [Conclusion] Mr. Zhang's thought of strengthening body resistance to remove pathogeny, smartly applying self-made Feiji-1 decoction has effective result on clinic.

Epidemiological characteristics and impact factors of adult measles during 2009-2012 in shanghai / 上海预防医学

[Objective] To analyse the impact factors for adult measles and its epidemiological characteristics in shanghai . [ Methods] The data on adult measles incidence during 2009-2012 were analyzed using descriptive epidemiology method .And the blood antibody titers was measured by ELISA method in the adult over18 years old in Hong Kou District of Shanghai . [Results] Zero dose vaccination and vaccination failure were the key reasons for the increase of adult measles , which were closely related to our history of prevention and treatment of measles . [ Conclusion ] Adult immunization should be strengthened to improve immune barrier and to reduce the measles incidence in adults , and it is suggested that the immunization for 10-15 year-olds should be strengthened so as to improve the overall antibody levels in adults as a whole .

Link Monitor of Hospital Infection Management of MDRO / 中华医院感染学杂志

OBJECTIVE To further strengthen the link monitor of hospital infection management of MDRO,prevent and control the occurrence and spread of MDRO in the hospital and ensure medical safety.METHODS The occurrence of MDRO,and the sterilization were monitored to guarantee the medical care personnel not infected with MDRO,Asepsis process during treatment and nursing,was supervised to cut off the weak link of MDRO spread,carry out standard prevention sense throughout,normalize the use of antibiotics,and fulfill the education of MDRO infection knowledge.RESULTS Through hospital infection management of MDRO,it got the effect of early prevention,early diagnosis and early control,reduced the infection rate of MDRO,prevented the occurrence and spread of MDRO in the hospital and ensure the medical safety.CONCLUSIONS Well done in the link of hospital infection management of MDRO is one of essential contents to evaluate the hospital infection management level,and improve medical care quality and ensure medical safety.

Diagnostic value of MR mammography in breast ductal carcinoma / 吉林大学学报(医学版)

Objective To study the diagnostic value of MR mammography(MRM) in judging the nature of breast disease.Methods 145 cases with breast disease were retrospectively studied to investigate the relationships between two parameters(early-phase enhancement rate and the type of the delayed enhancement) and different breast diseases.All patients underwent MRM examination before surgical operation.Results ①Strengthen multiple in early stage larger than 3 times was inclined to malignant lesion;Strengthen multiple smaller than 1 time was inclined to benign lesion.②Drop type of delayed enhancement was the important parameter in diagnosis of ductal carcinoma.If drop type of delayed enhancement was viewed as the diagnosis standard of the ductal carcinoma of breast only:81% cases with invasive type of the ductal carcinoma,65% cases with noninvasive type of the ductal carcinoma had been diagnosed correctly;14% cases with benign breast lesions had been diagnosed exaggeratedly.③If strengthen multiple in early stage larger than 2.5 times in rising type of delayed enhancement and drop type of delayed enhancement was viewed as the diagnosis standard of the ductal carcinoma of breast,87.9% cases with invasive ductal carcinoma,73.1% cases with noninvasive ductal carcinoma had been diagnosed correctly;21.4% cases within benign breast lesions had been diagnosed exaggeratedly.Conclusion Compared with differential of disease nature by the type of the delayed enhancement only,the correct rate of diagnosis of breast ductal carcinoma mentioned above is raised if two parameters are combined.But the correct diagnosis rate of benign lesions is decreased.

Using standardized patients to strengthen the basic skills training in Chinese Medicine Universities / 中华医学教育探索杂志

In the basic skill teaching of "Diagnostics Foundation"in Chinese medicine colleges and universities, the standardized patients are used to strengthen students’ clinical basic skill,let them consolidate their theoretical knowledge and change it into their skills,which is an effective way to guarantee the students to enhance their"double-base"ability,namely the elementary theory and clinical basic skill,and their self-confidence and shorten the time from the classroom to the clinical practice running-in period.

The Effect Evaluation by Conducting Short Reinforcement Training on Students Standardized Patients / 中华医学教育探索杂志

Medical science is a practical subject.Before entering the clinical practice,medical students should promote clinical-practice ability by using medical models and reviewing photograph recordings,and then take short reinforcement training by suing standardized patient in order to esteem the patients' rights.

On how to strengthen the construction and management of the students communites in institution of higher learning / 重庆医科大学学报

In the planned economic system, the old ways of management of college students domitories have existed for tens of years. But there are some problems which hamper the training of creative and high-quality talents. After the socialization of university rear service, it is necessary to strengthen the management of students community, speed up its construction, improve the quality of campus culture and provide good services. This will be probed in the article.