Time to initial diagnosis of imported malaria and its influencing factors in Jiangsu Province / 中国血吸虫病防治杂志

Objective To investigate the health-seeking behaviors of imported malaria cases after returning to China, and to investigate the factors affecting the time to initial diagnosis, so as to provide the scientific evidence for early identification of imported malaria cases and prevention of severe cases development and secondary transmission. Methods The individual demographic features, and the disease onset and the time to initial diagnosis of imported malaria cases in Jiangsu Province in 2019 were captured from the National Notifiable Disease Report System and the Information Management System for Parasitic Disease Control in China. The characteristics of health-seeking behaviors and epidemiological features of imported malaria cases were descriptively analyzed, and the factors affecting the time to initial diagnosis of imported malaria cases after returning to China were identified using multivariate logistic regression analysis. Results A total of 244 imported malaria cases were reported in Jiangsu Province in 2019, and the time to initial diagnosis of the cases were 1-12 days, with mean time of (1.53 ± 1.65) days, with median time of one day. The highest number of malaria cases seeking healthcare services were found on the day of developing primary symptoms (76 cases, 31.1%), followed by on the second day (68 cases, 27.9%), on the third day (46 cases, 18.9%), and 54 cases (22.1%) received initial diagnosis 3 days following presence of primary symptoms, including 3 cases with initial diagnosis at more than one week. High proportions of imported malaria cases with a delay in the time to initial diagnosis were seen in migrant workers who returned to China in January (14 cases, 5.7%) and December (13 cases, 5.3%) and those aged between 41 and 50 years (32 cases, 13.1%). Multivariate logistic regression analysis showed relative short time to initial diagnosis among imported malaria cases returning to China on March [odds ratio (OR) = 0.16, P = 0.03, 95% confidence interval (CI): (0.03, 0.85)] and those with a history of overseas malaria parasite infections [OR = 0.36, P = 0.001, 95% CI: (0.19, 0.67)]. Conclusions Timely health-seeking behaviors should be improved among imported malaria cases in Jiangsu Province, patients with a history of overseas malaria infections require faster health-seeking activities.

Study on the driving factors and forming mechanism of the willingness for primary doctors to make initial diagnosis / 中华医院管理杂志

Objective@#Based on the KAP and Prospect theory, to explore, construct and verify the theoretical model and formation mechanism of driving factors of primary care doctors′ willingness to carry out the primary diagnosis.@*Methods@#Using the random cluster sampling method, from April to May 2019, a questionnaire survey was conducted among doctors at 20 primary medical and health service institutions in Hangzhou. The survey covered the primary care doctors′ cognition level of primary diagnosis, their self-evaluation of primary medical care capabilities, evaluation of policies and systems, expectation of primary medical care, and their job satisfaction. Descriptive statistic, multiple linear regression and structural equation model were used to analyze and explore the driving factors and formation mechanism of their willingness to carry out the primary diagnosis.@*Results@#Primary care doctors′ willingness rate for primary diagnosis was 76.4%(308/403). Positive expectation(beta=0.309), cognition level(beta=0.216), evaluation of policies and systems(beta=0.184), and self-evaluation of primary diagnosis capability(beta=0.170), all of which directly affect the said willingness. The total effect of the five types of driving factors on the willingness of the primary diagnosis was as follows: cognitive level of the primary diagnosis(0.536), evaluation of the policy system(0.494), self-evaluation of the primary diagnosis capability(0.436), positive expectations of the primary diagnosis work(0.186), job satisfaction(0.146).@*Conclusions@#The cognition of the primary diagnosis, the capability of the primary diagnosis, the policy system and the positive expectation are the important premises, key driving forces, and a strong guarantee and motivation to drive primary care doctors to carry out the primary diagnosis. It is suggested that the government and medical institutions should further improve the cognition level of primary care doctors, focusing on systematically improving the service capability of primary care doctors′ primary consultation, coordinating to improve policy guidance measures such as financial input, medical insurance reimbursement and referral system, establishing and improving incentive measures such as career development, performance appraisal, salary and welfare of primary care doctors.

Study on influencing factors on willingness about basic initial diagnosis of patients in medical alliance in Beijing / 中国卫生政策研究

Objective:This article analyzes the cognition and satisfaction evaluation of patients in medical alli-ance. Under the medical alliance mode,the present study tries to explore the choice of medical treatment of patients, the first diagnosis of primary health care institutions and its influencing factors, in order to provide reference for the construction of medical alliance. Methods:With the help of stratified sampling method,eighteen (18) medical alli-ances were selected from 16 districts and counties in Beijing. The survey questionnaire was designed to be used as the tool for data collection. A total of 1 280 patients in medical alliance participated in this study. The Chi-square Test and binary logistic regression model were used for statistical analysis. Results:59.12% of patients understand the medical association and related policies. 39.12% of the patients are satisfied with the medical association,51.44% of patients are willing to take first diagnosis at primary health care institutions. The distribution of medical resources in various districts is uneven. The type of hospital visited,the degree of understanding of medical alliance,the expe-rience of medical alliance and the satisfaction toward medical alliance will have an impact on the willingness about basic initial diagnosis,and the influence make a significant statistical sense. Conclusions:The Medical alliance con-struction in Beijing has achieved a certain effect,as first visit at primary health care institutions will be the initial for-mation. But the unbalanced distribution of medical resources in various districts,the service capacity of primary care institutions which does not meet the needs of patients,the insufficient sensitization of relevant policy and the current health insurance policy are seen as limiting factors to the development of medical alliance.

Recent Updates Regarding Outcomes and Complications of Reverse Total Shoulder Arthroplasty

Indications of reverse total shoulder arthroplasty (RTSA) have been consistently extended by technical advancements in reverse arthroplasty prosthesis, continuous development of the implants, accumulated experiences and its successful treatment outcomes; accordingly, its use has rapidly increased. RTSA has been performed for a variety of indications, with variable outcomes depending on the initial diagnosis. However, controversial opinions still exist regarding the design of reverse arthroplasty prosthesis (medialized or lateralized design and the neck-shaft angle of the humeral prosthesis), suture of the subscapularis tendon, use of cement during placement of the humeral prosthesis, and surgical procedures; therefore, these should be investigated so that they can be better understood.

Recent Updates Regarding Outcomes and Complications of Reverse Total Shoulder Arthroplasty

Indications of reverse total shoulder arthroplasty (RTSA) have been consistently extended by technical advancements in reverse arthroplasty prosthesis, continuous development of the implants, accumulated experiences and its successful treatment outcomes; accordingly, its use has rapidly increased. RTSA has been performed for a variety of indications, with variable outcomes depending on the initial diagnosis. However, controversial opinions still exist regarding the design of reverse arthroplasty prosthesis (medialized or lateralized design and the neck-shaft angle of the humeral prosthesis), suture of the subscapularis tendon, use of cement during placement of the humeral prosthesis, and surgical procedures; therefore, these should be investigated so that they can be better understood.

The Initial Diagnosis and Treatment of Open Fracture of Tibia With A 124-case Report / 中国医师杂志

0 05); the infection rate of deep wound Ⅲ degree was the lowest in delayed wound closing group. Conclusions It is key to improve the quality of the initial diagnosis and treatment,its measures are effective early stage debridement, the use of antibiotic, reasonable wound closing ,drainage,fixation, primary bone graft,bone plantation at phase Ⅰ and rigid selection of amputation; interlocking medullary nailing and external fixation stand with limited internal fixation are effective methods for the fixation of open fracture of tibia in the initial diagnosis and treatment.

THE CLINICAL UTILITY OF POSITRON EMISSION TOMOGRAPHY FOR INITIAL DIAGNOSIS AND FOLLOW UP CHECK IN ORAL AND MAXILLOFACIAL CANCER PATIENTS

BACKGROUND: Positron Emission Tomography(PET) with [18F]-fluorodeoxyglucose (FDG) is a new imaging technique that has the advantage of imaging metabolic changes linked to malignancy. PET-FDG can provide a functional image of the regional biochemistry which may be more sensitive and accurate for detecting the presence of tumor in early stage. Recently, the clinical use of PET scan has been studied in many cancers but, there is a few clinical reports in oral and maxillofacial cancers. We have evaluated the ability of PET-FDG for initial diagnosis and detection of early subclinical recurrent malignancies in follow up check. PATIENTS AND METHODS: PET-FDG studies were performed in 33 patients from october, 1997 to september, 1998. 14 patients underwent PET-FDG evaluation for initial diagnosis and 19 patients for follow up check. RESULTS: Evaluated for initial diagnosis, PET-FDG was found to have an overall accuracy of 79%, sensitivity of 90%, specificity of 60%, positive predictive rate of 80% and negative predictive rate of 75%. Evaluated for follow up check, PET-FDG demonstrated accuracy of 84%, sensitivity of 91%, specificity of 75%, positive predictive rate of 83% and negative predictive rate of 86%. CONCLUSION: These data indicate that PET-FDG scan appears to be effective in initial diagnosis and detection of early recurrent oral and maxillofacial malignancies. The informations gained with PET-FDG can be included for essential treatment planning because of possibility of detection for early subclinical malignancies and distant metastases.