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Objective:To investigate the efficacy of two-way needle suture technique (TNST) in the minimally invasive repair of acute closed Achilles tendon rupture.Methods:From June 2019 to June 2021, 26 patients with acute closed Achilles tendon rupture were treated at Zhengzhou Orthopedic Hospital. They were 20 males and 6 females, with a mean age of 28 (23, 31) years. The rupture end was (4.2±1.3) cm away from the calcaneal insertion, and the interval from injury to operation 4.3 (2.0, 5.0) d. Preoperative MRI examinations revealed in all the patients closed Achilles tendon rupture which was to be repaired by TNST. The operation time, incision length, incidence of complications, ankle dorsiflexion and plantar flexion were recorded. The Arner-Lindholm scoring was used to evaluate the clinical efficacy.Results:The operation time was (20.0±5.0) min and the incision length (2.5±0.4) cm. Postoperatively, all incisions healed by the first stage, with no complications like incision infection, skin edge necrosis, deep vein thrombosis at lower limbs, injury to the sural nerve, or re-rupture of the Achilles tendon. All patients were followed up for (12.0±6.0) months. At the last follow-up, the patients walked normally, their incisions healed well, the continuity of the Achilles tendon was good by palpation, their heel lift was strong, and all their activities were restored to the levels before rupture of the Achilles tendon. The ankle dorsiflexion was 22.6°±3.7° and the plantar flexion 25.3°±3.7°, According to the Arner-Lindholm evaluation, the clinical efficacy was rated as excellent in 25 cases and as good in 1 case, giving an excellent and good rate of 100% (26/26).Conclusion:In the minimally invasive repair of acute closed Achilles tendon rupture, TNST shows the advantages of limited surgical invasion, a low incidence of postoperative complications, and reliable curative effects.
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Objective:To explore the application effect of "connections, concepts, concrete practice and conclusions (4C)" teaching method combined with two-way evaluation method in nursing teaching of gastrointestinal surgery, so as to provide reference for personnel training and quality control of practice.Methods:A historical controlled study was conducted to prospectively include the nursing interns received by the Department of Gastrointestinal Surgery of the hospital from May 2020 to May 2022 as the subjects of this study. The interns were divided into the control group (64 interns from May 2020 to May 2021) and the research group (93 interns from June 2021 to May 2022) according to the order of admission of nursing interns. The control group was taught by traditional nursing teaching method, while the research group was taught by "4C" teaching method combined with two-way evaluation method. The scores of theoretical knowledge and operation of nursing students in the two groups were compared after 6 weeks of practice. The self-directed learning ability of nursing students in the two groups was compared before and after 6 weeks of practice [Chinese version of self-rating scale of self-directed learning (SRSSDL)]. The evaluation of teaching quality between two groups of nursing students were compared. SPSS 25.0 was used for t-test and Chi-square test. Results:One person in the control group voluntarily quit the internship, and two in the observation group voluntarily quit the internship. Finally, 63 people in the control group and 91 people in the research group entered the study. There was no statistical significant difference between the two groups in baseline data ( P>0.05). At 6 weeks of practice, the scores of theoretical knowledge (87.96±4.62) and operation (92.60±4.25) in the study group were higher than those in the control group [(86.02±4.53) and (88.27±4.31)] ( P<0.05). At 6 weeks of practice, the total scores of learning awareness, learning behavior, learning strategies, learning evaluation, interpersonal skills and self-directed learning ability of the two groups were higher than those before practice, and the study group was higher than the control group ( P<0.05). After 2 weeks, 4 weeks and 6 weeks of practice, the scores of the two groups of nursing students in evaluating the teaching quality of the teachers increased gradually compared with that of the first week of practice ( P<0.05). Conclusion:The "4C" teaching method combined with the two-way evaluation method in the nursing teaching of gastrointestinal surgery can improve the nursing students' theoretical knowledge, practical operation ability and self-directed learning ability, and is conducive to the improvement of teaching quality.
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Objective@# To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. @*Methods @#The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model.@* Results@# A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral.@*Conclusions@# The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.
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In a completely randomized design, the experimental material should be homogeneous. Usually, the experimental materials are not so homogeneous in nature, particularly in agricultural ?eld experiments. In such a situation, the principle of local control is adopted and the experimental material is grouped into homogeneous subgroups. In this paper, cow milk data are used and applied four different types of treatments. The yield of a cow is analyzed and interpreted using Randomized Complete Block Design (RCBD). Results are explored, tabulated and interpreted
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SUMMARY: The information technology (IT) based "instant evaluation" is supported by IT, which allows instant evaluation of teaching phenomena based on certain evaluation criteria and provides instant feedback. In anatomy teaching, we explored and practiced the application of instant evaluation based on a platform called "Rain classroom." We found that IT-based instant evaluation had higher practicability and better student satisfaction, which could improve teaching efficiency during class time, help students improve learning methods, and promote knowledge mastery. Additionally, instant evaluation positively impacted teachers' evaluation ability and teaching skills.
RESUMEN: La "evaluación instantánea" basada en la tecnología de la información (TI) está respaldada por ésta y permite la evaluación instantánea de los fenómenos de enseñanza en función de ciertos criterios de evaluación proporcionando retroalimentación instantánea. En la enseñanza de la anatomía, exploramos y practicamos la aplicación de la evaluación instantánea basada en una plataforma llamada "Aula de lluvia" o Rain Classroom. Descubrimos que la evaluación instantánea basada en TI tenía una mayor practicidad y una mejor satisfacción de los estudiantes, lo que podría mejorar la eficiencia de la enseñanza durante el tiempo de clase, ayudar a los estudiantes a mejorar los métodos de aprendizaje y promover el dominio del conocimiento. Además, la evaluación instantánea tuvo un impacto positivo en la capacidad de evaluación y las habilidades de enseñanza de los maestros.
Sujets)
Humains , Étudiants , Évaluation des acquis scolaires/méthodes , Technologie de l'information , Rétroaction , Anatomie/enseignement et éducation , Enseignement , Logiciel , Chine , Enquêtes et questionnairesRésumé
Objective:To investigate mentor-mentee dual evaluation of the current status of mentor competency of clinical and translational research mentors, and provide the basis for mentor training focused on the mentor competences.Methods:A total of 121 clinical and translational research mentors and 170 mentees from Peking Union Medical College Hospital were enrolled. The Chinese version of the Mentor Competency Assessment (MCA) questionnaire was used to evaluate the mentor competency, including maintaining effective communication, aligning expectations, assessing understanding, fostering independence, addressing diversity, promoting professional development total 6 parts with 26 sub-items. The Likert scale was used to quantitatively evaluate the clinical and translational research mentor competency by mentor-mentee dual evaluations. And the composition and training needs of clinical and translational research mentors were investigated. SPSS 25.0 was used for t-test. Results:Seventy percent (119/170) of mentees considered the mentor guidance was very helpful, and 78.5% (95/121) of the mentors considered it necessary to carry out the mentor training. The mentee evaluation of mentor competency was significantly higher than that of mentor self-evaluation [total score (162.35±23.59) vs. (154.80±19.81), P < 0.01]. And the excellent rate of 26 sub-items by mentees and mentors were 100.0%(170/170) and 46.3%(56/121) respectively. The mentors and mentees shared the agreement of the strengths on trust-based relationship and encouraging mentees, and weaknesses on taking into account the possible prejudices in mentor-mentee relationship. Conclusion:The clinical and translational research mentors have already had good competences, but mentor training is still highly warranted. It's expected that to carry out targeted mentor training and assessment according to the mentor's competences will help to improve the construction of the medical talents training system.
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Objective:To explore the application effect of two-way evaluation combined with transposition learning in the teaching of standardized training of cardiac surgery.Methods:A total of 67 trainees received by the Department of Cardiac Surgery of our hospital from January 2019 to October 2020 were divided into group A ( n = 32) and group B ( n = 35) according to the time of standardized training. Group A was trained by conventional method, while group B was trained by two-way evaluation combined with transposition learning. The examination scores, the post competency, and the teaching recognition of trainees between the two groups at the time of departure were respectively compared. SPSS 22.0 was used for the Chi-square test and t-test. Results:At the time of departure, the scores of theory examination and skill operation examination in group B were higher than those of group A [(92.08±11.50), (91.06±12.08) vs. (83.09±10.26), (82.23±10.09)]. There was no significant difference in the scores of clinical basic ability, professional spirit and quality, doctor-patient communication, mastery and application of medical knowledge, teamwork, basic public health services, information and management, and academic research between the two groups before teaching ( P > 0.05). The scores of the above-mentioned aspects were all increased after teaching, and the scores of group B were higher than those of group A ( P < 0.05). The recognition of the teacher's sense of responsibility, teaching awareness, expression ability, knowledge level, communication ability, and teaching method in group B were higher than those of group A ( P<0.05). Conclusion:The application of two-way evaluation combined with transposition learning in the teaching of standardized training of cardiac surgery can enhance the teaching effect, improve the post competency, and can be more recognized by the trainees.
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Objective:To explore the application value of scenario simulation teaching combined with two-way evaluation in standardized training of pediatric nursing.Methods:A total of 34 trainees who received standardized training of pediatric nursing in The First Affiliated Hospital of Air Force Medical University from March 2018 to March 2019 were selected as the control group, and another 42 trainees from April 2019 to July 2020 were selected as the study group. The control group used traditional teaching, and the study group used scenario simulation teaching combined with two-way evaluation. Theoretical examination and scenario simulation exercise examination were used to assess the theoretical knowledge and clinical practice ability of the trainees, and questionnaire survey was used to evaluate the satisfaction of the trainees with the teaching effect. SPSS 22.0 was used for t-test. Results:The scores of theoretical examination[(95.12±6.24) vs. (91.05±5.12)] and scenario simulation exercise examination (nursing practice skill operation ability, ability to combine theory and practice, clinical thinking and judgment ability, emergency handling ability, communication ability, humanistic care and professional learning ability, and work attitude) of the trainees in the study group were higher than those in the control group, and the differences were statistically significant ( P<0.05). The satisfaction evaluation of the trainees in the study group with the teaching effect was higher than that in the control group, and the difference was statistically significant ( P<0.001). Conclusion:Scenario simulation teaching combined with two-way evaluation can improve the theoretical knowledge, clinical practice ability, and teaching satisfaction of pediatric nursing trainees.
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Objective:To explore the application of task-orientated method combined with two-way evaluation in hypertension nursing teaching.Methods:A total of 90 nursing students who practiced in the Department of Cardiovascular Medicine, Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from September 2019 to December 2020 were selected as the research objects. According to the order of their admission, the nursing students were divided into control group and research group, with 45 students in each group. The control group used traditional teaching, while the research group used task-orientated method combined with two-way evaluation. At the end of the practice, the two groups of practice nursing students were compared to evaluate the teaching quality of teaching teachers, meanwhile the two groups of teaching teachers evaluated the quality of practice nursing students. SPSS 22.0 was used for t test. Results:The four aspects (teaching attitude, teaching method, teaching content and teaching effect) of the nursing students' evaluation on the teachers in the research group were higher than those in the control group, and the difference was statistically significant ( P<0.05). The three aspects (theoretical knowledge, professional nursing skills and comprehensive quality) of the teachers' evaluation on the students in the study group were higher than those in the control group, and the difference was statistically significant ( P<0.05). Conclusion:The task-orientated method combined with two-way evaluation can improve the teaching quality of clinical nursing teaching and the recognition of clinical nursing students to the teaching quality of teaching teachers, so as to promote teaching and learning.
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" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.
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Construction of medical alliances could help structural adjustment of medical resources, promote the shift of medical and health investment to primary level, improve the overall effectiveness of the medical service system, and better meet the health needs of the people. Guangzhou has established a multi-form and multi-level medical alliance system in accordance with local conditions. According to the distribution characteristics of medical resources in the districts under the jurisdiction of Guangzhou, these districts were divided into areas of controlled development, those of stable development and those of encouraged development. Different strategies were taken for various medical alliances. Advantages of traditional Chinese medicine were given full play in community health management and elderly care services, alliance of traditional Chinese medicine specialists was established to provide residents with continuous medical and health services. An appropriate medical insurance payment system was established to promote the implementation of the hierarchical diagnosis and treatment system. However, there were still such problems as unbalanced distribution of medical resources, insufficient leverage role played by medical insurances, and rooms of improvement in the ability of primary medical services.
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Stroke has been harmful to human health for a long time, and there is no satisfactory treatment strategy because of its complex pathogenesis. Taohechengqi decoction has been effective in the treatment of stroke. In this study, the components were collected by TCMSP, TCMIP, BATMAN-TCM and TCMID databases, the targets were predicted and screened by PharmMapper and BATMAN-TCM databases, and the functional enrichment analysis of the targets was carried out by using R language package clusterProfiler. Finally, the key targets are verified by GEO database and molecular docking. The results showed that 51 active components of Taohechengqi decoction may regulate 15 key targets such as nitric oxide synthase, endothelial (NOS3), prostaglandin G/H synthase 2 (PTGS2), matrix metalloproteinase-9 (MMP9), affecting vascular endothelial growth factor signaling pathway and other pathways to play a role in the prevention of stroke, affecting tumor necrosis factor signaling pathway and other pathways to play a role in the treatment of stroke. GEO data analysis showed that androgen receptor (AR), caspase-8 (CASP8), intercellular adhesion molecule 1 (ICAM1), interleukin-1 beta (IL1B), mitogen-activated protein kinase 14 (MAPK14), MMP9, myeloperoxidase (MPO), peroxisome proliferator-activated receptor gamma (PPARG), PTGS2 and cellular tumor antigen p53 (TP53) were up-regulated genes, while serum albumin (ALB), estrogen receptor 1 (ESR1), NOS3, transcription factor p65 (RELA) and proto-oncogene tyrosine-protein kinase Src (SRC) were down-regulated genes. GEO analysis explained that Taohechengqi decoction may prevent stroke by down-regulating ESR1, NOS3, and treat stroke by up-regulating ICAM1, IL1B, MAPK14, MMP9, PPARG, PTGS2, TP53, and down-regulating RELA and SRC. The study found that in the process of prevention and treatment of stroke, Taohechengqi decoction played a two-way regulation role through multi-genes and multiple ways, which provided a new strategy for the treatment of stroke.
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Student's t test (t test), analysis of variance (ANOVA), and analysis of covariance (ANCOVA) are statistical methods used in the testing of hypothesis for comparison of means between the groups. The Student's t test is used to compare the means between two groups, whereas ANOVA is used to compare the means among three or more groups. In ANOVA, first gets a common P value. A significant P value of the ANOVA test indicates for at least one pair, between which the mean difference was statistically significant. To identify that significant pair(s), we use multiple comparisons. In ANOVA, when using one categorical independent variable, it is called one-way ANOVA, whereas for two categorical independent variables, it is called two-way ANOVA. When using at least one covariate to adjust with dependent variable, ANOVA becomes ANCOVA. When the size of the sample is small, mean is very much affected by the outliers, so it is necessary to keep sufficient sample size while using these methods.
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Objective@#To understand the referral status and the willingness for downward referral among rural elderlies with hospital stay experiences in the past year in Shandong province, and to explore its influencing factors on the willingness for downward referral.@*Methods@#Three prefecture-level cities in Shandong province were sampled by multi-stage stratified random sampling in August 2017. Questionnaire survey was conducted among 910 rural elderlies(over 60 years old)who had been hospitalized in the past year. The study included the basic information, the hospitalization experience, and perception of essential medicines system, ego-resiliency, the referral status and willingness for downward referral. Rank sum test, Chi-square test and t test were used for univariate analysis, and logistic regression was applied for influencing factors.@*Results@#Among 910 rural elderlies who had been hospitalized in the past year, 53(5.8%) were referred to other medical institutions in their recent hospitalization, and 597(65.6%)were willing to be referred downward. The main reason for their reluctance for downward referral was that the medical competency of primary medical institutions was low; and the main reason for willingness for downward referral was being close to home. The results showed that marital status, impression for the national essential medicines system and ego-resiliency were the influencing factors of their willingness to downward referral among rural elderlies who had been hospitalized in the past year(P<0.05).@*Conclusions@#The referral rate and willingness for downward referral among the rural elderlies in Shandong province are relatively low. We should further enhance the service capacity of primary medical institutions, strengthen the publicity and implementation of the national essential medicines system, pay attention to help with the elderlies′ negative emotions caused by diseases, and improve their ego-resiliency.
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At present, general practitioners in China lack both specialist knowledge and ability, which calls for close cooperation between general practitioners and specialists to better guarantee medical quality and patient safety. The authors reviewed the connotation, research status, development trend, problems and suggestions of general practitioners-specialists joint consultation service. Based on such, they pointed out that such a general practitioner-specialist joint clinic is quite new in the country, but numerous literature has confirmed that it can not only make up for services fragmentation, but also reduce referral rate.Furthermore, it can improve the quality of people′s lives, improve the general practitioner′s professional knowledge and skills, standardize general practitioner′s rational drug use. All these prove the reform an effective measure and deserves further promotion and greater supervision.
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Two-way referral system is an important measure to promote the rational distribution of medical resources and promote the health of patients, but now there is a typical characteristic of"referrals up easy but downward referral difficult". while the transitional care of downward referral patients is one of the important impetus to promote the implementation of downward referral, this paper summarizes the necessity, connotation, main service forms, application effects and problem analysis status of the transitional referral of patients in the two-way referral mode in our country, in order to provide the basis for the establishment of a nursing security system suitable for two-way referral of patients.
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Objective To make a systematic analysis of the interaction between osteoporosis and smoking to elucidate the molecular mechanisms underlying osteoporosis susceptibility affected by smoking.Methods First,a two-way ANOVA analysis was conducted using microarray data to search all potential genes associated with both smoking and osteoporosis.We further explored the potential biologically related metabolic pathways through gene pathway enrichment analysis.Then the interaction genes within enriched pathways were verified by genome-wide gene-environment interaction analysis.Finally,protein-protein interaction analysis was applied to identify the core regulatory network in which those verified genes involved.Results We identified 441 risk genes closely associated with both smoking and osteoporosis by microarray analysis.Through gene pathway analysis,we identified a vital metabolism pathway, gap junction, which is a potential mediator between smoking and osteoporosis process. Finally,we verified some critical genes by genome-wide gene-environment interaction analysis,and revealed a potential smoking-osteoporosis interaction core regulatory network that included 1 3 proteins by protein network analysis.Conclusion We have discovered a new regulatory framework connecting smoking and osteoporosis, which provides new clues about disease etiologies and novel promising drug targets.
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Objective To compare the evaluation of care behaviors among inpatients and nurses, in order to know the implementation of caring behavior from different perspectives, and to provide evidence for better humanistic care in hospitals. Methods The nurses' humanistic practice ability scale and the caring behavior scale were used to investigate 160 nurses and inpatients respectively in The Third Affiliated Hospital of Southern Medical University. Results The total score of nurses' self rating for caring behavior was (4.15 ± 0.58) points, while the score of self-management ability was lowest, which was (3.84 ± 0.67) points;and the total score of nurses' caring behaviors was (3.49 ± 0.92) points, while the lowest scoring dimensions were respect and connection (3.42 ± 0.95) points. Nurses and patients both feel better at basic care (such as meeting basic needs, providing good environment), psychological care (such as giving support and) and professional care (such as health education), but both of them think that nurses did not do good enough in the provision of high-level emotional needs (such as diversified care, spiritual sustenance)and participation in nursing programmes. Conclusions The evaluation of nursing caring behavior is in the middle and upper level, which shown that the nurses have certain humanistic care and practical ability in clinical practice, and have been recognized by patients, but there is still a lot of room for improvement, and suggested that nursing administrators should give nurses enough respect and consideration while considering patients.
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Objective To explore and discuss the factors for restricting the two-way referral system from the patient's perspective in order to promote the formation of hierarchical medical system in Changsha City.Methods The stratified random sampling method was adopted to divide the Chansha City into the 3 grades of high,middle and low according to the regional economical development situation,2 districts in one grade,including 6 districts.Then each district was redivided into high,middle and low grades according to the economic situation,2 basic medical institutions were selected from each grade.A total of 360 patients were randomly sampled for conducting the questionnaire investigation.The patients and doctors specially participating in the two-way referral conducted the deep interview.Results The patients choosing to primary hospital for first visit accounted for 60.9％.The awareness degree of patients to two-way referral system was 21.1％,and the two-way referral service satisfaction in the patients with two-way referral was 85.7 ％.The patients' will of transfer treatment from primary hospital to superior hospital in case of disease condition need was 82.9 ％.The patients' will for conducting rehabilitation treatment from superior hospital to primary hospital was 77.6 ％.Conclusion Few patients choose primary hospital for first visit.The signing rate of family contract services is low and awareness degree of two-way referral system is not high.
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A two-way referral system for eye diseases management was developed between the Weifang community health service centers and Shanghai eye hospital in May 2014.With the “peer-to-peer” two-way referral model, the physicians in community health service center and ophthalmologists in eye hospital were directly responsible for screening , diagnosis and treatment of patients.The specialists of eye hospital also regularly provided clinic service in the center for longitudinal management of the patients .The “peer-to-peer” two-way referral model played a positive role in enhancing the cooperation between community health service center and superior hospital , upgrading skills of general practitioners, and improving the residents′satisfaction.