One-year follow-up for patients with diabetic retinopathy in Shanghai communities / 中华全科医师杂志

Objective To investigate the outcomes of patients with diabetic retinopathy (DR) in Shanghai communities and the influencing factors.Methods From October 2015 to April 2016,533 type 2 diabetic patients with DR were selected by target sampling and cluster random sampling method from six community health service centers in Shanghai.Patients were followed up for 1 year.The demographic information,physical examination,laboratory tests and eye fundus exam results were documented and the DR was graded.The factors associated with the regression of DR were analyzed.Results Total 478 patients,including 280 females (58.6％) and 198 males (41.4％),were followed up for 1 year.The mean age of patients was (64±7) years and the mean disease duration was (8.85±4.20) years.The original DR lesion was remitted in 35 patients with an improvement rate of 7.3％;while the original DR lesion was aggravated in 29 patients with a progression rate of 6.1％.Ordinal logistic regression analysis revealed that age (OR=0.197,95％CI:0.056-0.699),body mass index (BMI) (OR=0.383,95％CI:0.171-0.856),glycosylated hemoglobin (HbAlc) (OR=0.287,95％CI:0.102-0.803),triglycerides (TG) (OR=0.541,95％CI:0.295-0.991),urinary albumin to creatinine ratio (ACR)(OR=0.218,95％CI:0.066-0.720) were associated with DR in type 2 diabetic patients.Conclusion The regression of DR is closely related to age,BMI,glucose,serum lipids and renal function,so it is suggested that lowering BMI,controlling glucose and serum lipids and maintaining normal kidney function are necessary for preventing the progression and promoting the improvement of DR in diabetic patients.

Mobile internet and cloud computing promotes the development of electronic health record / 中华全科医师杂志

Currently, electronic health records (EHR) are largely created and maintained by physicians, and used just as an electronic record. In future, EHR will be a tool of information sharing and patients may participate in decision making for their own health with this tool. This article summarizes the concept of EHR, the problems it faces and how the mobile internet and cloud computing can promote the development of EHR.

Effect of community management of type 2 diabetes patients with signing on family doctor service in Shanghai / 中华全科医师杂志

Objective To assess the effect of community management of type 2 diabetes mellitus (T2DM)patients with signing on family doctor service in Shanghai.Methods Six community health service centers in two Shanghai districts were selected by cluster random sampling method from April 2014 to March 2017.T2DM patients,who visited the community health service centers more than three times in the last one year, were enrolled in the study.The questionnaire survey was conducted and lab tests were documented.Results A total of 5 078 T2DM patients were enrolled in this study,among whom 2 033 had signed contract service with family doctors(signing group)with a signing rate of 40.8%.Compared to non-signing group,the patients in the signing group were better followed the recommendations of blood glucose control[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)], diet[64.6%(1 320/2 053)vs.35.7%(1 061/2 978)]and physical activity[63.4%(1 295/2 053)vs.34.8%(1 033/2 978)](χ2=356.507, 400.649 and 393.996, P<0.01).The medication compliance rate and regular exercise rate in signing group were higher than those in non-signing group[80.2%(1 615/2 053)vs.77.6%(2 272/2 978), χ2=3.894,P<0.05;81.8%(1 679/2 053)vs.74.5%(2 215/2 978),χ2=38.084, P<0.05]. The control rates of GLU,2 h PPG,HbA1c,and blood pressure in signing group were higher than those in non-signing group[40.0%(823/2 053)vs.35.9%(1 069/2 978),47.3%(971/2 053)vs.45.4%(1 352/2 978),35.2%(722/2 053)vs.32.5%(968/2 978), χ2=18.495,5.218, 5.006, all P<0.05].Conclusion The community management with signing on family doctor service enhances the improvement of health related behaviors in patients with type 2 diabetes; but currently the rate of contract signing is still low.

Application of Lean Six Sigma theory in clinical medicine / 中华全科医师杂志

One of the effective methods to resolve the conflict between the ever-increasing medical demands and relatively limited medical resources is to improve the work efficiency of the medical institutions as well as to effectively control their operating cost through continuous reforms and improvements of the management modes in the medical industry.The Lean Management and Six Sigma Management theories which have been applied in manufacturing industry and service industry are now gradually being introduced to clinical medicine.This article systematically describes the Lean Management and Six Sigma Management theories and illustrates some examples of its application in health management renovation and the effects achieved.

Analysis on risk factors of microvascular complications in type 2 diabetes mellitus based on classification tree model / 中华全科医师杂志

Objective To analyze the risk factors of microvascular complications in patients with type 2 diabetes mellitus (T2DM).Methods The demographic and clinical data of 5078 T2DM patients in six communities of Shanghai were collected during September 2014 to April 2015. The risk factors of microvascular complications in T 2DM were analyzed by classification tree model .Results Among 5078 T2DM patients there were 1007 cases of diabetic retinopathy (DR) (21.1%) and 1937 cases of diabetic nephropathy (DN) (38.4%).The classification tree models showed that the risk factors of DR were higher hemoglobin A1C ( HbA1c), fasting blood glucose ( FBG), postprandial blood glucose ( PBG) and triacylglycerol ( TG) levels;longer course of disease and younger age of onset .The model showed that the risk factors of DN were higher HbA1c, FBG, hypertension, PBG, body mass index ( BMI ) and triacylglycerol (TG) levels;and lower high-density lipoprotein (HDL) level.The HbA1c, course of disease and PBG were more closely related to DR and HbA 1c, hypertension and FBG were more closely related to DN.Conclusion HbA1c is the most important risk factor to microvascular complications; FBG and PBG are independent risk factors of microvascular complications;the course of disease and hypertension are risk factors of DR and DN , respectively .

Survey on the schoolchildren's bronchial asthma outbreak in jinyang community, pudong new district / 中国基层医药

Objective Investigate 6 to 9-year-old Schoolchildren,from 7 primary schools in Pudong Jinyang district,for their bronchial asthma outbreak situation.Methods Ouster Survey from each sampled school.Results altogether 4895 students were surveyed,110 diagnosed sick children were found and the disease rate was 2.25%.The asthma outbreak has been found correlated with gender,age of the first onset,respiratory tract infections,allergy and Genetic factors.Conclusion The cause of asthma outbreak might be related to respiratory tract infections and the change of living environment.