Visualized analysis on trend and hot spot of research on multimorbidity using knowledge map / 中华全科医师杂志

Objective:To analyze the trend and hot spots of research on multimorbidity.Methods:The Chinese and English literature in databases of CNKI, Wanfang data and Web of science from inception to July 2022 were retrieved using "multimorbidity" and "multiple chronic conditions" as the search terms. The scientific knowledge mapping software VOSviewer was used to analyze the co-occurrence network of scientific knowledge from the aspects of countries, Chinese and English keywords,burst terms and existing research results; and the status quo and hot trends of studies on multimorbidity at home and abroad were summarized and compared.Results:A total of 251 Chinese publications and 6 351 English publications were included. From the perspective of research trends, the overall trend of domestic and international publications showed a fluctuating upward trend in general, but the pace of development was different. The cooperation network represented by the United States, England, Canada, China, Japan, Australia and other countries was the largest regional cooperation network. Germany, the Netherlands, the United States, Australia and other countries were the first regions to carry out studies on multimorbidity. Studies on multimorbidity in China mainly focused on three topics: diagnosis, treatment and care of multimorbidity, common disease management of multimorbidity, and research methods of multimorbidity. The English literature mainly focused on the clustering of three topics: multi-disease co-diagnosis and care research, multi-disease co-management model research, and multimorbidity related research. The analysis of burst terms indicated the research focus and trend change in different time periods. The results of the outburst word analysis showed that the recent research hotspots of multimorbidity were public health, machine learning, geriatric medicine and so on.Conclusions:The number of studies on the multimorbidity is rapidly increasing both domestically and internationally, and related research in China is still in the early stages of development. In terms of research hotspots, the research of multimorbidity has gradually shifted from phenomenon description to topics such as medical services and research methods of multimorbidity.

Disease spectrum referred from community health service centers among regional cooperative healthcare system in Shanghai Yangpu district / 中华全科医师杂志

Objective:To investigate the disease spectrum referred from the community health service centers to the district tertiary hospital in the region.Method:The data of the referred patients from the community health service centers to Shanghai Yangpu District Hospital-a tertiary hospital in the region from January 2016 to December 2019 were collected. The composition and characteristics of the disease spectrum of the referred patients were analyzed.Results:The number of patient visits to the community health service centers in the region was increased from 4 684 938 in 2016 to 4 776 921 in 2019. The number of patient referral from the community centers to Yangpu Hospital was increased from 3 125 in 2016 to 6 853 in 2019. There were total 18 308 patients referred in 4 years, including 8 012 males (43.8%) and 10 296 females (56.2%). The age range of referred patients was from 1 to 99 years, including 53 referred patients aged ≤ 18 (0.3%), 927 aged 19-39 (5.1%), 2 831 aged 40-59 (15.5%), 4 424 aged 60-79 (62.2%) and 1 209 aged ≥ 80 (17%). The top five systems of diseases, which accounted more than 60% of total diseases, were circulatory system, endocrine nutrition and metabolic system, urogenital system, eye and appendage, and digestive system. Compared with male patients, more female patients with urogenital diseases were referred.Conclusion:The referral rate of community health service centers were increased from 2016 to 2019. The referred patients cover all age groups, more frequently in age group 60-79. The diseases of referred patients cover all system, and are different between males and females.

Study on training requirements of doctoral candidates in general practice / 中华全科医师杂志

Objective:To survey the training requirements for doctoral candidates in general practice.Methods:A questionnaire survey was conducted to investigate the requirements for general practice doctorate training; the items included the training target, training objectives and training contents. A total of 130 stakeholders of general practice participated in the survey, including administrators in health committees, general practice educators of medical schools, general practitioners in hospital and community health service centers and students in general medicine. The participants were divided into training unit group ( n=42), employer group ( n=42) and doctor and student group ( n=46). Results:Among all training objectives, the training "general medicine scientific research ability" ranked the first (121, 93.1%); while 114 (87.7%) respondents believed that the training target should be the leading talents in general medicine. Regarding the content of clinical competence training, 86 (66.1%) respondents believed that there was a lack of medical care training for whole life-cycle and whole population currently. The training requirement for acute disease management and referral competence in employer group was significantly higher than the training unit group (χ2=25.73, P<0.01) and the doctor and student group (χ2=24.37, P<0.01). Most survey respondents believed that the doctorate candidates in general medicine should focus on scientific research training in community clinical medicine ( n=110, 84.6%), community preventive medicine and epidemiology ( n=114, 87.7%); 117 (90.0%) respondents believed that clinical research design and methodology training should be strengthened, and 125 (96.2%) respondents believed that clinical teaching thinking training should be strengthened; 108 (83.1%) survey respondents believed that it is necessary for their units to recruit personnel with doctoral degree in general medicine. Conclusion:The training of doctorate candidates in general medicine should aim at cultivating leading talents in general medicine, strengthen the training of clinical scientific research capabilities, and focus on cultivating their comprehensive abilities of "being able to research, be good at teaching, and understand management", so that they can truly become the leaders in this discipline.

Disease composition and characteristics of elderly patients with multymorbidity in Jing′an district of Shanghai / 中华全科医师杂志

Objective:To analyze the disease composition and characteristics among elderly patients with multimorbidity in Jing′an district of Shanghai.Methods:A total of 68 147 patients aged 60 and above in Shanghai Jing′an district were selected in the study by stratified random sampling method, The clinical data of patients from January 2017 to December 2018 were obtained from hospital information system, the status of multimorbidity, the disease composition and characteristics were analyzed with SPSS software.Results:Among 68 147 elderly patients, 43 953 had 2 or more chronic diseases. The top five chronic diseases were hypertension, chronic ischemic heart disease, diabetes, hyperlipidemia, and cerebrovascular disease. There was significant difference in prevalence of multimorbidity between male and female patients (χ 2=15.276, P<0.01); compared to males, females had higher prevalence of multimorbidity ( OR=1.152, P<0.01). There was significant difference in prevalence of multimorbidity among different age groups of patients (χ 2= 48.547, P<0.01); compared to age group 60-69, patients age 70-79 ( OR = 1.629, P<0.01) and aged 80 and above ( OR=2.686, P<0.01) had higher prevalence of multimorbidity. When 4 chronic diseases coexist, male urinary system diseases and female joint diseases rank in the top five comorbid diseases, while when 5 chronic diseases coexist, female sleep disorders rank in the top five positions. For patients aged ≥80 years, when 5 chronic diseases coexist, diabetes mellitus is no longer among in the top five comorbid diseases. Conclusions:The elderly women and older-aged patients have higher prevalence of multiomorbidity. Hypertension is still the top priority of chronic disease prevention and control for the elderly in the community. It is suggested to establish the precise prevention and control mechanism for the aging chronic disease.

Dose-response relationship of alfentanil inhibiting gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy / 中华麻醉学杂志

Objective:To evaluate the dose-response relationship of alfentanil inhibiting gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy.Methods:Patients of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged ≥60 yr, scheduled for elective painless gastroscopy, were selected. Propofol 1.5 mg/kg combined with alfentanil was given intravenously in all the patients. The dose of alfentanil was determined by the Dixon up-and-down method. The initial dose of alfentanil was set at 5 μg/kg. The dose of alfentanil in the next patient was determined according to the development of gag reflex, and the ratio between the two successive doses was 1.1. The median effective dose (ED 50) and 95% confidence interval of alfentanil-induced inhibition of gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy were calculated using the by up-and-down sequential allocation. Results:The ED 50 (95% confidence interval) of alfentanil-induced inhibition of gag reflex when combined with propofol 1.5 mg/kg was 2.8 (2.4-3.2) μg/kg in elderly patients undergoing painless gastroscopy. Conclusion:When combined with propofol 1.5 mg/kg, the ED 50 of alfentanil inhibiting gag reflex is 2.8 μg/kg in elderly patients undergoing painless gastroscopy.

Analysis of the resource elements of the development in clinical disciplines / 中华医学科研管理杂志

This paper analyzed the exogenous and endogenous resource elements in a view of their supportive effect on the construction and development of clinical disciplines,proposed the relationship between two resources elements and development of clinical disciplines,,and provided references to the construction of clinical disciplines by elaborating the specific content and focus of these elements.

Analysis and evaluation of the effect of the implementation plan of personnel training in medical institutions / 中华医学科研管理杂志

Objective To establish an evaluation system to assess the effect of personnel training program for health professionals in the hospital,in order to achieve the goal that improve the overall competitiveness of the hospital.Methods Comparing and analyzing the differences in research project,research achievements,personnel capacity building before and after implementation of the training program.Paired T-test was used to exam the differences.Results There are statistically significant differences for proposed analyses (p ≤ 0.05).Conclusions The outcome of this study indicates that the personnel training program is extremely important to further development of the hospital.

Analysis of the necessity and possibility to establish a general practice department at tertiary hospitals / 中华医院管理杂志

The paper identified bottlenecks in establishing general practice departments at tertiary hospitals.With analysis of the importance of general practice education,medical service and research,as well as complete disciplinary building at such hospitals,the authors explored strategies and measures for talent training and development of general practice.

Construction of database for clinical cases based on evidence-based medicine / 中华医学科研管理杂志

Based on the background,conception and the core ideas of the evidence-based medicine,the construction and application of domestic clinical cases database was discussed.Problems concerning statistics,management and application in scientific research encountered in the database devel opment were presented,and suggestions were proposed.

Investigation of job burnout and related factors of nurses / 中华行为医学与脑科学杂志

Objective To explore the job burnout and its related factors among nurses.Methods 486 clinical nurses from a three grade second level general hospital were investigated by Moreno-Jimenez nursing burnout scale (NBS) and using SPSS17.0 software and ANOVA method to analyse the data.Results NBS results showed the score of job burnout in 486 objects was (164.92 ± 25.60).Significant differences of job burnout levels were showed among ages,marital status,professional titles,working periods,working relationship,work load,income,and housework periods (P ＜ 0.05).Conclusion Job burnout is a general phenomenon in these investigated nurses and its level is above average.Administrators should pay more attention to these related factors which can easily cause job burnout and take positive feasibility assistant strategies.

Exploration of compensatory mechanism in public medical institutions in Shanghai SongJiang District / 中华医院管理杂志

The paper introduced the exploration made by Shanghai SongJiang District in its compensation mechanism for public hospitals and community health centers.This attempt aimed at increasing government financial support,identifying public health needs in the development of public medical institutions,developing the compensatory measures to fit the task completed,and the service provided and individual items.It took such factors as the present personnel,workload,population and area taken into account.All these are designed to make the mechanism more appropriate and fair.

Strategy and methodology of clinical medicine in its discipline development / 中华医院管理杂志

A description of the implementation strategy and methodology of clinical medicine as a discipline in terms of building clinical technology features, making scientific research centering on clinical questions, building technical and academic branding, and building discipline bases.Authors also emphasized human resource cultivation, and held that the clinical discipline development should be carried out by means of organization and culture management for the discipline.

Organization and management in hospital's humanistic services / 中华医院管理杂志

The service behavior of medical staff is influenced by the organizational environment and management mode of the hospital. That is to say, the organization and management determine the standardization and sustainability of a hospital's humanistic services, and organizational driving force is also an important factor for the staff to innovate their services. Organization and management of a hospital' s humanistic services is composed of three factors: service operation management, service elements management and service performance management. These factors ensure a hospital's humanistic services to achieve whole-staff-participation, sustainability and standardization.

The Ways and Methods of Clinical Practice Teaching in Higher Medical College and University / 中华医学教育探索杂志

In order to further promote teaching effect of clinical practice in higher medical college & university,we should focus on the following main points:renovating teaching ideal and educational thought;reinforcing the cultivation of diagnosis and treatment technique and diagnosis thoughts;reforming teaching method and strategy;strengthening the teaching management;combining scientific research with training practice;infiltrating humanities-social sciences thoughts.

Current situation of mental health service in domestic general hospitals and measures for improvement / 中华医院管理杂志

By analyzing the scope and demands of mental health service in general hospitals, the authors point out that at present domestic general hospitals are confronted with such problems as insufficiency of resources for mental health service, low recognition rate of dysphrenia, and lack of systematic consultations and liaison in psychiatric work. Then they put forward a number of measures for improving mental health service in general hospitals: ①establishing a department of psychiatry in each general hospital; ②widely conducting consultations so as to maintain a strong liaisom in psychiatric work; ③genuinely achieving the transformation of the medical mode; ④strengthening education in psychological medicine and the spread of popular science so as to broaden the channel and coverage of mental health service and meet the needs of reform and development of the health cause in the contemporary era.