Physician awareness and attitudes regarding early warning score systems in mainland China: a cross-sectional study

INTRODUCTION@#The purpose of this study was to assess the application of the early warning score system (EWS-S) and gauge physician awareness, perceptions of necessity and attitudes regarding these tools based on previously experienced unnoticed clinical deterioration (CDET).@*METHODS@#A cross-sectional survey was carried out via an online questionnaire at a large 3,500-bed Class 3A general hospital in China. A total of 299 physicians of adult general wards were asked to answer a translated questionnaire that was localised from the original version. Demographic profiles of patients were included as well as three other sections assessing awareness of CDET/EWS-S and gauging attitudes towards and perceptions of the necessity of EWS-S at our hospital.@*RESULTS@#A high level of physician awareness of the CDET problem was observed. Most physicians knew about the existence of a systematic assessment tool for clinical application. Physicians with previous experience in reanimation, unplanned transfer to intensive care unit (UTICU) and/or death tended to consider EWS-S necessary in attentive and well-trained staff (p < 0.05). Physicians who had previous experience with UTICU were more likely to recommend implementing EWS-S in their wards compared with those without such experience (p < 0.05).@*CONCLUSION@#Most physicians have positive attitudes towards EWS-S. However, their awareness should be further heightened. Physicians who had previous experience with CDET/UTICU were more likely to employ EWS-S in their clinical practices. To better facilitate the implementation of EWS-S in Chinese hospitals, existing facilities, policy supports, standardised managements and the development of information systems should be strengthened.

Application of"family member-like"care strategies among COVID-19 patients in an isolation ward / 中南大学学报(医学版)

Objective:To control the pandemic of coronavirus disease 2019 (COVID-19) effectively, strict isolation measures have been taken in China. Suspected patients must be isolated, and the confirmed patients specifically are isolated in negative-pressure isolation rooms. During the isolation, patients face difficulty in adapting to their surrounding environment, worry about the prognosis of the disease, lack confidence in treatment, separate from their families, and have a sense of distance from medical staff. Isolated patients may possess the feelings of negativity, including loneliness, anxiety, depression, insomnia, and despair. Hence, to reduce the risk of adverse psychological outcomes,"family member-like"care strategies were developed and implemented to solve problems associated with the COVID-19 pandemic. This study aims to examine whether using"family member-like"care strategies can improve psychological resilience and reduce depression, anxiety, and stress symptoms among patients with COVID-19 in an isolation ward.Methods: A quasi-experimental design was used to evaluate the"family member-like"care strategies for adult patients with COVID-19 in an isolation ward. COVID-19 patients in the Xiangya ward of the West District of the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology in Wuhan, Hubei province, were included in this study from February 9 to March 20, 2020. Healthcare providers who volunteered as family members were assigned to patients. They practiced one-to-one care and provided continuous and whole care for the patients who were from admission to discharge. Connor-Davidson Resilience Scale-10 (CD-RISC-10) and Depression Anxiety Stress Scale-21 (DASS-21) were used to evaluate the resilience and psychological status of COVID-19 inpatients upon hospital admission, 2 weeks after admission, and at their discharge from the hospital. Results: The questionnaire response rate of the"family member-like"strategies was 100％. Of the 60 patients, 39 (65.0％) were male, and 21 (35％) were female. The hospital stay was (27.5±3.5) days. All the 60 patients were cured and discharged without any death and serious complications. The total scores for CD-RISC were 8.83±6.86 at admission, 29.13±5.42 at 2 weeks after admission, and 33.87±6.14 at discharge, which were significantly improved at the 2 follow-ups (F=404.564, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant improvements in tenacity (F=360.839, P<0.001), strength (F=368.217, P<0.001), and optimism (F=328.456, P<0.001) at the 2 follow-ups. The total scores of DASS-21 were 49.27±11.30 at admission, 30.77±16.71 at 2 weeks after admission, and 4.17±11.03 at discharge, and the scores were significantly decreased at the 2 follow-ups (F=270.536, P<0.001). Multivariate analysis and repeated measurements also indicated that patients experienced significant decreases in depression (F=211.938, P<0.001), anxiety (F=285.592, P<0.001), and stress (F=287.478, P<0.001) at the 2 follow-ups.Conclusion:"Family member-like"strategies had positive effects on improving psychological resilience and reducing the symptoms of anxiety and depression of COVID-19 patients. It might be an effective care method for COVID-19 patients. It should be incorporated into emergency care management to improve care quality during public health emergencies of infectious diseases.

Exploration and reflection on the mini-lecture in the training mMode for research-oriented graduate students in Chinese traditional medicine / 中华医学教育探索杂志

In order to solve the problems of feeble research foundation and inadequate experiment skills,the central laboratory for science and technology at general hospital introduced a series of minilectures with different styles for research-oriented graduate students in Chinese Traditional Medicine,including basic strengthening style,tailored style,leading innovated style and academic salon style.The minilecture contents covered biomedical basic research,the commonly used experimental technologies of cell culture,molecular biology,histochemistry and some others,and the latest research advances.According to the needs of postgraduate research projects,the mini-lectures were also organically combined with the laboratory self-produced micro videos and scientific research training,which aroused the enthusiasm of medical science postgraduates for scientific research participation,and explored a new way to improve the quality of experimental teaching.

The application of PDCA cycle in the bio-safety training for research-oriented medical postgradu-ates / 中华医学教育探索杂志

The laboratory of science and technology center at general hospital explored the appli-cation of PDCA cycle in the bio-safety training for research-oriented medical postgraduates, and then analyzed the effect of the training. The laboratory applied the PDCA cycle (Plan-Do-Check-Act) into the bio-safety training practice based on its own characteristics. The 4 links of bio-safety practice including bio-safety factors analysis, training plan implementation, training effectiveness evaluation and problems feed-back were integrated with 4 processes of PDCA cycle management. In view of the problems existing in the laboratory bio-safety training, the PDCA cycle model was applied to bio-safety training. Though the PDCA cycle, the laboratory can establish a bio-logical safety quality monitoring mechanism and achieve the system-atization, standardization and normalization of biosafety training.

Study on TCM Syndrome Characteristics of Menopausal Syndrome Based on Literature / 中国中医药信息杂志

Objective To study distribution rules of TCM syndrome characteristics of menopausal syndrome; To provide references for clinical treatment and further study.Methods The articles related to menopausal syndrome in CNKI, VIP, Wanfang Data, CBM and TCMDS during Jun. 1983 to Jun. 2013 were retrieved and analyzed. The original data were input into computer and established the menopausal syndrome literature database. Methods of cluster analysis, factor analysis, and frequency analysis were combined to conduct statistical analysis.Results A total of 270 articles and 730 patients were included in the analysis, including 42 syndromes and 73 symptoms. The four diagnostic information of top 9 syndromes was analyzed by clustering and 5 kinds of basic syndrome types were obtained, including liver and kidney yin deficiency, liver depression, heart-kidney disharmony, heart and spleen deficiency, and spleen and kidney yang deficiency; the core symptoms of each syndrome were extracted by factor analysis and frequency dominance method, and the main points of syndrome differentiations were initially established. Conclusion Three methods combined with relevant expert advice were used to initially establish the syndrome diagnosis of menopause syndrome, which can lay a solid foundation for further study.

Clinical observation of the segmented external dissection and internal ligation and leather bridge ligation plastic surgery in treatment of circumferential mixed hemorrhoids / 中国医师进修杂志

Objective To observe the effect of segmented external dissection and internal ligation and leather bridge ligation plastic surgery in treatment of circumferential mixed hemorrhoids. Methods One hundred and twenty patients with circumferential mixed hemorrhoids were enrolled in this study, and they were divided into observation group and control group according to operation methods, with 60 cases in each group. The patients in two groups were treated with segmented Milligan-Morgan. The patients in observation group were treated with leather bridge ligation plastic surgery, and the patients in control group were treated with slit skin bridge plastic surgery. Postoperative complications and effect were observed. Results The pain scores on the first day and the third day after operation in two groups had no significant differences (P>0.05). On the seventh day after operation, the pain scores in observation group was significantly better than that in control group (P 0.05). The number of broken leather bridge in observation group was significantly shorter than that in control group (P<0.01). The healing time in the observation group was significantly shorter than that in control group:(24.0 ± 3.6) d vs. (29.6 ± 4.70) d, t =- 6.05, P<0.01. Conclusions Segmented external dissection and internal ligation and leather bridge ligation plastic surgery in treatment of circumferential mixed hemorrhoids is safe and easy to operate, and it has a significant clinical effect.

Curative efficacy of sodium phosphocreatine combined with aminophylline in the treatment of postpartum hypertensive heart failure / 中国基层医药

Objective To investigate the curative efficacy of sodium phosphocreatine combined with amin-ophylline in the treatment of postpartum hypertensive heart failure.Methods 80 patients with postpartum hyperten-sive heart failure were randomly divided into the control group and the observation group equally by random number table method,40 cases in each group.The control group was given conventional treatment,such as oxygen inhalation, diuresis by furosemide,strengthening heart by cedilanid,vascular dilation by nitroglycerin,keeping water -electrolyte balance and so on.Besides that,the observation group was given sodium phosphocreatine in combination with amin-ophylline.Then,the curative efficacy,changes of blood pressure,indices of cardiac function and adverse reactions were compared.Results The total effective rate of the observation group was 95.0%,which was higher than 80.0% of the control group(χ2 =4.1 1 ,P <0.05).After treatment,SBP,DBP,LVEDD,LVESD,LVEF in the control group and the observation group were (1 25.7 ±6.5)mmHg vs (1 20.1 ±7.2)mmHg(t =3.651 ),(88.4 ±8.9)mmHg vs (81 .4 ± 9.0)mmHg(t =3.498),(64.0 ±6.8)mm vs (61 .3 ±6.2)mm(t =2.268),(53.7 ±6.3)mm vs (51 .0 ±5.6)mm (t =2.461 ),(38.6 ±9.0)% vs (42.5 ±8.7)%(t =2.476),respectively.In comparison with the control group, SBP[(1 25.7 ±6.5)mmHg vs.(1 20.1 ±7.2)mmHg],DBP[(88.4 ±8.9)mmHg vs.(81 .4 ±9.0)mmHg], LVEDD[(64.0 ±6.8)mm vs.(60.7 ±6.2)mm],LVESD[(53.2 ±5.3)mm vs.(50.2 ±5.6)mm]were signifi-cantly reduced and LVEF[(38.6 ±9.0)% vs.(42.5 ±8.7)%]was significantly increased in the observation group (t =3.651 ,3.498,2.268,2.461 ,2.476,all P <0.05).During the treatment,there was no severe adverse reaction. Conclusion Sodium phosphocreatine combined with aminophylline is effective for postpartum hypertensive heart fail-ure,which can significantly increase curative efficacy,decrease blood pressure and improve cardiac function with less adverse reactions.

Palmoplantar pustulosis: causative factors and efficacy of total glucosides of paeony / 中华皮肤科杂志

Objective To analyze causative factors for and therapeutic effect of total glucosides of paeony (TGP) on palmoplantar pustulosis (PPP).Methods Ninety patients with PPP were recruited in this study.A questionnaire survey was carried out to collect clinical data from these patients,and a patch test to identify contact allergens for these patients.All the patients were randomly divided into two groups:observation group treated with TGP capsule 0.6 g thrice a day,and control group treated with tripterygium glycosides tablets 20 mg thrice a day.Both groups topically applied mometasone furoate cream once a day.The efficacy and side effects were evaluated 4 and 8 weeks after initiation of treatment.Results Of the 90 patients,the ratio of male to female was 1 ∶ 1.64,smokers amounted to 42.22％,and 23 (26.67％) reported a history of infection before the onset of PPP.As the patch test showed,potassium dichromate and nickel sulfate were the most common contact allergens in these patients.The response rate was significantly higher in the observation group than in the control group after 4 weeks of treatment (64.44％ vs.40.00％,x2 =5.388,P ＜ 0.05),but similar between the two groups after 8 weeks of treatment (88.89％ vs.80.00％,x2 =1.353,P ＞ 0.05).No significant difference was observed in the occurrence of adverse reactions between the two groups (17.78％ vs.11.11％,x2 =0.809,P ＞ 0.05).Conclusions Smoking may play a certain role in the development of PPP,and infection seems to be a primary inducing factor.TGP combined with mometasone furoate cream is effective for the treatment of PPP.

Clinical study on teibivudine combined with adefuvir dipivoxii in the treatment of Hepatitis B patients with decompensated cirrhosis / 中国基层医药

Objective To observe the effect of telbivudine combined with adefuvir dipivoxil in the treatment of Hepatitis B patients with decompensated cirrhosis.Methods 56 Hepatitis B patients with decompensated cirrhosis were divided into two groups:treatment group (30 cases) and control group (26 cases).During 24 weeks,the control group received adefuvir dipivoxil( 10mg daily),supportive and symptomatic treatments,while the treatment group received telbivudine therapy(600mg daily) combiled with adefuvir dipivoxil ( 10mg daily) based on the regular treatments.After 24 weeks,the effect was observed and compared between the two groups.Results After treatment,the biochemical markers,Child-Pugh score of the treatment group was (33.2 ± 13.8) μmol/L,(44.5 ± 16.4) U/L,(36.1 ±1.5) g/L,(6.1 ± 1.8) points,respectively,and was better than those of the control group[ (71.8 ±18.6) μ mol/L,(89.9 ±44.9) U/L,(29.7 ± 1.3)g/L,(8.1 ±2.2) points] (t=15.32,15.20,23.37,6.09,all P＜0.05) ;HBV-DNA negative rate,HBeAg seroconversion rates of the treatment group was 93.3％ (28/30),43.3％(13/30),and was higher than that of the control group[76.9％ (20/26),7.6％ (2/26) ] (x2 =4.87,9.08,all P＜0.05).Conclusion Telbivudine combined with adefuvir dipivoxil was effective and safe for the treatment of Hepatitis B patients with decompensated cirrhosis.

Exploration and thinking in teaching of basic chemistry knowledge for preparatory international students / 中华医学教育探索杂志

To investigate the effect of the basic knowledge of chemistry teaching for preparatory international students,bilingual teaching based on Chinese-English languages and multimedia teaching,such flexible applications are carried out,which increases the students' listening,speaking,reading and writing skills in Chinese and helps them to adapt to the academic environment in China,and to master basic chemistry knowledge efficiently so that students can lay a good foundation for undergraduate program.