Chinese General Practice

The Knowledge and Skills System in General Practice

HAO Li-xiao，WANG Ting，CHEN Li-fen，CHEN Chao，JIA Jian-guo

2018, 21(19): 2269-2276. DOI: 10.12114/j.issn.1007-9572.2018.19.001

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Objective　Based on the construction of the knowledge and skills system in general practice，this article aims to provide advice in this aspect for our country.Methods　By retrieving books related to the knowledge and skills of general practice at home and abroad from 2006 to 2016 in the Dayi Medical Search Database，and combined with the relevant training documents of general practitioners published recently in our country，the knowledge and skills system in general practice was constructed through the panel discussion and demonstration with a degree assessment of each content.The contents of the system were compared with the training syllabus in documents.Results　Finally，66（48 in Chinese and 18 in English） books were included.The system involved basic skills and knowledge of general practice，common symptoms，common diseases and relevant clinical skills.Compared with the current training documents of general practitioners，this system proposed to increase the basic knowledge of general practice of screening and chemical prevention，concept and clinical application of evidence-based medicine，future development of general practice，technical update in examination，and other common symptoms like upper limb pain，wrist pain，and ankle pain.It was recommended to increase diseases with rising incidence or visiting rate，such as lung abscess and bronchiectasis in the respiratory system，dyspepsia and inflammatory bowel diseases in the digestive system，obesity and osteoporosis in the endocrine system，somnipathy in the nervous system，visual disorders（refractive errors，amblyopia/strabismus） in the ophthalmology，domestic violence in psychiatry and so on.It was recommended to increase knowledge of palliative care and hospice care，and other knowledge of humanity.It was proposed to reduce the mastery of more specialized diseases，such as bone and joint infections and gestational trophoblastic disease.There is no increase or decrease about relevant clinical skills compared with contents of the training syllabus.Conclusion　The knowledge and skills system in general practice is relatively comprehensive，and it optimized and improved the knowledge and skills needed by general practitioners according to the training syllabus，which provides a reference for the compilation of relevant training books and documents for general practitioners in the future.

Measures for Building Trust between Patients and Primary Care Physicians under the Implementation of the Hierarchical Medical System　

PENG Ying-chun

2018, 21(19): 2277-2280. DOI: 10.12114/j.issn.17-9572.2018.19.002

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Under the vigorous implementation of the hierarchical medical system，grassroots medical institutions are generally responsible for providing healthcare（especially initial care） for common diseases and frequently-occurring diseases.As these settings designed to offer primary care including continued care for specific populations，building good and trustworthy relationships between patients and primary care physicians is of great significance in improving the service efficiency，enhancing the accessibility of primary care as well as promoting social stability.We analyzed the patient flow for seeking healthcare during the implementation of the hierarchical medical system，as well as the feasibility of building trustworthy relationships between patients receiving continued care and primary care physicians.Furthermore，we intensively evaluated the physician-patient relationship in primary care，analyzed the impact exerted by the implementation of hierarchical medical system on it，and put forward measures for building good and trustworthy physician-patient relationships in primary care using theory of repeated games.

Community-based Long-term Care Services in Taipei and Changchun in China：a Comparative Study

comZHOU Meng，PENG Xin，LIN Pay-fen，JIA Hui-ying

2018, 21(19): 2281-2286. DOI: 10.12114/j.issn.17-9572.2018.19.003

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With the increasing of aging population，the long-term care needs of elderly has become a worldwide health care and social challenge.Community-based long-term care services have become an important part of the long-term care system.This paper intends to make comparison of community-based long-term care services in Taipei and Changchun from seven aspects：insurance type，service content，service mode，expense commitment，service object，human resources，and quality control.There are some suggestions for long-term care in mainland China，such as continuously developing and reforming long-term care policies and regulations，strengthening the quality control，clarifying the service object，improving the insurance system，realizing cooperation and service diversification，and promoting long-term care service team specialization.In addition，"Internet + long-term care" is the important direction in the future.It will not only help reduce the demand of human resources，but also help expand the scope of services and improve service quality in the era of shortage of human resources and popularization of the Internet.

Role of the Healthcare Department of Neighborhood Centers in the Promotion of Family Doctor Services

LU Hai-feng，JIA Jie，CHEN Jing，YANG Jian-zhao，LIU Mei，QIU Wei，ZHAO Wei-zhong

2018, 21(19): 2287-2290. DOI: 10.3969/j.issn.1007-9572.2018.00.048

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Objective　To explore the role of the healthcare department of neighborhood centers in the promotion of family doctor services.Methods　We conducted this study from January to April 2017.Using simple random sampling with a sampling fraction of 1∶10，we selected totaled 1 502 registered residents seeking outpatient treatment（725 from the healthcare department，Jixiangfang Neighborhood Center，Minhang District Maqiao Community Health Center，362 from Qizhong Health Station，415 from Linsong Health Station）.Then we conducted a survey among them with a self-developed questionnaire for collecting the data about demographic characteristics，awareness of family doctor services，status of signing a contract with the family doctor，initial consultation with the family doctor and making an appointment with the family doctor，level of satisfaction with the family doctor service，as well as the level of trusting the family doctor services.Results　A total of 1 451（96.6%）participants〔703 from the healthcare department，Jixiangfang Neighborhood Center（healthcare department of neighborhood center group），748 from the two health stations（health station group）〕 were included in the final analysis.Compared with the health station group，healthcare department of neighborhood center group demonstrated higher rate of signing a contract with the family doctor 〔33.9%（238/703）vs 28.6%（214/748）〕，higher rate of having initial consultation with the family doctor〔68.7%（483/703）vs 63.8%（477/748）〕，and higher rate of making an appointment with the family doctor〔50.5%（355/703）vs 45.2%（338/748）〕（P<0.05）.Furthermore，healthcare department of neighborhood center group showed higher levels of satisfaction with the overall family doctor services，convenience in seeking healthcare，home-based care，service attitude，health education，and psychological counseling，and higher levels of trusting doctor attending to their needs，their willingness to participate in therapy，the doctor being honestly liable for medical mistakes，the doctor keeping patient-doctor conversations with complete confidentiality（P<0.05）.However，healthcare department of neighborhood center group and health station group showed no significant difference in the awareness of family doctor services〔93.2%（655/703） vs 90.6%（678/748）〕（P>0.05）.Moreover，both groups exhibited similar levels of satisfaction with the waiting time for consultation，vaccination service，and regular physical examination，and similar self-perceived doctors' attention level，self-perceived level of best efforts used by the doctor during management，level of adherence to doctors' advice，levels of trust in the matters informed by the doctor，management delivered by the doctor，and professional capabilities of the doctor（P>0.05）.Conclusion　The healthcare department of the neighborhood center plays an important role in improving the level of satisfaction with family doctor services and level of trusting such services in the residents.However，the rate of signing a contract with the family doctor and rate of having initial consultation with the family doctor in the residents under management should be improved further.

Breast Cancer Prevention and Control Process Based on General Hospital-Community Collaboration Model

CHEN Ge，ZHU Ji，MA Qia-yi，BI Fang-fang，WANG Jie，LI Li，TAN Yu-ting，WANG Lei

2018, 21(19): 2291-2296. DOI: 10.12114/j.issn.1007-9572.2018.00.006

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Objective　To construct a complete，standardized and patient-centered breast cancer prevention and control process based on general hospital-community collaboration model with clear division of labor at all levels of medical institutions through integrating and optimizing the commonly used breast cancer screening tools and based on the foundation of regional family doctor contracted service.Methods　Through literature review，the current guidelines for breast cancer prevention and control at home and aboard were summarized.And then expert consultation method，brainstorming method and flow chart method were used to build the breast cancer prevention and control process.Results　The prevention and control process of breast cancer mainly consisted of three steps.Step 1：To build residents' awareness of cancer prevention through the health education from community general practitioners.Step 2：Gail-2 risk assessment and clinical breast examination were carried out by community general practitioners to screen out high-risk groups of breast cancer，and these high-risk residents were transferred to higher level of medical institutions.Step 3：Breast cancer was diagnosed and treated through mammography and other breast-related examination performed by specialists in general hospitals，and a rehabilitation prescription was issued.Conclusion　The establishment of breast cancer prevention and control process could enable the implementation of clinical guidelines for breast cancer and form a practical and feasible plan of breast cancer focusing on patient as the center with the reasonable division of labor among general hospital specialists and community general practitioners.It also completed the entire process from the early detection and early diagnosis to early treatment of breast cancer，avoiding the waste of medical resources because of multiple examinations and visits.At the same time，it could improve the ability of general practitioners in the clinical examination and control of breast cancer.

Current Status of Family Doctor Contracted Services and Its Satisfaction Degree in Jiangsu Province

WANG Dong-yang，CHEN Yong-nian，FANG Pei-ying，SHEN Bo，HUANG Xiao-guang

2018, 21(19): 2297-2302. DOI: 10.3969/j.issn.1007-9572.2018.00.19

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Objective　To discuss the current situation of family doctor contracted services and its satisfaction degree in Jiangsu Province to provide reference for the further development of family doctor contracted services.Methods　Multistage sampling method was conducted.Eight primary medical institutions（four community health centers and four township health centers） from each of 13 cities in Jiangsu Province were selected by typical sampling method，in which the family doctor contracted services was implemented.And three doctors from each of primary medical institutions were selected by random number table method to fill in the questionnaires.A total of 312 doctors conducted a self-designed questionnaire from November to December in 2016.The questionnaire mainly included general situation of family doctors，current situation of the contracted services，residents' cognition and enthusiasm of contracted services and their satisfaction level.A total of 312 questionnaires were distributed and 296 valid questionnaires were collected.The effective rate was 94.9%.Results　Among 296 doctors，the number of contracted residents of each doctor was from 0 to 8 380 with the median of 220（790）．Family doctors thought that the reasonable number of contracted residents of each doctor should be from 0 to 3 000 with the median of 200（420）．The working time of 150（50.7%） doctors was 9 to 10 hours.Working time engaged in the contracted services accounted for 3% to 99% of the total working hours with the median of 30%（30%）．And 175（59.1%） doctors saw no change in salary basically.While 254（85.8%） doctors were clear about the contents of contracted services，275（92.9%） doctors knew responsibilities of family doctors．Then 260（87.8%） doctors thought that they were qualified for the family doctor contracted services，while 171（57.8%） doctors were positive in the contracted services.The average score of satisfaction degree to the contracted services of urban family doctors was（3.37±0.05），and that of rural family doctors was（3.54±0.05）．Scores of rural family doctors on the support of agencies，referral services provided by the superior hospital，social environment and overall satisfaction degree were higher than that of the urban family doctors with a significant difference（P<0.05）．There was no significant difference in the satisfaction degree of family doctors with different sex，age and practicing registration（P>0.05），while there was a significant difference in the satisfaction degree of family doctors with different education level and professional titles（P<0.05）．Conclusion　There is a certain gap between the actual number of residents contracted with family doctors and the number guided by policy，which needs the improvement of relevant policies.Family doctors have limited time to engage in the contracted services，and therefore more doctors are needed.Family doctors have a good self-evaluation with positive enthusiasm，and their service capabilities need to be further improved.Family doctors are less satisfied with personal development，and incentive mechanism should be improved.

Diagnostic Value of TriAGe+ Score for Stroke in Patients with Dizziness

WANG Wei-qiang，YU Hui，ZHU Rui-fang

2018, 21(19): 2303-2307. DOI: 10.12114/j.issn.1007-9572.2018.19.007

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Objective　To evaluate the value of TriAGe+ score in the diagnosis of stroke in patients with dizziness.Methods　A total of 1 437 patients with dizziness who received treatment from the Suzhou Hospital Affiliated to Anhui Medical University from February 2014 to August 2017 were enrolled.According to the final diagnosis，the patients were divided into two groups：stroke group （n=137，accounting for 9.5%） and non-stroke group （n=1 300）.The diagnostic value of TriAGe+ score for stroke in dizziness patients was determined by ROC curve and compared with ABCD2 score.According to the TriAGe+ score，those scored 10-17，8-9，5-7，0-4 were assigned to very high-risk group，high-risk group，medium-risk group and low-risk group，respectively.Comparisons were made between the 4 risk groups in terms of the incidence of stroke and between stroke and non-stroke groups in regard to clinical data.Stepwise Logistic regression analysis was performed for investigating the associated factors for stroke.Results　Patients with stroke and those without showed significant differences in the distribution of sex，blood pressure levels at admission，duration of dizziness，and type of dizziness，prevalence of functional limb weakness or speech impairment，prevalence of inducing factors for dizziness，prevalence of brainstem or cerebellar dysfunction，dizziness history percentages of labyrinth disorder or vestibular disease history，diabetes history，hypertension history，and atrial fibrillation history （P<0.05），except in the distribution of age （P>0.05）.Logistic regression analysis showed that sex，blood pressure levels at admission，functional limb weakness or speech impairment，duration of dizziness，inducing factors for dizziness，type of dizziness，brainstem or cerebellar dysfunction，dizziness history labyrinth disorder or vestibular disease history，diabetes history，hypertension history，atrial fibrillation history were associated factors for stroke in dizziness patients （P<0.05）.The incidence of stroke in very high-risk group，high-risk group，medium-risk group and low-risk group was 65.5% （57/87），27.0% （51/189），5.8% （23/394），0.8% （6/767），respectively，with significant differences （P<0.05），and the difference in terms of incidence of stroke between any two groups was significant（P<0.008 3）.For the diagnosis of stroke，the AUC of TriAGe+ score was larger than that of the ABCD2 score 0.890〔95%CI（0.866，0.914）〕vs 0.806〔95%CI（0.769，0.843）〕（P<0.001）.When the TriAGe+ score was 10，its sensitivity was 0.834，specificity was 0.727，and Youden's index was 0.561.Conclusion　TriAGe+ score is contributive to quickly identifying stroke in dizziness patients.

Relationship between Family Functioning and Health Behaviors in Patients with Type 2 Diabetes

MellitusYU Ting-ting，ZHAO Ruo-hua，XU Bi-xiang，LI Ya-ling

2018, 21(19): 2308-2312. DOI: 10.12114/j.issn.1007-9572.2018.19.008

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Objective　To explore the correlation between family functioning and health behaviors in patients with type 2 diabetes mellitus（T2DM）.Methods　225 T2DM patients who were treated in the People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine from April 2016 to February 2017 were selected.McMaster Family Assessment Device（FAD） was used to evaluate the family functioning.Health-promoting Lifestyle Profile Ⅱ（HPLP-Ⅱ） was adopted to evaluate the health behaviors of the patients.Spearman rank correlation analysis was performed to explore the correlation between family functioning and health behaviors.Results　A total of 206 returned responsive questionnaires，with a response rate of 91.6%.The FAD score of the patients ranged from 94 to 169，with an median score of 141.5（20.0）；The HPLP-Ⅱ score of the patients ranged from 68 to 187，with an average score of（129.1±25.4）.The family functioning score differed significantly by the duration of T2DM and the prevalence of complications（P<0.05）.Moreover，the results of Spearman rank correlation analysis showed that there was a negative correlation between FAD score and HPLP-Ⅱ score（rs=-0.237，P<0.05）.Conclusion　T2DM patients were found with both fair family functioning and health behaviors.Good family functioning contributes to the development of health behaviors.

Influencing Factors of Hypertensive Emergencies

LU Xiao-di，ZHOU Yu-qiu，WANG Yue-feng，QIN Huan-huan，MENG Li-na

2018, 21(19): 2313-2318. DOI: 10.12114/j.issn.1007-9572.2018.19.009

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Objective　To explore the influencing factors of hypertensive emergencies（HE）.Methods　A case-control study was performed among 782 patients with hypertension from Department of Cardiology，Daqing Oilfield General Hospital，Heilongjiang Province from September 2015 to July 2017.Of them，310 with a history of HE and other 472 without were assigned to HE group and non-HE group，respectively.Clinical data were collected by a questionnaire survey using a self-developed Baseline Characteristics Questionnaire，Chinese version of Morisky Medication Adherence Scale，Chinese version of Health-promoting Lifestyle Profile Ⅱ（HPLP-Ⅱ-C），Chinese version of 12-item Short Form Health Survey（SF-12-C），Social Support Rating Scale（SSRS），Chinese version of Family Assessment Device（FAD-C），and Chinese version of Self-rated Abilities for Health Practices Scale（SRAHP-C），and were compared between the groups.Multivariate stepwise Logistic regression analysis was used to explore the influencing factors of HE.Results　The incidence of HE was 39.6%.There were no significant difference in sex，alcohol consumption history，family history of hypertension，family history of cerebrovascular disease，family history of diabetes，BMI，waistline and mean score of SSRS between the two groups（P>0.05）.However，smoking history，diabetes history，family history of cardiovascular disease，salt consumption status，exercise status，sleep quality，medication compliance，age，fasting plasma glucose，total cholesterol，triglyceride，mean score of HPLP-Ⅱ-C，SF-12-C，FAD-C and SRAHP-C differed significantly between the groups（P<0.05）.Multivariate stepwise Logistic regression analysis revealed that diabetes history，sleep quality，mean score of HPLP-Ⅱ-C，SF-12-C and FAD-C were the influencing factors of HE（P<0.05）.Conclusion　The morbidity of HE is high in patients with hypertension.And diabetes history，poor sleep quality，poor lifestyle，poor quality of life and poor family functioning are the risk factors.

Prevalence and Associated Factors of Sleep-disordered Breathing in Patients with Different Stages of Chronic Kidney Disease

FENG Yi-duo，GONG Yong，ZHANG Yin，WANG Dong-xue，DING Xia，WU Yu，ZHANG Chang-qin，ZHOU Yi-lun

2018, 21(19): 2319-2323. DOI: 10.12114/j.issn.1007-9572.2018.19.010

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Objective　To evaluate the prevalence and associated factors of sleep-disordered breathing （SDB） in patients with different stages of chronic kidney disease （CKD）.Methods　A total of 132 inpatients from Department of Nephrology，Beijing Tiantan Hospital were enrolled during August 2016 to May 2017.We collected their baseline characteristics，laboratory test data，available parameters associated with sleep quality such as apnea-hypopnea index （AHI） and oxygen desaturation index （ODI） derived from the automatic analysis of overnight sleep monitoring results （performed in the department） by Morpheus Ox web-based server software.Based on the definition of CKD and the eGFR level calculated by the modified CKD-EPI equation for Chinese populations with CKD，the patients were divided into non-CKD group，CKD 1-3 stages group，CKD 4-5 stages with dialysis group.Sleep quality was assessed by the Epworth Sleepiness Scale （ESS）and the Pittsburgh Sleep Quality Index （PSQI） .Statistical significance of the differences between three groups was tested using one-way ANOVA for continuous variables and χ2 test for categorical variables.Multivariable Logistic regression analysis was used to investigate the associated factors of moderate to severe SDB.Results　The distribution of age and systolic blood pressure （SBP），percentages of hypertension history，and cardiovascular disease history differed significantly between the three groups （P<0.05），while the distribution of sex，diastolic blood pressure （DBP） and body mass index （BMI），prevalence of smoking and alcohol consumption，percentage of diabetes history did not （P>0.05）.The distribution of eGFR，hemoglobin and albumin levels varied obviously between the three groups （P<0.05），but that of total cholesterol and fasting blood glucose levels did not（P>0.05）.Three groups demonstrated similar mean AHI，similar percent of patients with an AHI≥15 and similar mean ESS score （P>005），but significantly different mean ODI and PSQI （P<0.05）.The percent of patients with an ODI≥5 in CKD 4-5 stages with dialysis group was higher than that of non-CKD group （P<0.017）.The mean PSQI score was significantly higher in CKD 4-5 stages with dialysis group compared with that of other two groups （P<0.017）.Univariate Logistic stepwise regression analysis showed that age，hypertension，BMI and eGFR levelwere associated with mild to severe SDB （P<0.05），and in multivariate regression analysis， BMI and eGFR level were independently associated with mild to severe SDB （P<0.05）.Conclusion　Different mean ODI and PSQI in patients with different stages of CKD； decreased eGFR level as well as increased BMI were the risk factors for mild to severe SDB.

Bone Density and Body Composition Changes in Middle-aged and Older Urban-dwelling Females

LI Zong-tao，LAI Qin，YANG Tao，SUN Jin-hai

2018, 21(19): 2324-2329. DOI: 10.12114/j.issn.1007-9572.2018.19.011

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Objective　 To study the changes in bone density （BD） and body composition with aging among middle-aged and older urban-dwelling females，and to offer suggestions for scientific exercising.Methods　421 healthy middle-aged and older healthy females were enrolled from 10 urban communities of a city in Shandong Province and were stratified into age groups of 55-59，60-64，65-69，70-74.OsteoPro UBD2002A Ultrasonic Bone Densitometer was used to measure the BD.ZEUS 9.9 Body Composition Analyzer was adopted to examine the parameters associated with muscle，fat，water and so on.Comparisons of the above indicators were made between the 4 age groups.Results　Except the body fat parameters （P>0.05），the bone mineral content，osteoporosis index （OI），the T-score and Z-score of BD，total body skeletal muscle mass，total body protein mass，left upper extremity skeletal muscle mass，right upper extremity skeletal muscle mass，left lower extremity skeletal muscle mass，right lower extremity skeletal muscle mass，trunk muscle mass，total body water volume，total body water percentage，volumes of intracellular and extracellular fluid，and edema index differed significantly between the 4 age groups （P<0.05）.In more detail，70-74 age group showed lower bone mineral content compared with 60-64 age group and lower T-score of BD compared with age groups of 60-64 and 65-69 （P<0.05）； age groups of 60-64 and 70-74 presented lower Z-score of BD than 65-69 age group （P<0.05）； 70-74 age group demonstrated less total body skeletal muscle mass and total body protein mass compared with other age groups （P<0.05）； 70-74 age group showed less left upper extremity skeletal muscle mass compared with other three younger age groups （P<0.05），and 65-69 age group also showed less left upper extremity skeletal muscle mass than other two younger age groups （P<0.05）； age groups of 65-69 and 70-74 had less right upper extremity skeletal muscle mass compared with age groups of 55-59 and 60-64 （P<0.05）； 60-64 age group showed more right lower extremity skeletal muscle mass than 65-69 age group （P<0.05）； 70-74 age group showed less trunk muscle mass than age groups of 60-64 and 65-69 （P<0.05）； the total body water volume，volumes of intracellular and extracellular fluid were less in 70-74 age group compared with other age groups （P<0.05）； total body water percentage was lower in 70-74 age group than in 65-69 age group （P<0.05）； edema index was lower in age groups of 55-59 and 70-74 compared with age groups of 60-64 and 65-69 （P<0.05）.Conclusion The age of 70 is a critical period for the changes in bone density and body composition with aging for middle-aged and older urban-dwelling females.In age periods of 65-70 and 70-75，bone loss，and loss of skeletal muscle mass，and total body water accelerate implicitly and explicitly，respectively.In view of this，suggestions are put forward as follows： 1.Appropriate exercising intervention and water supply should be performed to prevent or delay the development of such changes.2.Priorities should be given to particular skeletal muscles during functional training exercises and the order of exercise should be arranged properly，if rapid atrophy of lower extremity skeletal muscles appears earlier than that of trunk muscles.3.Muscular training should be strengthened for muscle atrophy may greatly contribute to the osteoporosis and deficiency of body fluid.

Correlation between Serum 25-（OH）D and Neonatal Infectious Pneumonia

LIU Liang，SONG Hong，ZHOU Chuan，LI Jing-jing，FENG Xiao-xia

2018, 21(19): 2330-2334. DOI: 10.12114/j.issn.1007-9572.2018.00.041

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Objective　To investigate the relationship between serum 25-（OH）D level and neonatal infectious pneumonia.Methods　The participants were all enrolled from the Second Affiliated Hospital of Zhengzhou University from August 2015 to July 2017，including 65 neonates with infectious pneumonia〔pneumonia group （consisting of 34 with mild infectious pneumonia and 31 with severe infectious pneumonia）〕 from the Neonatal Intensive Care Unit，and 60 healthy neonates （control group）. We compared the levels of serum 25-（OH）D，Ca2+，procalcitonin （PCT），C-reactive protein（CRP），and interleukin-6（IL-6） between the controls and neonates with mild infectious pneumonia and those with severe infectious pneumonia. Spearman's rank correlation analysis was performed to investigate the relationships of 25-（OH）D with Ca2+，PCT，CRP and IL-6 in pneumonia group.Results　Serum Ca2+ level did not differ significantly between the controls and mild and severe infectious pneumonia neonates（P>0.05）. However，serum 25-（OH）D，PCT，CRP and IL-6 varied obviously between them（P<0.05），to be specific，the mild and severe infectious pneumonia neonates had lower serum 25-（OH）D
but higher PCT，CRP and IL-6 levels compared with the controls（P<0.05）；neonates with severe infectious pneumonia demonstrated lower serum 25-（OH）D but higher PCT，CRP and IL-6 levels than those with mild infectious pneumonia（P<0.05）.Among the neonates with infectious pneumonia，serum 25-（OH）D was negatively correlated with PCT and IL-6（rs values were -0.434，-0.315；P<0.05），while showed no correlation with Ca2+ and CRP（rs values were -0.053，-0.184；P>0.05）.Conclusion　Decreased serum 25-（OH）D is found in neonates with infectious pneumonia. Moreover，it declines with the aggravation of the disease.Therefore，monitoring serum 25-（OH）D is contributive to the assessment of the severity of neonatal infectious pneumonia.

A Multi-faceted Assessment System for General Practice Residency Training

HUANG Wen-juan，LIN Hui-si*，Stephens Timothy Noel，XU Si-zhe，GUO Jing-zhu

2018, 21(19): 2335-2337. DOI: 10.12114/j.issn.1007-9572.2018.00.040

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The quality of primary healthcare in China is largely determined by the ability of general practitioners.However，a single form of assessment method cannot effectively assess the competency of general practitioners.Therefore，it is necessary to establish a systematic comprehensive assessment system to conduct multi-faceted assessment of residents.Based on a thorough analysis of assessment systems for residents in western countries，including Miller's pyramid for assessing clinical competence，this paper proposes a multi-faceted assessment system for general practitioners in residency training.This assessment system includes written examination，computer simulation tests，objective structured clinical examination（OSCE），clinical logbook，practice-based assessment，mentor reports，case analysis，and personal profiles，which can comprehensively understand the ability of general practice residents in various aspects.

The Training Modes for Postgraduates with Professional Degree Majoring in General Practice

WANG Yuan-yuan，ZHAO Wen-wen，Qi Ran，HE Zhen-yin，WANG Ya-yi，WANG Jin-yan，WANG Rong-ying

2018, 21(19): 2338-2342. DOI: 10.12114/j.issn.1007-9572.2018.19.014

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With the changes of modern medical pattern and residents' growing need for healthcare，training of postgraduates with professional degree majoring in general practice has become the key to the medical education reform and the development of community health services.In this paper，on the basis of analyzing related latest literature，the training significance of postgraduates with professional degree majoring in general practice，training status quo both at home and abroad are reviewed.Meanwhile，this paper prospects the development of training modes for postgraduates with professional degree majoring in general practice in our country.With the construction of a general practitioner-based mentor team，the optimization of course setting，the innovation of teaching methods，the enhancement of humanistic accomplishment，and the strengthening of the construction of general practice department can cultivate a group of postgraduates with professional degree majoring in general practice who have the great scientific research and innovation ability with solid theoretical basis and can provide quality medical services.

Application Effect and Associated Factors of Comprehensive Community Interventions for Hypertension Control Based on Remote Ambulatory Blood Pressure Monitoring

HUANG Zhi-jie，WANG Hao-xiang，ZHOU Zhi-heng，CHEN Bao-xin，OU Wen-sen，WU Wen-lin，YANG Zhi-peng，ZHANG Man，ZHONG Yong-yi，WANG Jia-ji

2018, 21(19): 2343-2347. DOI: 10.12114/j.issn.1007-9572.2018.19.015

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Objective　To explore the effect and associated factors of comprehensive community interventions for hypertension control based on remote ambulatory blood pressure monitoring（RABPM）.Methods　1 000 patients with hypertension were selected from 41 community health centers in Guangzhou between January 2015 and September 2016 by multi-stage random sampling.All of them signed a contract with the community general practitioner and enjoyed the one-to-one contractual services，and received the comprehensive community interventions for hypertension control delivered by health mangers，family doctors，and the patient's family members based on the blood pressure levels measured by a new type of RABMP.The intervention effects were evaluated by the status of hypertension control，health behaviors and BMI of patients at the end of 6-month，12-month and 18-month intervention.Multivariate Logistic regression analysis was carried out to determine the factors associated with hypertension control outcome.Results　A total of 954 cases who completed the trial were included for further analysis.The 18-month follow-up showed the following results：At the end of 6-month intervention，although the mean diastolic blood pressure（DBP） of the patients changed a little（P>0.05），the mean systolic blood pressure（SBP） decreased significantly（P<0.05） compared with baseline.Compared with at the end of 6-month intervention，both mean DBP and SBP levels of them were much lowered when they finished 12-month intervention（P<0.05）.When the 18-month intervention ended，the patients were found with both lower mean DBP and SBP levels compared with at the end of 12-month intervention（P<0.05），and were identified with lower rate of lack of exercise，lower mean BMI and longer mean duration of exercise（P<0.05） but similar prevalence of smoking and alcohol consumption（P>0.05） compared with baseline.The rate of hypertension control increased as the intervention went on（P<0.05）.Multivariate Logistic regression analysis revealed that age，concomitant illness，smoking and BMI were associated factors for hypertension control outcome（P<0.05）.Conclusion　 Comprehensive interventions based on RABPM could effectively improve the hypertension control outcome of community-dwelling hypertensive patients.Age，concomitant illness，smoking and BMI of the patients could influence the management effect.

Evaluation of Self-management Related Functions in Mobile Health Software for Hypertensive Patients

CHEN Zhi-long，LIU Lu，HE Chao-zhu，SU Ji-liang

2018, 21(19): 2348-2352. DOI: 10.12114/j.issn.1007-9572.2018.19.016

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Objective　To evaluate the self-management related functions of mobile health software for hypertensive patients.Methods　In July 2017，"blood pressure" was used as the search term to search for eligible mobile health software in the "App Store" and "Baidu Mobile Assistant" and the number of functions related to self-management of hypertensive patients in each software was counted.The self-designed criteria for grade evaluation were used to evaluate the quality of these functions.Results　A total of 24 software were included eventually.There were 11 functions related to self-management，including blood pressure record，hypertension information，timed reminder，medical consultation，health assessment，exercise record，family management，medication record，discussion group，abnormal reminder，and daily self-evaluation.The number of software with the corresponding functions was 24（100.0%），24（100.0%），17（70.8%），10（41.7%），8（33.3%），7（29.2%），7（29.2%），6（25.0%），5 （20.8%），3（12.5%） and 2（8.3%）.Among these software，1（4.2%）software had 10 functions and 9（37.5%） software had more than 6 functions.In the grade evaluation，the number of software that were evaluated for A grade in the aspects of blood pressure only，data record，easy to use，comprehensive score，quality of information，number of users，downloads，effect of reminding，and consultation responses was 17（70.8%），15（62.5%），9（37.5%），8（33.3%），5（20.8%），5（20.8%），4（16.7%），3（12.5%） and 2（8.3%）.There were 4（16.7%） software with 5 or more functionss evaluated for A grade.Conclusion　The mobile health software for hypertensive patients have preliminarily provided convenient，continuous and personalized self-management functions for patients with hypertension in China.To a certain extent，it could help patients improve their self-management abilities，but there are few high-quality software that are fully functional and can meet the needs of hypertensive patients.The actual application effects need to be further evaluated.

Role of WeChat Official Account in Community-based Diabetes Management

YUAN Dong-deng，LE Jia-yi，YU Min-jie，SONG Rui，SHEN Shi-feng

2018, 21(19): 2353-2356. DOI: 10.12114/j.issn.1007-9572.2018.19.017

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Objective　To explore the role of WeChat official account in community-based diabetes management.Methods　This study was conducted from May to November 2017 in 220 patients with type 2 diabetes，who were selected from the registered patients receiving the management of Huangpu District Ruijin 2nd Road Community Health Center（HDRSRCHC），and those individuals participated in the activity of "Concern about Physical Examination" initiated by HDRSRCHC.Using the random number table，the participants were equally divided into the control group receiving the conventional health management，and the observation group receiving the conventional health management，plus peer support from the WeChat self-health management group，and management（including regular health education of diabetes-related knowledge，blood glucose monitoring，instructions for individual health-related behaviors and medication） from health management group（consisting of physicians，nurses and dietitians） established on the platform of the WeChat official account set up and run by the HDRSRCHC.We compared the levels of glycemic and blood lipid indices，and scores of MOS 36-item short-form health survey（SF-36） between the groups before and after a 6-month intervention.Moreover，the level of satisfaction with the management was also compared between the groups at the end of intervention.Results　Before intervention，two groups showed similar average levels of glycosylated hemoglobin（HbA1c），total cholesterol（TC），triacylglycerol（TG），and low-density lipoprotein cholesterol（LDL-C），as well as similar average scores of all the domains of SF-36（physical functioning，physical role functioning，bodily pain，general health perceptions，vitality，social role functioning，emotional role functioning，mental health）（P>0.05）.However，after intervention，compared with the control group，the observation group demonstrated much lower average levels of HbA1c，TC，TG and LDL-C，and significantly higher average scores of all the domains of SF-36（P<0.05）.Furthermore，the observation group presented obviously higher average level of satisfaction with management（P<0.05）.Conclusion　WeChat official account plays an important role in enhancing the participation in self-management，promoting glycemic control，and improving the quality of life among community-dwelling patients with type 2 diabetes.In addition，it achieves high level of patient satisfaction.

Clinical Effect of Simplified Huoxue Powders in the Treatment of Knee Osteoarthritis　#br#

LI Yu-bin，XIE Li-min，YU Tong，ZHANG Zhen-nan，WANG Wen-yue，QIAO Xin，YIN Yong，SHEN Ling，WU Biao，CHEN Han-yu，FU Li-xin

2018, 21(19): 2357-2361. DOI: 10.12114/j.issn.1007-9572.2018.00.047

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Objective　To discuss the clinical effect of the simplified huoxue powders on knee osteoarthritis（KOA）.Methods　We enrolled 96 orthopedic outpatients with KOA from Guang'anmen Hospital，China Academy of Chinese Medical Sciences from February to June 2017，and divided them into huoxue powders group（n=30），wenjingtongluo group（n=19），xingqihuoxue group（n=17），simplified huoxue powders group（n=30），receiving 14-day external treatment with huoxue powders prescription，wenjingtongluo prescription，xingqihuoxue prescription，simplified huoxue powders prescription，respectively.The Visual Analog Scale（VAS）score for subjective knee pain，WOMAC score and TCM syndrome score were compared between the groups at baseline and after treatment.Results　VAS score，WOMAC score and TCM syndrome score at baseline did not differ significantly between the groups（P>0.05）.After treatment，all of them except wenjingtongluo group decreased significantly in all groups（P<0.05）.Moreover，intergroup comparisons showed that simplified huoxue powders group demonstrated much lower VAS score compared with wenjingtongluo group （P<0.05）；xingqihuoxue group had substantially higher WOMAC score than both huoxue powders group and simplified huoxue powders group（P<0.05）；xingqihuoxue group displayed much higher TCM syndrome score compared with huoxue powders group and simplified huoxue powders group（P<0.05）.Conclusion　Simplified huoxue powders prescription can relieve the knee pain and improve the conditions of KOA patients to some extent.

Bloodletting at Ear Apex Combined with Foot Bath with Chinese Medicine for Elderly Patients with Mild Hypertension：a Clinical Study

CHEN Jia-xin，CHEN Qing-zhao，LIAO Wei-feng，LIN Hui-xing

2018, 21(19): 2361-2364. DOI: 10.12114/j.issn.1007-9572.2018.00.053

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Objective　 To study the clinical effect of bloodletting at ear apex combined with foot bath with Chinese medicine for elderly patients with mild hypertension.Methods　 We enrolled 180 elderly patients with mild hypertension（stage 1 hypertension） who received free medical consultation in Chengnan Clinic，Foshan Chancheng Central Hospital from August 2015 to November 2016 and using a random number table，equally divided them into group A treated by bloodletting at ear apex，group B treated by foot bath with Chinese medicine，and group C treated by bloodletting at ear apex combined with foot bath with Chinese medicine.All of them were treated for 4 weeks（a course of treatment）．Comparisons were made between the groups in terms of the clinical response and systolic blood pressure（SBP） and diastolic blood pressure（DBP） measured at both baseline and the end of treatment.Results　After treatment，the clinical response in the groups was significantly different（P<0.05）；group C achieved better clinical response compared with group B（P<0.05）．SBP and DBP levels at baseline were similar in all groups（P>0.05），but after treatment，the two parameters differed significantly（P<0.05），both of them were lower in group C compared with other two groups（P<0.05），and DBP level was lower in group A compared with group B（P<0.05）．Both SBP and DBP levels decreased substantially in all groups after treatment（P<0.05）．Conclusion　The combination therapy was better than each of its components alone in improving the blood pressure.

Operation Status of the System for Initial Consultation in Dongguan's Community-based Outpatient

LIU Hai-lan，YIN Ai-ru，HE Sheng-hong，ZENG Li-bin

2018, 21(19): 2365-2368. DOI: 10.12114/j.issn.1007-9572.2018.19.020

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The system for initial consultation in community-based healthcare settings is a key part of the hierarchical medical system.In Dongguan，the system for initial consultation in community-based outpatient clinics has been implemented since 2008.So far，it has obtained the following achievements：the mean annual workload shows an increasing trend during 2009 to 2016；the problem of "It is difficult and expensive to see a doctor" for residents has been addressed to some extent；the prevention and management of chronic diseases have been improved；the equity in healthcare use and healthcare efficiency have been enhanced.However，challenges such as significant differences in the operation status of this system across different towns（streets） of Dongguan，complicated referral procedures，high rate of referrals，intractable recruitment of health professionals and poor health workforce stability were identified.In order to promote the sustainable development of the system，we put forward the following measures：establishing community health centers in a unified manner，standardizing the referral standard for community-based outpatient clinics，developing scientific payment systems and promotion mechanisms for health professionals and guiding the residents to change the thought of seeking healthcare mostly in secondary or tertiary hospitals.

The Investigation and Analyses of Women's Health Care Service Capability in Community Health Service Centers of Beijing

LYU Kai-min，SUN Yan-ge*，YAN Yan，LI Chao

2018, 21(19): 2369-2373. DOI: 10.12114/j.issn.1007-9572.2018.19.021

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Objective　To observe women's health care service capability of community health service centers in Beijing.Methods　By means of purposive sampling，16 districts/counties in Beijing were stratified by urban areas and suburbs/counties，and the samples were taken according to a ratio of 1∶1.A total of 93 community health service centers were selected，including 48 centers in the urban area and 45 centers in the suburbs/counties.A self-designed questionnaire was conducted from June to July in 2016.The main contents of the questionnaire were the settings of women's health care departments，the items of women's health care services provided by community health service centers，laboratory tests and imaging examination.A total of 93 questionnaires were distributed and 93 valid questionnaires were returned.The effective response rate was 100.0% （93/93）.Results　Of the 93 community health service centers，72 （77.4%） centers had specialized gynecologists，and 31 （43.0%） centers had independent gynecological clinics.There was no statistically significant difference in the settings of independent gynecological clinics between community health service centers in urban areas and suburbs/counties of Beijing（P>0.05）.Among 93 community health service centers，47（50.5%） centers provided cervical cancer screening；53（57.0%） centers provided breast cancer screening；28（30.1%） centers provided family planning surgery；57（61.3%） centers provided menopausal care；and 34（36.6%） centers provided antenatal examinations.The proportion of community health service centers providing family planning surgery and menopausal care in urban areas and suburbs/counties were significantly different（P<0.05），while the proportion of centers providing cervical cancer screening，breast cancer screening and antenatal examinations in urban areas and suburbs/counties had no significant difference（P>0.05）.Among 93 community health service centers，80（86.0%），45（48.4%），15（16.1%），37（39.8%），74（79.6%），86（92.5%），and 23（24.7%） centers provided respectively color Doppler ultrasound，ultrasonic bone density testing，electronic colposcopy，gynecological transvaginal ultrasonography，breast ultrasonography，blood biochemical examination，and female hormone testing.There was significant difference among the proportion of community health service centers providing color Doppler ultrasound，ultrasonic bone density testing，and gynecological transvaginal ultrasonography in urban areas and suburbs/counties（P<0.05），while the proportion of community health service centers providing electronic colposcopy，breast ultrasonography，blood biochemical examination，female hormone testing had no statistically significant difference（P>0.05）.Conclusion　The community health service centers of Beijing have the relevant personnel and facilities to carry out the women's health care with various forms，but it is still necessary to increase the number of gynecological professionals and strengthen settings of gynecological clinics.

Utilization Status of Medical，Nursing and Elderly Care Service for Senior Citizens Living in High Buildings without Elevators in Jingan District of ShanghaiZHU

Yu，AI He-ling，LUO Wei，CHEN Qi，PENG De-rong，TAO Hai-qi，HU Min，LIU Deng

2018, 21(19): 2374-2378. DOI: 10.12114/j.issn.1007-9572.2018.19.022

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Objective　To investigate utilization status of medical，nursing and elderly care service for senior citizens living in high buildings without elevators and to discuss relevant problems and countermeasures in Jingan District of Shanghai.Methods　Purposive sampling method was adopted to select Linfen Road Street，Pengpu Xincun Street and Pengpu Town Street which the dense residential buildings without elevators were in from 14 streets of Jingan District in Shanghai.Senior citizens aged 80 years old or older living on the third floor and above in residential buildings without elevators were selected randomly in accordance with a ratio of 1∶1∶1： from these three streets.In March 2017，a survey was conducted using self-designed survey questionnaire through in-home visits among these senior citizens.The questionnaire was used to investigate the basic information of respondents and their utilization status of medical，nursing and elderly care service in last month.A total of 224 questionnaires were distributed and all of them were returned.The effective recovery rate was 100.0%.Results　Among 224 senior citizens，71.9% （161/224） of them used medical service；60.3%（135/224） of them used nursing service；25.4%（57/224） of them used elderly care service in last month.Among those who used medical service，72.7% （117/161） of them used outpatient service and 98.1% （158/161） of them used medication service.And 77.6% （125/161） of them had difficulty in going downstairs.Among those who used nursing service，40.0% （54/135） of them thought they had great financial pressure on nursing service and 68.1% （92/135） nursing service was provided by family members and relatives.Among those who used elderly care service，39.6% （21/53） of them used the marketized housekeeping and meal delivery.Among 224 senior citizens，emergency contacts were respondents themselves accounting for 52.3% （104/199）.Conclusion　Senior citizens living in high buildings without elevators in Jingan District of Shanghai have higher utilization rate of medical service and nursing service，while the utilization rate of elderly care service is relatively low.At present，the living arrangements for some senior citizens are unreasonable.Heavy financial pressure and poor quality of nursing service，insufficient utilization rate of socialized elderly care service and inadequate emergency preparedness are still remaining problems.It is recommended that the provision of medical，nursing and elderly care service for senior citizens living in high buildings without elevators should be improved as well as a long-term emergency response mechanism.

The Effect of Incretin Mimetic Drugs on Atherosclerotic Cardiovascular Disease in Diabetic Patients

XU Yuan-xin，LI Qiang

2018, 21(19): 2379-2383. DOI: 10.12114/j.issn.1007-9572.2018.19.023

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As a high-risk group of atherosclerotic cardiovascular disease（ASCVD），there is a growing demand for medications in patients with diabetes mellitus that could both reduce blood glucose as well as the prevalence of ASCVD，or at least may not increase it.In view of the presence of glucagon-like peptide 1 receptor（GLP-1R） on the cardiac myocytes，incretin mimetic drugs may play a role in ASCVD of diabetic patients.To explore the effect of incretin mimetic drugs on ASCVD in diabetic patients，this article systematically reviews previous published literatures at home and abroad to introduce the structure and function of incretin，and the effect of incretin on cardiac myocytes，cardiac function，blood pressure and blood lipid level.We hope to provide basis for further research and development of drugs that not only reduce blood glucose but also protect cardiovascular system，and ultimately improve the therapeutic effect and prognosis of diabetic patients，especially those with ASCVD.

Exercise Therapy of Acute Exacerbation of COPD：a Literature Review

ZHU Jin-mei，ZHANG Cai-hong，GUO Hong-hua，CHEN Xiao-mei

2018, 21(19): 2384-2388. DOI: 10.12114/j.issn.1007-9572.2018.00.051

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Lack of exercise is deemed as a key factor which can cause weakness of skeletal muscle in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.This review aims to synthesize current studies regarding safety，commencement，and exercise prescription of exercise therapy for AECOPD patients.The result shows that exercise therapy tends to have a higher level of safety for AECOPD patients.Additionally，Most clinical studies have shown that it is better to start exercise therapy within 48 hours after AECOPD patients are admitted to the hospital or in the period of pulmonary infection control window（PIC）.Nowadays，aerobic exercise，resistance exercise and aerobic & resistance exercise are considered as main approaches in the field of AECOPD exercise therapy.As there remains few researches on AECOPD exercise therapy so far，especially high quality ones，it is necessary to explore and develop this therapy widely and deeply in the future.

Session Impact in Psychological Counseling and Psychotherapy　

YANG Jia-ping，LIU Ding，ZHANG Xiao-Yuan

2018, 21(19): 2389-2394. DOI: 10.12114/j.issn.1007-9572.2018.00.045

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Session impact refers to the direct and subjective impact of a session on visitors.It can monitor and manage the effects of psychological counseling.It is one of the important methods to identify the counseling deterioration，reduce the failure in psychological counseling and improve the effects of psychological counseling ultimately.This paper introduces the research process of session impact，including its definition，assessment tools，influencing factors and relationships between influencing factors and the consulting process and outcome variables.In addition，this paper suggests that further research should focus on developing the assessment tools，strengthening the integrity of session impact and improving the assessment system.

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