Table of Content

05 January 2019, Volume 22 Issue 1

Previous Issue    Next Issue

Commentary

Declarations from Alma-Ata and Astana：Development of General Practice is a Top Priority for Achieving Universal Health Coverage　

YANG Hui

2019, 22(1):  1-4.  DOI: 10.12114/j.issn.1007-9572.2019.01.001

Asbtract ( )   PDF (1244KB) ( )  

References | Related Articles | Metrics

At the Global Conference on Primary Health Care held on October 25，2018，197 member states of the WHO unanimously adopted the Astana Declaration，which reviews the Alma-Ata Declaration and puts forward the direction of action towards universal health coverage.The core idea of the Alma-Ata Declaration and Astana Declaration is justice，equality and solidarity，and both of them clearly point out that "Health for All" is the most important social goal，and primary health care is a vital approach to the achievement of this goal.As an essential part of primary health care，general practice services play a major role in the attainment of the goal of "Health for All".On the basis of the global status of implementation of primary health care，and the specific contents of the Astana Declaration，we analyzed the ways for developing general practice，with a view to offering a reference for the sustainable development of general practice.



Monographic Research

Roles of General Practitioners Working in Primary Healthcare Settings Joining in a Regional Medical Consortium　

WANG Ronghua，LI Yuntao，ZHAO Ling，OU Ting，TANG Zhongquan，JI Guozhong

2019, 22(1):  5-9.  DOI: 10.12114/j.issn.1007-9572.2019.01.002

Asbtract ( )   PDF (1026KB) ( )  

References | Related Articles | Metrics


General practitioners（GPs） are the "gatekeeper" for residents' health. Exploration of the roles of GPs working in primary healthcare settings of a regional medical consortium and the relationship between the roles，the conditions under which the GPs play a role in the medical consortium，etc. helps GPs better understand their roles and responsibilities，and promotes the improvement of the structural system of the medical consortium. We discussed the 5 roles 〔the initial care provider，health manager，conveyor of health information to patients （for reducing the asymmetry in information between them and patients），health service hub，teacher and researcher〕 of GPs who work in primary healthcare settings joining in a regional medical consortium，and the relationships of the roles. Moreover，we analyzed the problems that hinder GPs from playing their due roles，such as the unsatisfactory overall qualities and work enthusiasm of GPs working in primary healthcare settings，patients' inactive primary healthcare-seeking，and incomplete structure of the regional medical consortium. Furthermore，for addressing these problems，we proposed suggestions，such as attaching importance to the continuing education and incentives for GPs，pricing health management services，formulating positive and negative incentive measures for the performance of GPs，intensifying the publicity connotation and details of family doctor system，and integrating the resources owned by the members of a regional medical consortium with the concept of modern medical model.


Practice and Performance Evaluation of the Collaborative General Practice Clinic in Hierachical Medical System　

FENG Wei，WANG Weizhong，XIN Wenlin

2019, 22(1):  10-15.  DOI: 10.12114/j.issn.1007-9572.2019.01.003

Asbtract ( )   PDF (1020KB) ( )  

References | Related Articles | Metrics

The implementation of hierarchical medical system is an important initiative for achieving rational allocation of medical resources and equity of basic health services.It is also an important part of deepening the reform of the medical and healthcare system as well as the basic medical and healthcare system with Chinese characteristics.As the "gate-keeper" for residents' health，general practitioners（GPs） are directly involved in the implementation of hierarchical medical system.For further deepening the primary healthcare reform and improving the implementation of hierarchical medical system in a fair and orderly manner in Shanghai，Shanghai Pudong Hospital with many community health centers （belonging to a medical consortium in Southern Pudong New Area） initiated a collaborative general practice clinic in which most of the workers are GPs，and deliver services exploratively.We summarized the characteristics and analyzed the achievements and challenges of this delivery pattern of services，and proposed feasible improvement measures，with a view to providing a reference for the successful achievement of dual referrals and improving the implementation of hierarchical medical system between the institutions in the medical consortium for realizing healthcare seeking in an orderly way and rational allocation of medical resources.


Construction of a Conceptual Model for Identifying the Factors Associated with Signing a Health Service Contract with the Family Doctor in Community-dwelling Residents　

JIA Wei，DU Yaping，FAN Minhua

2019, 22(1):  15-19.  DOI: 10.12114/j.issn.1007-9572.2019.01.004

Asbtract ( )   PDF (1027KB) ( )  

References | Related Articles | Metrics

Background　The implementation of the contracted family doctor services has a late start in China. Moreover，the implementation status of this kind of services differs significantly across regions，and the factors associated with residents' signing a contract with the family doctor are diverse. Objective　To construct a conceptual model for exploring the factors associated with signing a health service contract with the family doctor in community-dwelling residents. Methods　Totals of 956 community-dwelling residents were recruited from Hangzhou by convenience sampling during March to May 2018. Data about residents' intention and performance concerning signing a health service contract with the family doctor were collected through a survey with a questionnaire developed by our research group based on the Theory of Planned Behavior （TPB） and information-motivation-behavioral skills（IMB） model. On the basis of the survey results，a structural equation model （SEM） was constructed to explore the factors associated with residents' contract signing. Altogether，910 participants returned responsive questionnaires，achieving a response rate of 95.2%. Results　The Cronbach' s α of the questionnaire was 0.934，the KMO value was 0.924，and the Bartlett's spherical test was significant （P<0.01），indicating that the questionnaire was appropriate for factor analysis，and the factors extracted by factor analysis explained 76.776% of the total variance. Analysis with the SEM model found that，residents' signing a health service contract with the family doctor was influenced directly by information （0.529），intention of signing the contract （0.195），and perceived behavior control （0.184），and it was influenced indirectly by acting according to the intention （0.085），positive attitude （0.045） and normative beliefs （0.039），the coefficient of determination for the model was 0.522 （P<0.01）．Conclusion　The factors associated with residents' behaviors of signing a contract with the family doctor can be explained well by our model constructed on the basis of the TPB and IMB model. The most important factor is information，followed by intention of signing a contract，then perceived behavior control.


Comparative Study on Visit Status of Patients with Medically Unexplained Physical Symptoms from General Practice Ward and Specialist Ward in General Hospitals　

ZHAO Wenwen，WANG Rongying，ZHANG Jinjia，WANG Yayi，ZHANG Yali，SUN Yanjie

2019, 22(1):  20-23.  DOI: 10.12114/j.issn.1007-9572.2019.01.005

Asbtract ( )   PDF (1006KB) ( )  

References | Related Articles | Metrics

Background　The clinical manifestations and auxiliary examinations on patients with medically unexplained physical symptoms（MUPS）are difficult to diagnose as one or some certain diseases，which may affect optimal treatment time and increase medical costs. Most patients are referred to general hospitals with relatively high medical technology after initial diagnosis and treatment in community medical and health institutions，consulting in various specialties. However，there is no relevant report on whether MUPS patients are treated differently in different specialties.Objective　To analyze visit status of MUPS patients from general practice ward and specialist ward in general hospitals，so as to provide basis for MUPS inpatients to choose specialty departments in general hospitals.Methods　A total of 616 patients who received treatment in general ward（312 cases）and specialist ward （304 cases）in the Second Hospital of Hebei Medical University in 2017 were selected as subjects.Patients were surveyed by self-developed questionnaire，including sociodemographic characteristics，diagnosis situation，number of referral，diagnosis time，treatment expenses，daily communication with doctors and nurses，patients' and family satisfaction and follow-up situation.Results　Among the patients who were surveyed，their visit reasons of choosing general practice department covered different specialties，and there were no difference on the composition ratio of visit reasons（P>0.05）.MUPS patients from general practice department gained higher overall level of diagnosis rate，of 75.6%（236/312），than those from specialist department，of 60.5%（184/304）（P<0.05）.The number of referrals，diagnose time and treatment expenses in general practice department were significantly less than those in specialist departments （P<0.05）.Daily communication time of patients with doctors and nurses in charge in general practice department were longer than that in specialist departments（P<0.05）.Patients' and their family satisfaction and follow-up rate in general practice department were significantly higher than those in specialist departments（P<0.05）.Conclusion　Most patients with MUPS have gained more optimized treatments of their health problems in general practice department of general hospitals，therefore general practice department should undertake the diagnosis and treatment of patients with MUPS，to provide continuous services for residents.


Status and Associated Factors of Patients' Behaviors of Seeking Community-based Outpatient Services after the Comprehensive Medical Reform of Separating Drug Sales from Medical Treatment Launched in Beijing, 2017　

DAI Yunhe，WANG Tao，YU Hongxia，BU Xiaoxian

2019, 22(1):  24-31.  DOI: 10.12114/j.issn.1007-9572.2019.01.006

Asbtract ( )   PDF (1044KB) ( )  

References | Related Articles | Metrics

Background　On April 8，2017，a new medical reform was launched officially in Beijing. According to the regulations of the reform，the gap in medical service fees of different levels of medical institutions is widened appropriately，aiming to promote the development of hierarchical diagnosis and treatment by guiding the patients to seek healthcare rationally via the pricing leverage. However，there are no studies concerning the effect of the implementation of the medical reform in this city on patients' healthcare-seeking behaviors from patients' perspective.Objective　To evaluate the effect of the medical reform launched in Beijing in 2017 on improving the hierarchical diagnosis and treatment status.Methods　This survey was conducted in 2 100 typically sampled outpatients from seven community health stations/centers in Yanshan area in Beijing's Fangshan District from November 20 to December 5，2017，with a self-developed questionnaire for collecting demographic characteristics of society，the changes in the choice of healthcare institution，awareness of the services delivered by the community healthcare setting after the medical reform launched in Beijing in 2017，awareness of the policies concerning the reform，and the prevalence of chronic disease.Results　Totaled 2 077 questionnaires were returned，with a 98.90% response rate.The preferred institution for initial treatment differed significantly before and after the reform （χ2=74.349，P<0.05），as did the preferred institution for the retreatment of chronic diseases （χ2=255.112，P<0.05）． Among the respondents who preferred to choose a tertiary hospital in Fangshan District for initial treatment before the reform，15.12%（314/2 077） sought initial treatment in a community healthcare setting after the reform.Of those who preferred to choose a tertiary hospital in Fangshan District for the retreatment of chronic diseases before the reform，21.62%（449/2 077） sought retreatment in a community healthcare setting after the reform.Multivariate Logistic regression analysis showed that educational level，average monthly household income，level of awareness of the services delivered by the community healthcare settings，seeking healthcare in community healthcare settings being more convenient than in hospitals were associated with the changes in the institution for initial treatment（from a tertiary hospital to a community healthcare setting）；average monthly household income，level of awareness of the services delivered by the community healthcare settings，and suffering from chronic diseases were associated with the changes in the institution for the retreatment of chronic diseases（from a tertiary hospital to a community healthcare setting）． After the reform，80.74%（1 677/2 077） of the respondents demonstrated no reduction in the number of hospital visits although the registration fee increased，15.07%（313/2 077） prescribed drugs less frequently，and 11.22%（233/2 077） showed a decrease in the average monthly medical costs.Conclusion　Since 2017 the medical reform has been carried out，many patients who preferred to seek healthcare in tertiary hospitals before the reform go to community healthcare settings for care，but a few patients who preferred to seek healthcare in community healthcare settings before the reform go to the tertiary hospitals for care.The changes in the institution for treatment（from a tertiary hospital to a community healthcare setting） more frequently occur in those seeking retreatment for chronic diseases compared with those seeking initial treatment.Socioeconomic status，level of awareness of the services delivered by community healthcare settings，level of convenience in seeking healthcare in community healthcare settings，and suffering from chronic diseases are associated with the changes in the institution for treatment（from a tertiary hospital to a community healthcare setting）． Patients' medical burden has not been affected much by the reform.The insufficiency of medicines in community healthcare settings has made some patients give up seeking healthcare in such institutions.


Health Services Utilization and Influencing Factors in Elderly Migrants in Shanghai：a Mixed-method Study

WANG Yongyi，WANG Wei，YAN Fei

2019, 22(1):  32-37.  DOI: 10.12114/j.issn.1007-9572.2018.00.363

Asbtract ( )   PDF (1028KB) ( )  

References | Related Articles | Metrics

Background　Family migration has become a main pattern of population migration in China. The number of elderly people moving with their children is increasing year by year. According to the data of Shanghai part of the Sixth National Population Census of the People's Republic of China，the permanent residents migrated to Shanghai is 8.977 0 million，of whom 0.234 1 million are older people aged 60 or over. However，there are few studies about the health-seeking behaviors of elderly migrants. Objective　To investigate health services utilization and influencing factors among elderly migrants in Shanghai. Methods　Quantitative and qualitative approaches were used in this mixed-method study. Quantitative data came from the data of health service utilization of the elderly migrants in Shanghai（n=752）in the National Dynamic Monitoring Project of the National Health and Family Planning Commission in 2015. The qualitative data came from in-depth interviews with 30 elderly migrants in Shanghai from September to December 2015，including the basic social and economic characteristics，health status and quality of life，health service needs，health services utilization and existing problems. The health services utilization of elderly migrants in Shanghai was analyzed. And the influencing factors of health services utilization of this population were identified with binary Logistic regression. Results　A total of 752 elderly people were included. Among them，the prevalence rates of self-perceived good health，hypertension or diabetes，and having medical insurance were 96.8%（728/752），23.1%（174/752），and 64.4%（484/752），respectively. In terms of the management of a mild illness，the prevalence rates of visiting a doctor，looking for/buying drugs in places near the residence or treating themselves，using drugs brought from hometown，waiting for self-healing without treatment and the others were 56.8%（427/752），37.1%（279/752），2.4%（18/752），2.7%（20/752）and 8（1.0%） respectively. Logistic regression analysis showed that reasons for migration，and number of friends in Shanghai were factors associated with the health-seeking behaviors when having a mild illness in the elderly migrants （P<0.05）．Personal in-depth interviews revealed that off-site reimbursement of medical charges，income，difficulties in seeking healthcare，and incapability of seeking healthcare independently were associated with health services utilization in the　elderly migrants （P<0.05）． Conclusion　The elderly migrants in Shanghai are found with good health and high rate of health services utilization. Reasons for migration，and number of friends in Shanghai are associated with the rate of health services utilization. In order to further improve the heath services utilization in this population，the accessibility of health services should be enhanced by improving the network of primary care institutions，social groups and family members should play their roles in guiding reasonable　utilization heath services　utilization in elderly migrants，and the system of off-site medical settlement should be improved to make the procedure simpler and quicker.


Parity and Risk of Type 2 Diabetes among Women from Sichuan，China：a Prospective Study　

CHENG Xiaoling，WAN Qin，DENG Sijie

2019, 22(1):  38-42.  DOI: 10.12114/j.issn.1007-9572.2019.01.008

Asbtract ( )   PDF (1018KB) ( )  

References | Related Articles | Metrics

Background　China is the country with the highest prevalence of diabetes in the world.Therefore，it is necessary to explore the risk factors of diabetes.So far，no agreement has been reached on whether parity（number of live births） has a relationship with the incidence of diabetes in women or not.Objective　To explore the influence of parity on the risk of type 2 diabetes in women，providing fertility counseling for women of childbearing age.Methods　This study was conducted in 1 815 nondiabetic women aged ≥40 who met the criteria of this study.They were recruited from those who participated in the epidemiological survey of cancer risk in Chinese patients with type 2 diabetes mellitus in Luzhou，Sichuan from April to November 2011.According to self-reported parity，they were divided into 1-birth group（n=1 115），2-birth group（n=403），3-birth group（n=173），and 4 or more births group（n=124）．All groups received a follow-up from June to November 2016，during which the blood glucose levels were recorded and compared.Logistic regression analysis was used to explore the relationship of parity with type 2 diabetes.Results　Compared with baseline，during the follow-up period，all participants showed no significant changes in fasting plasma glucose（FPG） levels（P>0.05）；1-birth and 2-birth groups demonstrated lower 2-hour plasma glucose（2 hPG） levels after an oral glucose tolerance test（OGTT），but other two groups presented higher 2 hPG levels after OGTT（P<0.05）．The rates of developing type 2 diabetes in all the participants，1-birth group，2-birth group，3-birth group，and 4 or more births group were 9.15%（166/1 815），6.64%（74/1 115），9.68%（39/403），19.65%（34/173），and 15.32%（19/124），respectively.The 3-birth group showed a higher rate of developing type 2 diabetes compared with 1-birth group，and 2-birth group（P<0.05）．And the 4 or more births group presented a higher rate of developing type 2 diabetes than 1-birth group（P<0.05）．Multivariate Logistic regression analysis showed that compared with women having 1 birth，the risk of developing type 2 diabetes was almost the same in those having 2 births〔OR（95%CI）=1.216（0.797，1.856）〕，but it was 2.355 times in those having 3 births〔95%CI（1.474，3.761）〕，and was 1.860 times in those having 4 or more births〔95%CI（1.058，3.270）〕.Conclusion　Multi-parity may increase the risk of type 2 diabetes in women.To prophylactically reduce this risk，it is recommended that women have one or two children.

Disability Status of Community-dwelling Elderly and the Influence of Chronic Diseases on Them　#br# #br#

BAI Jinwen，MA Xiaobin，CHEN Changxiang

2019, 22(1):  43-47.  DOI: 10.12114/j.issn.1007-9572.2019.01.009

Asbtract ( )   PDF (1005KB) ( )  

References | Related Articles | Metrics

Background　Degenerative disorders of physical functions increase susceptibility to diseases. Affected by various chronic diseases，the elderly lose their ability to take care of themselves in daily life, even lead to varying degrees of disability. With the aging and increase of average life expectancy of the Chinese population，the number of elderly people with disability is increasing. Objective　To evaluate the disability in community-dwelling elderly people with different chronic diseases，providing a basis for the delivery of countermeasures. Methods　From July 2016 to January 2017，a multi-stage stratified cluster random sampling method was used to randomly select 1 out of 8 secondary hospitals and 8 tertiary hospitals in Tangshan City，Hebei Province. The elderly（≥60 years old）in all the community health service centers（stations）under the jurisdiction of these two hospitals were selected as the subjects. A household survey was conducted for collecting sociodemographic characteristics and prevalence of chronic diseases（stroke，arthritis/rheumatism，hypertension，diabetes，heart disease，osteoporosis，depression） and the disability in the elderly with a questionnaire consisting of 3 parts〔sociodemographic data，prevalence of chronic diseases，and a 14-item Activities of Daily Living （ADL）〕. In this study，the total score of ADL is 14-56，and individuals with ADL scores of 14，greater than 14 but less than 22，equal to or greater than 22 are defined as independent，mild disability，severe disability，respectively. Logistic regression analysis was conducted to analyze the associated factors for the disability in the elderly. Results　Of the 6 342 participants，6 171 responded to the study questionnaire，giving a response rate of 97.30%. Among the respondents，the prevalence rates of independent，mild disability and severe disability，were 59.67%（3 682/6 171），21.73%（1 341/6 171），and 18.60%（1 148/6 171），respectively. The overall prevalence of disability was 40.33% （2 489/6 171）．Logistic regression analysis found that age，education level，marital status，chronic diseases（stroke，diabetes，heart disease，osteoporosis，depression） were the influencing factors of disability in community-dwelling elderly people （P<0.05）．Conclusion　Chronic disease aggravates the level of disability in community-dwelling elderly people. In view of this，elderly people with chronic disease are suggested to seek treatment actively in order to reduce of the possibility of having disability and to relieve the burden of care.


Impact of Stroke with Excessive Daytime Sleepiness on Post-stroke Blood Pressure Variability　

WANG Wenyi，WAN Fuming，LI Peng

2019, 22(1):  48-53.  DOI: 10.12114/j.issn.1007-9572.2019.01.010

Asbtract ( )   PDF (1060KB) ( )  

References | Related Articles | Metrics

Background　Hypertension is an important independent risk factor for stroke. The physiopathologic mechanisms for its relationships with the onset and outcomes of cardiovascular and cerebrovascular diseases have been fully elucidated，but its relationship with excessive daytime sleepiness（EDS） has been rarely reported.Objective　To investigate the effect of stroke with EDS on post-stroke blood pressure variability（BPV）.Methods　We recruited 244 stroke outpatients and inpatients from the ward and clinic of VIP Acupuncture & Moxibustion Department，First Teaching Hospital of Tianjin University of TCM during September 2014 to August 2016，including 120 with EDS（EDS group） and 124 without（non-EDS group）.We compared the baseline clinical data，biochemical parameters and ambulatory blood pressure monitoring parameters（ABPMPs） of the two groups. Pearson's correlation analysis was performed to explore the correlations of the Epworth Sleepiness Scale （ESS） score with ABPMPs in stroke patients with EDS.Results　Compared with non-EDS group，EDS group had a greater mean age，and a longer average course of stroke（P<0.05）.Both groups had no significant differences in the distribution of sex，type of stroke，prevalence of hypertension，distribution of course of hypertension and prevalence of antihypertensive drugs use in the past 3 months in those with hypertension（P>0.05）.EDS group had a higher mean serum triacylglycerol（TG）level（P<0.05），but showed similar mean serum levels of total cholesterol（TC），low density lipoprotein cholesterol（LDL-C），and high density lipoprotein cholesterol（HDL-C） compared with non-EDS group（P>0.05）.The mean nocturnal systolic blood pressure（SBP） and diastolic blood pressure（DBP），prevalence of non-dipping circadian patterns of SBP and DBP were higher in EDS group than those of the non-EDS group（P<0.05）.Both groups showed no significant differences in mean daytime SBP and DBP，mean 24-hour SBP and DBP and rate of pulse pressure reduction（P>0.05）.Pearson's correlation analysis showed that in stroke patients with EDS，the ESS score was linearly correlated with the circadian rhythms of SBP and DBP（P<0.05），but had no correlations with mean daytime SBP and DBP，mean nocturnal SBP and DBP，mean 24-hour SBP and DBP and rate of pulse pressure reduction（P>0.05）.Conclusion　Compared with simple stroke，stroke with EDS is more likely to occur in older people with more severe dyslipidemia. Moreover，the nocturnal blood pressure will be increased in stroke patients with EDS，which leads to higher possibilities of having non-dipping and reverse circadian patterns of blood pressure，resulting in higher risks of adverse outcomes and recurrence of stroke.


Association between Dietary Vitamin C Intake and Knee Osteophytes and Joint Space Narrowing　

LI Jiatian，WU Ziying，LI Xiaoxiao，LONG Huizhong，XU Bei，QIAN Yuxuan，WANG Yilun，TAN Ying

2019, 22(1):  54-58.  DOI: 10.12114/j.issn.1007-9572.2018.00.378

Asbtract ( )   PDF (1018KB) ( )  

References | Related Articles | Metrics

Background　Previous studies have shown that vitamin C may affect the development of osteoarthritis, but most of the results are not completely consistent.Objective　To examine the influence of dietary vitamin C intake on the prevalence of knee osteophytes（OST） and joint space narrowing（JSN）．Methods　Totals of 5 764 participants who underwent a health checkup at the Health Management Center of Xiangya Hospital，Central South University from October 2013 to November 2014 were included in this study.The basic information of each participant was collected and dietary vitamin C intake was assessed.According to the tertiles of the dietary vitamin C intake level，the participants were divided into three groups：low vitamin C intake group（≤85.65 mg/d，n=1 902），medium vitamin C intake group （85.66-132.08 mg/d，n=1 902） and high vitamin C intake group （≥132.09 mg/d，n=1 960）．Multivariable Logistic regression analysis was used to test the effect of dietary vitamin C intake on knee OST and JSN.Results　The prevalence of knee OST was 16.46%（313/1 902），12.72% （242/1 902），and 12.45%（244/1 960），in low，medium and high vitamin C intake groups，respectively，with a significant difference（P<0.001）．Multivariate Logistic regression analysis showed that vitamin C intake level，age，gender，body mass index （BMI），diabetes，and hypertension were the influencing factors of knee OST （P<0.05）．The prevalence of knee JSN in the low，medium and high vitamin C intake groups was 29.34%（558/1 902），28.65%（545/1 902），28.88%（566/1 960），respectively，with no significant difference（P>0.05）．Multivariate Logistic regression analysis showed that age，gender and BMI were the influencing factors of knee JSN （P<0.05）．Conclusion　The low dietary vitamin C intake may be a risk factor of knee OST，but not knee JSN.


Correlation between the Gastrointestinal Functions at Early Hospitalization and Progression of Acute Pancreatitis 　

WANG Minjing，FANG Xiaoping，LI Xueyang，CHEN Mingxia

2019, 22(1):  59-62.  DOI: 10.12114/j.issn.1007-9572.2019.01.012

Asbtract ( )   PDF (1020KB) ( )  

References | Related Articles | Metrics

Background　Intestinal tract acts an important organ for nutrition absorption and immune regulation.In addition，it plays a vital role in the progression of acute pancreatits（AP）.However，there are few reports about the role of gastrointestinal functions in assessing the severity of AP at early hospitalization.Objective　To explore the relationship of gastrointestinal function with the progression of mild AP at early hospitalization.Methods　Using convenient sampling，AP patients receiving inpatient treatment from Pancreas Center，the First Affiliated Hospital with Nanjing Medical University between December 2017 and May 2018 were selected.They were divided into mild AP group（n=58），moderate AP group（n=28），and severe AP group（n=14）according to the discharge diagnosis by Chinese Guidelines for the Management of Acute Pancreatitis（2013，Shanghai）.The time of first stool after admission，scores of the Chinese version of Gastroparesis Cardinal Symptom Index-Revised （GCSI-R） assessed on the 1st，2nd，and 3rd days of admission were collected，and their correlations with the severity of AP were analyzed.Results　Analysis of variance showed that there were no significant differences in the general clinical data such as the distribution of gender，average age，average BMI，prevalence of smoking，prevalence of drinking，average total volume of intravenous fluids administered within 24 h after admission between the three groups（P>0.05）.All groups showed significant differences in the time of first stool after admission，the average scores of the GCSI-R and its two dimensions（early satiety and bloating） assessed on the 1st，2nd，and 3rd days of admission（P<0.05），but had no obvious difference in the average score of nausea/vomiting dimension during the three days（P>0.05）.Correlation analysis showed that the severity of AP was positively related to the time of first stool after admission，the total score of GCSI-R and scores of early satiety and bloating on the 1st，2nd and 3rd days of admission（P<0.05），but had no relation with the score of nausea/vomiting dimension on the 1st，2nd，and 3rd day of admission （P>0.05）. Conclusion　The gastrointestinal function in patients with mild AP is closely related to the progression of the disease at early hospitalization. It reflects the severity of AP，and can be used as one of the indicators of prognosis evaluation.


Acupoint Acupressure Combined with Exercise for Marginally Elevated Serum Cholesterol in the Elderly　

HUO Yongyan，TANG Bin，QIU Yimin，YU Jingzhu，GUO Jinghu

2019, 22(1):  63-66.  DOI: 10.12114/j.issn.1007-9572.2019.01.013

Asbtract ( )   PDF (1218KB) ( )  

References | Related Articles | Metrics

Background　Elderly people are at high risk of hypercholesterolemia.Marginally elevated serum cholesterol is a transitional stage from normal cholesterol level to hypercholesterolemia.Active interventions can effectively reduce the incidence of cardiovascular and cerebrovascular diseases in elderly people with marginally elevated serum cholesterol.Objective　To investigate the clinical effect of acupoint acupressure combined with exercise on the marginally elevated serum cholesterol in the elderly.Methods　We recruited 200 elderly health checkup examinees with marginally elevated serum cholesterol from Xuhang Community Health Center from May 2015 to May 2016.By use of the random number table，they were divided into 4 equal groups，the control group，exercise group，acupoint acupressure group，and acupoint acupressure with exercise group，receiving the conventional community-based health management，conventional community-based health management with wuzang yangsheng gymnastics，conventional community-based health management with acupoint acupressure，conventional community-based health management with acupoint acupressure and wuzang yangsheng gymnastics，respectively.The interventions for all groups lasted for 12 months.Treatment compliance and control rate of marginally elevated serum cholesterol were recorded during follow-ups at the end of the 6-month and 12-month interventions，and were compared between the groups.Results　At the end of the 6-month and 12-month interventions，exercise group，acupoint acupressure group，and acupoint acupressure with exercise group showed no significant difference in treatment compliance（P>0.05）．The control rate of marginally elevated serum cholesterol differed significantly across all 4 groups（P<0.05）．More specifically，compared with the control group，other 3 groups showed a higher control rate of marginally elevated serum cholesterol（P<0.05）；acupoint acupressure with exercise group demonstrated a higher control rate of marginally elevated serum cholesterol compared with exercise group and acupoint acupressure group（P<0.05）．Conclusion　Both acupoint acupressure and exercise can effectively reduce the level of serum total cholesterol and lower-density lipoprotein in the elderly，and the intervention effect is even better if the two are used combinedly.The combined intervention is recommended for clinical application and promotion.


Oxidative Stress Level in Patients with Nonorganic Insomnia　

WANG Xinyuan，CHEN Qiang，PAN Yan，LI Ling，SHE Qin

2019, 22(1):  67-70.  DOI: 10.12114/j.issn.1007-9572.2019.01.014

Asbtract ( )   PDF (1111KB) ( )  

References | Related Articles | Metrics

Background　Studies show that cerebral free radicals accumulate during daytime wakefulness and are removed during sleep. The removal of excess free radicals during sleep is fulfilled by reducing the production of free radicals and increasing the efficiency of endogenous antioxidant mechanisms. However, the relationship between oxidative stress and insomnia is unclear yet.Objective　To examine the levels of free radicals and antioxidant enzymes in patients with nonorganic insomnia, and to evaluate whether they have a correlation with nonorganic insomnia.Methods　This study was implemented from January 2015 to March 2017，following a case-control design.From Sleep Disorders Department，Xinjiang Mental Health Center，78 inpatients and outpatients with nonorganic insomnia〔diagnosed in accordance with the corresponding criteria included in ICD-10，in combination with Pittsburgh Sleep Quality Index （PSQI） total score ≥7 〕 were invited，and other 76 healthy workers of this hospital were invited as the controls.The plasma levels of catalase （CAT），glutathione peroxidase （GSH-PX），malondialdehyde （MDA） and superoxide dismutase （SOD） were compared between the two groups.Results　There were no significant differences in the distribution of age and sex，prevalence of smoking and drinking between the two groups （P>0.05）．The nonorganic insomnia group had higher PSQI total score and factor scores than the control group （P<0.001）．The levels of CAT，GSH-PX，and SOD activity of the nonorganic insomnia group were lower than those of the control group（P<0.001），but the level of MDA activity was similar in both groups（P>0.05）.Conclusion　Nonorganic insomnia patients have increased oxidative stress level，suggesting that oxidative stress may be involved in the development of nonorganic insomnia.


Effect of Videotaped Role-play Simulation in Standardized Training of General Practitioners　

WANG Yayi，WANG Rongying，HE Zhenyin，WANG Yan，ZHANG Jinjia，LI Yukun，ZHAO Wenwen

2019, 22(1):  71-74.  DOI: 10.12114/j.issn.1007-9572.2019.01.015

Asbtract ( )   PDF (1819KB) ( )  

References | Related Articles | Metrics

Background　By the end of 2017，the number of general practitioners（GPs） working in China has reached 253 000，but it is far from meeting the target of 5 GPs for every 10 000 residents.The training for GPs started late in China，and its development is hindered by some factors such as the restriction of traditional methods and views of teaching.Objective　To explore the effect of videotaped role-play simulation，a teaching method，in standardized training of GPs.
Methods　We recruited 86 health workers with an experience of attending the standardized training for GPs from the Second Hospital of Hebei Medical University from March to September 2018.They were randomly divided into the observation group and control group according to the numeric code of the dormitories that they lived during the training period，with 43 in each，receiving training using the traditional teaching methods，and training using analyses of videotaped role-play simulation，respectively.When the training ended，the theories，practical skills and performance in simulated consultations of both groups were assessed and compared.Moreover，the level of self-rated interest in training method，and self-assessed benefits from the training were also compared between the two groups.Results　Compared with the control group，the observation group scored much better in terms of theories，practical skills and simulated consultations（P<0.05）.Furthermore，the self-evaluation results of the observation group were much superior to those of the control group in terms of interest in the teaching mode，learning achievement, and so on（P<0.05）.Conclusion　Videotaped role-play simulation used in standardized training for GPs can increase the learning initiative and enhance the comprehensive skills of the GPs，which is recommended for use in general practice teaching.



Effect of Training on Community Physicians' Awareness Level of Controllable Risk Factors in Secondary Prevention of Stroke：a Pre- and Post-training Comparative Study　

GAO Caihong，PEI Jianji，MA Lifang，MU Lichun，ZHU Qianqian，AN Qiang

2019, 22(1):  75-78.  DOI: 10.12114/j.issn.1007-9572.2019.01.016

Asbtract ( )   PDF (1084KB) ( )  

References | Related Articles | Metrics

Background　For stroke patients，secondary prevention is of great significance in preventing the incidence of vascular complications and recurrence of stroke.Community physicians play a major role in the prevention and treatment of stroke.Objective　To evaluate community physicians' pre-training and post-training awareness levels of the controllable risk factors in secondary prevention of stroke，and based on this，to assess the training effect.Methods　By use of simple random sampling，we selected 50 community physicians whose scope of practice is internal medicine or general practice from 12 community health centers in Mentougou District of Beijing from May 2017 to May 2018.They received a training about controllable risk factors in secondary prevention of stroke，including standardized secondary prevention and management of abnormal blood pressure，blood glucose and blood lipids，and atrial fibrillation，and the management of antiplatelet aggregation therapy.Before and after the training，the participants received an assessment of the awareness level of the related data，respectively，and the pre- and post-training qualified rates in each aspect were compared to evaluate the training effect.In terms of the aspects of knowledge that the participants still mastered unsatisfactorily after training（qualified rate <90.0%），Pareto analysis was used to explore the associated factors. Results　Before training，the percentage of participants with a qualified mastery of the knowledge about blood pressure management for stroke was 80.0%，but the percentages with a qualified mastery of the knowledge about blood glucose，blood lipids，atrial fibrillation，and antiplatelet aggregation therapy were all less than 80.0%.After training，the percentages of participants with a qualified mastery of the knowledge of the 5 aspects increased significantly compared with pre-training（P<0.05）.Except for the aspect of management of atrial fibrillation 〔pass rate was 70.0%（35/50）〕，the percentages of participants who had a qualified mastery of the knowledge of other 4 aspects reached the desired requirements 〔pass rate were 100.0%（50/50），92.0%（46/50），90.0%（45/50），96.0%（48/50）〕.Pareto analysis found that，the awareness level of anticoagulant drugs（40.0%，20/50），mastery of the indications of anticoagulation in atrial fibrillation（28.0%，14/50） and bleeding risk assessment of anticoagulant treatment for atrial fibrillation（18.0%，9/50） were factors associated with the unsatisfactory training effect of atrial fibrillation management.Conclusion　In general，the awareness level of controllable risk factors in secondary prevention of stroke is inadequate in community physicians.To be specific，they have a good mastery of the knowledge of blood pressure management，but have an unsatisfactory mastery of the knowledge of atrial fibrillation management.Corresponding standardized training can improve their awareness levels of such knowledge.


Physicians' Perceptions of the Policies Related to Multi-site Practice　

SONG Baoxiang，ZHU Chang'e，XIA Chenbin

2019, 22(1):  79-84.  DOI: 10.12114/j.issn.1007-9572.2019.01.017

Asbtract ( )   PDF (1081KB) ( )  

References | Related Articles | Metrics

Background　Physician multi-site practice is conducive to promoting the rational flow of high-quality doctor resources and alleviating the problem of "difficulty in seeing a doctor".However, the current registration of doctors is not very satisfactory. Objective　To explore the perceptions of multi-site practice policies among physicians from Jiangsu Province.Methods　From July to August 2017，this study was conducted in a convenience sample of physicians who met the criteria from 9 medical institutions purposively sampled from southern，central and northern Jiangsu（1 primary，1 secondary，and 1 tertiary medical institutions from each of these three regions）．They were surveyed with a self-designed questionnaire for collecting the data concerning demographic characteristics，and perceptions of multi-site practice（including the understanding level of multi-site practice policies，level of support for multi-site practice，intention to practice in multiple sites，opinions of the prospect of multi-site practice，possible benefits gained from practicing in multiple sites，concerns and misgivings of practicing in multiple sites，preferred patterns for practicing in multiple sites.Of the 204 questionnaires distributed，194 were returned，yielding a 95.1% response rate.Results　Of the 194 respondents，93.3%（181/194）were well/good/fair aware of multi-site practice policies；78.4%（152/194）approved of multi-site practice policies；70.1%（136/194）were willing to practice in multiple sites；47.4%（92/194）thought that multi-site practice was very promising；80.9%（157/194）hold that multi-site practice contributed to reach self-actualization；75.3%（146/194）considered that multi-site practice helped increase incomes；65.5%（127/194），62.4%（121/194），60.8%（118/194）showed particular concerns about payment，social esteem and working environment，respectively；62.4%（121/194）felt ill equipped to manage medical accidents and disputes brought by multi-site practice and 60.3%（117/194）worried that the environments in multiple sites would be too diversified to adapt；61.9%（120/194）preferred doctors studio，53.6%（104/194）preferred the institutions within a medical consortium（for providing needed services） and 47.9%（93/194）preferred a registered practice site when it comes to the patterns of multi-site practice.Among the respondents，the level of awareness of multi-site practice policies differed significantly by sex，professional and technical title，location area of the medical institution（P<0.05）；the level of support for multi-site practice varied obviously by professional and technical title，location area and level of the medical institution（P<0.05）；the intentions to practice in multiple sites changed substantially according to years of working，professional and technical title，and location area of the medical institution（P<0.05）；the views of the development prospect of multi-site practice diversified by sex，educational level，professional and technical title，and location area of the medical institution（P<0.05）．Conclusion　Most of the physicians understood multi-site practice policies，showed support for multi-site practice and intended to practice in multiple sites.However，they also demonstrated misgivings.The understanding level of multi-site practice policies diversified according to demographic factors.


Policies Related to Physician Multi-site Practice：Good But Difficult to Implement　

ZHU Chang'e，SHENG Mengfei，SONG Baoxiang

2019, 22(1):  85-90.  DOI: 10.12114/j.issn.1007-9572.2019.01.018

Asbtract ( )   PDF (1083KB) ( )  

References | Related Articles | Metrics

Background　Currently policies associated with physician multi-site practice are popular but difficult to implement，to explore further promote its causes and countermeasures contributes to the promotion of policies related to physician multi-site practice.Objective　To explore the reasons for policies associated with physician multi-site practice which are popular but difficult to implement，and propose targeted suggestions.Methods　We conducted this study in a convenience sample of physicians who met the criteria from 9 medical institutions purposively sampled from southern，central and northern Jiangsu（1 primary，1 secondary，and 1 tertiary medical institutions from each region） between July and August 2017.We surveyed these physicians with a self-designed questionnaire for obtaining the data concerning demographic characteristics，perceptions and attitude of multi-site practice（including the level of support for multi-site practice，employee turnover，the associated factors for employee turnove，attitude toward the cancellation of staffing，the hindrances for the implementation of multi-site practice policies，the problems possibly caused by multi-site practice，the parties responsible for medical malpractice occurred during multi-site practice）.Of the 204 questionnaires administered，194 of them were responsive，achieving a 95.1% response rate.Results　Of the 194 respondents，78.4%（152/194） approved practicing in multiple sites；15.5%（30/194） held that employee turnover rate at their own institution was high/very high；80.4%（156/194） thought that payment，69.1%（134/194） thought that personal career development and 63.4%（123/194） thought that working environment were associated factors for employee turnover；76.8%（149/194） considered that staffing management hindered employee turnover；40.7%（79/194） approved/strongly approved cancellation of staffing；71.6%（139/194） thought that multi-site practice was impeded by the regulations of their own hospital；69.1%（134/194），4.4%（125/194），5.2%（107/194）thought that the problems possibly caused by multi-site practice were distraction of physicianso time and energy，unclear responsible parties for healthcare risks，increased workload，respectively；61.3%（119/194） considered that their primary and secondary practice sites should be co-responsible for the medical disputes occurred during practicing in multiple sites.Conclusion　A majority of physicians in Jiangsu Province are in support of multi-site practice but only a minority of them have registered for multi-site practice，which may be caused by staffing management，hindrances from the first practice hospital and unclear parties liable for medical malpractice occurred during practicing in multiple sites and so on.Therefore，targeted interventions for specific problems should be taken to promote the implementation of multi-site practice policies.


Hospital Managers' Perspectives on the Problems and Countermeasures in Multiple-site Physician Practices：a Qualitative Study Based on Grounded Theory

HUANG Huihua，YU Changyin，ZHANG Nian，WEI Lai，FENG Yi

2019, 22(1):  91-96.  DOI: 10.12114/j.issn.1007-9572.2019.01.019

Asbtract ( )   PDF (1016KB) ( )  

References | Related Articles | Metrics

Background　The implementation of multiple-site physician practices is an important measure to promote the allocation of high-quality medical resources to primary care.As hospital managers are a key factor associated with multiple-site physician practices，their perspectives on problems and countermeasures in multiple-site physician practices are contributive to the promotion of such practices.Objective　To discuss the problems and countermeasures in multiple-site physician practices in Guizhou Province from hospital managers' perspectives using grounded theory and NVivo 11.0 qualitative data analysis software.Methods　This study was conducted from January to November in 2017.Useing purposeful and theoretical sampling，78 managers were recrited from 53 medical institutions in 9 cities/prefectures，Guizhou Provinces.Data were obtained by using a semi-structured interview approach.Problems concerning multiple-site physician practices were intensively studied with open coding，axial coding and selective coding.Results　After three stages of coding，1 373 free nodes，102 tree nodes，10 categories and 5 main categories and 3 core categories were determined.The three core categories include development prospects，limiting factors，practice conditions.Then a story line was formed as follows：the hospital managers assumed that the implementation of multiple-site physician practices has advantages and disadvantages，and its development shows an upward trend although there are many hinderances.Physician understaking multiple-site practices should be alternately dispatched or should be practiced in the member institutions of a regional medical consortium，and the profits obtained from multiple-site practices should be shared by the physician，the hospital and department where he works，but the managers did not reach a consensus regarding the responsible parties which should be liable for medical malpractice.Conclusion　The hospital managers supported physicians undertaking multi-site practice，under the prerequisite that the rights and interests of the primary practice site should not be impaired，and that the allocation of benefits as well as medical damage liability of multi-site practices are determined reasonably.


Motivational Interviewing for Smoking Cessation in Community Health Service Centers：a Single Center Randomized Controlled Trial　

ZHANG Zhenhan，HUANG Yafang，LIU Tao，GUO Aimin

2019, 22(1):  97-100.  DOI: 10.12114/j.issn.1007-9572.2019.01.020

Asbtract ( )   PDF (1036KB) ( )  

References | Related Articles | Metrics

Background　Smoking is a major risk factor for many chronic diseases. Motivational interviewing（MI）is a technique with solid theoretical basis and ease to operate.Objective　To evaluate the effectiveness of MI for smoking cessation in community health service centers.Methods　All subjects in this study were smoking patients from Balizhuang Community Health Service Center in Chaoyang District in Beijing. Blocked randomization was used.Totally 210 smoking patients were allocated into either intervention group or control group followed allocation concealment rules.All subjects were included from July 2016 to October 2016.We followed the Chinese Clinical Smoking Cessation Guideline（version 2015） to provide brief smoking cessation intervention in the control group. MI was used in the intervention group and was given by family physicians. The follow-up period was 3 and 6 month respectively. The outcomes include smoking prevalence abstinence，CO-oximetry value and nicotine dependency level.Results　 The baseline characteristics showed that there was no significant difference between the intervention group and control group with regard to gender，age，level of education，marriage，prevalence of chronic disease，years of smoking，knowledge of smoking ban in Beijing，CO-oximetry value and scores of Fagerstrom Test of Nicotine Dependence（FTND）（P>0.05）. Results from intention to treat analyses（ITT） showed that compared with control group，CO-oximetry value and FTND scores decreased significantly in the intervention group at the 3 and 6 month follow-up respectively（P<0.05）. Compared with control group，the 3 and 6 month smoking prevalence abstinence did not decreased significantly in the intervention group（P>0.05）. Results from per protocol set（PPS） showed that compared with control group，FTND scores decreased significantly in the intervention group at the 3 month follow-up（P<0.05）. Compared with control group，neither the smoking prevalence abstinence nor the CO-oximetry value decreased significantly in the intervention group at the 3 month follow-up（P>0.05）. Compared with control group, CO-oximetry value and FTND scores decreased significantly in the intervention group at the 6 month follow-up（P<0.05）. Compared with control group，the 6 month smoking prevalence abstinence did not decrease significantly in the intervention group（P>0.05）.Conclusion　Compared with brief smoking cessation intervention，MI is very likely to decrease the exhaled CO-oximetry value and nicotine dependence level for smokers，but may fail to decrease smoking cessation rate.


Effect of Long-term Use of Jiangyabao Series of Chinese Patent Medicines on the Outcome of Hypertension：a Cohort Study　

CUI Weifeng，FAN Xiaohui，WANG Shoufu，FAN Junxing，WU Kewen，DENG Songtao，FAN Junming

2019, 22(1):  101-105.  DOI: 10.12114/j.issn.1007-9572.2019.01.021

Asbtract ( )   PDF (1010KB) ( )  

References | Related Articles | Metrics

Background　There is a close causal relationship between hypertension and the risk of cardiovascular disease morbidity and mortality. Jiangyabao series of Chinese patent medicines （a sort of hypotensors） have good effects on essential hypertension. Objective　To evaluate the effect of long-term administration of Jiangyabao series of Chinese patent medicines on the outcome of patients with hypertension. Methods　This study was carried out from 2001 to 2003 based on a cohort design. The 1 364 participants with essential hypertension were recruited from Henan Hypertension Management Center of Integrated Traditional Chinese and Western Medicine. All of them received standardized secondary prevention interventions for hypertension and oral administration of Jiangyabao series of Chinese patent medicines. In accordance with the duration of voluntary administration，they were assigned to short-term medication group （n=236，≤42 months），long-term medication group （n=1 128，>42 months），respectively. Data of age，family history of early onset of hypertension，duration of hypertension，stage of hypertension，use of western antihypertensive drugs，smoking history，drinking history，education level，amount of exercise and sleeping status were collected. All of them were followed up for 42 months，during which the incidence of adverse outcomes （death caused by cardiovascular and cerebrovascular diseases，myocardial infarction，cerebral infarction，cerebral hemorrhage） was recorded. Cox proportional hazards regression analysis was used to analyze the effect of long-term administration of Jiangyabao series of Chinese patent medicines on the outcome. Results　The incidence of adverse outcomes in new included participants during the whole study period was 15.90%（217/1 364），and 22.22%（80/360），13.06%（64/490） and 14.20%（73/514） in 2001，2002 and 2003. By the end of the experiment，the incidence of adverse outcomes in the long-term medication group was lower than that in the short-term medication group 〔10.17%（24/236）vs 17.11%（193/1 128），χ2=7.03，P=0.008〕．Analyses with different Cox proportional risk regression models showed that the incidence of adverse outcomes in short-term medication group was higher than that of the long-term medication group （HR>1.00，P<0.05）．Conclusion　Long-term administration of Jiangyabao series of Chinese patent medicines can significantly reduce the incidence of adverse outcomes in patients with hypertension.


Pareto Analysis of the Needs of Community-based Diabetes Care in Community-dwelling Residents with Diabetes or Prediabetes and Suggested Countermeasures　

YOU Jianhua，QIU Hanyan，ZHUANG Rujie

2019, 22(1):  106-111.  DOI: 10.12114/j.issn.1007-9572.2019.01.022

Asbtract ( )   PDF (1035KB) ( )  

References | Related Articles | Metrics

Background　Diabetes is a chronic non-communicable disease whose global prevalence is relatively high. Community-based diabetes care, a part of the national diabetes care system, plays an important role in the implementation of diabetes care. The needs of community-based diabetes care vary from person to person.Objective　To investigate the needs characteristics of community-based diabetes care in community-dwelling residents with diabetes or prediabetes based on the Pareto principle. Methods　From October 2017 to January 2018，a questionnaire survey was conducted among diabetic patients or individuals at high risk of diabetes in the service area of Hongkou District Jiaxing Road Community Health Center，Shanghai. The major contents of survey included was the eeds for community-based diabetes care，including 4 categories （data collection，health education，individual intervention and quality control） covering 58 items. The service items were classified according to the level of demand and the level of active demand. And the primary，secondary and general service items that the patients needed were analyzed by Pareto diagram. Results　A total of 318 patients participated in the survey. All of them completed the questionnaire effectively，achieving a response rate of 100.0%. Pareto classification of demand level showed that the primary and secondary demand items accounted for 86.2% of the total，contributing 87.1% of the cumulative constituent ratios；Pareto classification of active demand level showed that the primary and secondary demand items accounted for 58.6% of the total，contributing 89.3% of the cumulative constituent ratios. The main needs of the participants included data collection，items of "blood glucose monitoring" and "medication intervention" belonging to individual intervention，and the item of "health education content" belonging to health education. Conclusion　The patients with diabetes or prediabetes showed no significant difference in the level of demand for the service items included by community-based diabetes care，but demonstrated significant difference in the level of active demand for some service items. In view of this，community healthcare institutions should improve their capabilities to provide community-based diabetes care to satisfy multiple needs of patients with diabetes or prediabtes as much as possible. Moreover，they should publicize and popularize the preferred services of such patients，which can also contribute to the development of other services.


Primary Diagnosis and Treatment of Patients with Type 2 Diabetes Mellitus in General Practice　

GAO Fengjuan，MA Pengtao，ZUO Qingyao

2019, 22(1):  112-116.  DOI: 10.12114/j.issn.1007-9572.2019.01.023

Asbtract ( )   PDF (1004KB) ( )  

References | Related Articles | Metrics

Type 2 diabetes is one of the major diseases managed by general practitioners （GPs），and poor glycemic control in patients is a great challenge for GPs，requiring them to continue learning and improving their competency.A series of relevant guidelines have been issued，but it is not uncommon for general practitioners to have different opinions on them. In practice，diagnosis，prescription，and non-drug treatment of diabetes，and health records writing（SOAP）are not standardized among general practitioners. This article reports a primary treatment process of a patient with type 2 diabetes in the community health service center. Combined with relevant guidelines and literatures，this article provides reference of diabetes intervention in communities for GPs in the "5 +3" resident standardized training.



Clinical Pathway of Medically Unexplained Physical Symptoms in Primary Care：Low Back Pain　

ZHU Xiaodan，LI Yanhua，LI Junwei

2019, 22(1):  117-122.  DOI: 10.12114/j.issn.1007-9572.2019.01.024

Asbtract ( )   PDF (1055KB) ( )  

References | Related Articles | Metrics

medically unexplained physical symptoms（MUPS） are physical symptoms which cannot be explained well or in the early stage of a certain disease. Low back pain is a common MUPS with characteristics of high prevalence，high recurrence rate and high medical expenditure，linking to many diseases. Moreover，it can seriously affect people's quality of life and bring about great burdens on families and society. We did a review of the articles，clinical guidelines and expert consensuses regarding low back pain that were searched from databases of CNKI，WANFANG DATA，PubMed，and Web of Science. And based on this，we detailed the types，diagnosis and management of low back pain from a general practitioner's perspective，and developed a clinical pathway for low back pain suitable for GPs using an experimental approach，aiming to provide a clear thought process of low back pain management for GPs，optimize the procedure of low back pain management，and contributing to the achievement of hierarchical diagnosis and treatment and bidirectional referrals.