Chinese General Practice

The Challenges and Responsibilities of Family Doctors in the New Global Coronavirus Outbreak　

LI Guodong

2020, 23(7): 761-762. DOI: 10.12114/j.issn.1007-9572.2020.00.247

Asbtract ( )

PDF (1310KB) ( )

Related Articles | Metrics

A new coronavirus has begun to spread in Wuhan since December 2019.Primary medical and health institutions are the net bottom of the health service system，which plays an important fundamental role in community prevention and control of the new coronavirus epidemic and in advancing the threshold.It is also a critical moment that the roles and responsibilities of family doctors are assessed and recognised.We invited the President of WONCA Dr. Donald Li to explain the challenges and responsibilities of family doctors and primary medical teams in the face of this global crisis.It includes family doctors as "gatekeepers" in the fight against outbreaks and coordinators of primary care teams，improving their capabilities in an all-round way and actively carrying out business innovation etc.

Guidance on the Control and Prevention of SARS-CoV-2 Infection in Primary Healthcare Settings in Rural China（First Edition）　

ZHANG Dongying，YAO Mi，WANG Jiaji，YE Dan，CHEN Qingqi，GUO Fagang，ZOU Chuan，LIN Kai，LU Hui，HUANG Xiang，ZHENG Jinping，CHI Chunhua，ZHONG Nanshan

2020, 23(7): 763-769. DOI: 10.12114/j.issn.1007-9572.2020.00.246

Asbtract ( )

PDF (1296KB) ( )

References | Related Articles | Metrics

CHI Chunhua，Professor，Chief physician，Doctoral supervisor；E-mail：chichunhua2012@qq.com
Since the outbreak of the COVID-19，all regions of China have carried out prompt responsive actions in an active way to control and prevent the disease，among which rural areas face particularly severe challenges，because they are the weak link in the control and prevention of public health emergencies due to shortage of health resources and poor diagnostic and therapeutic level.According to characteristics and the actual situation of the current rural primary healthcare settings，this guidedance introduced the requirements of setting environmental space for epidemic prevention and control，the process of referral，home observation，persons with special health care，health education for villagers，personal protection for health staff，and nosocomial infection control．It would provide a standardized and safe way for primary healthcare settings in rural areas in the epidemic prevention and control．

Expert Advice on Hypertension Management in Counties in the Context of SARS-CoV-2 Infection　

Hypertension Group，Professional Committee for Chronic Disease

2020, 23(7): 770-773. DOI: 10.12114/j.issn.1007-9572.2020.00.303

Asbtract ( )

PDF (1276KB) ( )

References | Related Articles | Metrics

At present，epidemics of Corona Virus Disease 2019(COVID-19) have occurred in Wuhan，provinces across China，and overseas countries.Aiming at the large group of patients with hypertension in China，especially those distributed at the grassroots level，expert advice on hypertension management in the context of COVID-19 is proposed.This guidance is limited to patients with hypertension who do not have the SARS-CoV-2 infection.

Integrated Care Model for Screening and Multidisciplinary Collaboration of Community Patients with Atrial Fibrillation　

LIU Yanli，MA Li

2020, 23(7): 774-778. DOI: 10.12114/j.issn.1007-9572.2020.00.189

Asbtract ( )

PDF (1019KB) ( )

References | Related Articles | Metrics

With the aging of the population，atrial fibrillation（AF） has become a major public health problem in China and worldwide.AF is an important risk factor for stroke，cardiovascular disease and embolism，which seriously threatens patient's health and quality of life.Studies abroad have shown that a multidisciplinary，nurse-led，patient-centered integrated care model can help reduce the readmission rate，incidence of cardiovascular events，and all-cause mortality of AF patients，as well as improve their satisfaction and quality of life.At present，there are many problems in the AF management in China，and a standardized integrated care model has not yet been formed.Based on domestic and foreign AF management guidelines and related literature，this paper reviewed the process of integrated care model for AF，including its screening，comprehensive evaluation，management strategy development，health education，regular follow-up and referrals，and specific content of each process.The process of AF screening and integrated care model suitable for the community in China were formulated preliminarily in this paper，which could provide a reference for the establishment of a AF standardized management system in the community.

Theory and Implementation of General-specialty Hierarchical Management Mode for Chronic Heart Failure　

DAI Huimin，BU Jun，ZHANG Fang，ZHU Min，TANG Lan

2020, 23(7): 779-783. DOI: 10.12114/j.issn.1007-9572.2019.00.591

Asbtract ( )

PDF (1031KB) ( )

References | Related Articles | Metrics

Based on the "1+1+1" hierarchical contractual service delivery mode implemented in Shanghai，Weifang Community Health Service Center（WCHSC） and Renji Hospital，Shanghai Jiaotong University School of Medicine（RHSJUSM） co-developed a general-specialty hierarchical management mode for chronic heart failure（CHF）．This mode of care is co-delivered by both WCHSC（offering primary care） and RHSJUSM（offering specialty care） in Renji-Weifang CHF Studio in WCHSC，using the co-developed CHF hierarchical diagnostic and treatment criteria（based on NYHA functional class，body weight changes，and BNP or NT-proBNP），and referral procedure，under the conditions of sharing drugs，as well as laboratory test results for CHF.We detailedly introduced both the theory and implementation of general-specialty hierarchical management mode for CHF，and put forward that，using this mode is contributive to the appropriate allocation of high-quality medical resources to primary healthcare institutions，to the improvement of GPs' diagnostic and therapeutic ability，and to the identification of the severity of disease in a more simple and effective way.Moreover，during the management，with the help of the full-time assistant in monitoring weight and consecutive self-management，the self-management compliance of patients can be improved.This mode is helpful to form a hierarchical diagnosis and treatment model characterized by separate treatment of acute and chronic diseases，and cooperation between higher- and lower-level healthcare institutions.

Effect of the Regional Cooperative Treatment System on the Treatment Efficiency and Short-term Prognosis of Patients with Acute ST-segment Elevation Myocardial Infarction　

CAO Mengzhu，QIAO Zengyong

2020, 23(7): 784-788. DOI: 10.12114/j.issn.1007-9572.2019.00.784

Asbtract ( )

PDF (1067KB) ( )

References | Related Articles | Metrics

Background　Delayed treatment of acute ST-segment elevation myocardial infarction（STEMI） usually leads to prolonged total ischemia time and increased mortality.Regional cooperative rapid treatment system can shorten the treatment time of acute myocardial infarction and reduce the occurrence of adverse cardiovascular events.Objective　To explore the effect of the regional cooperative treatment system on the treatment efficiency and short-term prognosis of patients with acute STEMI.Methods　This study relied on the treatment data of patients with acute STEMI before and after the operation of the regional cooperative treatment system with the South Campus of the Sixth People's Hospital，Shanghai Jiao Tong University as the treatment center，and the treatment data were retrospectively analyzed.Patients who received emergency PCI therapy for acute STEMI were selected as the control group from April 2017 to March 2018（n=84），and the patients with acute STEMI from April 2018 to March 2019 were selected as the experimental group（n=122）.Patient's clinical data，from onset to the first medical contact（S-FMC） time，from first medical contact to balloon dilatation（FMC2B） time，from onset to balloon dilatation（S2B） time，from entering hospital door to balloon dilatation（D2B） time，standard-reaching rate of FMC2B time，standard-reaching rate of D2B time，whether combined with adverse cardiovascular events rate were collected and compared.Results　There was no significant difference in gender，age，history of coronary heart disease，history of previous PCI，history of cerebral infarction，history of angina pectoris before infarction，history of hypertension，history of diabetes，history of smoking，BNP，blood lipid index and distribution of criminal vessels between the two groups（P>0.05）.S-FMC and FMC2B were positively correlated with S2B〔rs =0.947，95%CI（0.924，0.963），P<0.001；rs=0.496，95%CI（0.381，0.591），P<0.001〕.S-FMC，FMC2B and D2B were positively correlated with S2B in self-admission group and calling ambulance group（P<0.05），while only S-FMC and FMC2B were positively correlated with S2B in non-PCI hospital referrals（P<0.05）.The time of S-FMC，FMC2B，S2B and D2B in the experimental group were shorter than those in the control group，while the proportion of ECG transmission through WeChat was higher，and the rates of adverse cardiovascular events were lower（P<0.05）.Conclusion　The regional cooperative treatment system can shorten the treatment time of acute myocardial infarction，improve the treatment efficiency，and reduce the occurrence of adverse cardiovascular events，which should be vigorously promoted.

Problems Affecting Contracted Family Doctor Services and Their Severity Based on Literature Analysis　

CHEN Haoyang，LI Xiangyi，YAN Ruyu，CAO Zhihui

2020, 23(7): 789-794. DOI: 10.12114/j.issn.1007-9572.2020.00.080

Asbtract ( )

PDF (1052KB) ( )

References | Related Articles | Metrics

Background　The contracted family doctor service is a major measure to deepen the reform of the medical and health system and improve people's sense of gain when seeking medical attention.However，there are still many problems in the development of contracted family doctor services in China.Through the introduction of bibliometrics theory to study related problems，identifying problems that need to be resolved first will make it easier for the government to determine the main direction of governance and further promote the development of contracted family doctor services.Objective　On the basis of literature analysis，to clarify the list of problems affecting contracted family doctor services in China，reveal the main problems，and identify the severity of the problems.Methods　Literature related to remaining problems of the contracted family doctor services was retrieved from CNKI database，Wanfang Data Knowledge Service Platform，and CQVIP database in April 2019.The publication time of literature was limited to 2009—2018.Basic information about the included literature and relevant statements of problems affecting contracted family doctor services were collected.The list of problems were summarized and analyzed based on the macro model of health system.Selecting the geographical areas of the problems，the levels of authors' affiliations and fields the problems involving in as indicators to measure the severity of the problems.The cluster analysis method was used to classify the problems into three categories，severe problems，general problems，and not serious problems.Results　A total of 222 qualified documents were analyzed and 22 categories of problems affecting contracted family doctor service were identified.There were three severe problems，and all of them were structural problems，the lack of professional talents in the family doctor team，relatively low professional level，education level，and poor service skills of family doctors，unclear understanding and distrust of residents with contracted family doctor services and family doctor's service ability.Conclusion　This study has drawn a ranking of problems affecting contracted family doctor services and identified the severe problems.The main direction of the government's next step is to increase the number of family doctors，improve their professional quality and pay more attention to individual attitudes of residents towards contracted family doctor services.

Medical Insurance Payment Reform of Chongqing Medical Consortium　

LIU Lei，FU Xiao，HU Yueyi，ZHANG Bin

2020, 23(7): 795-798. DOI: 10.12114/j.issn.1007-9572.2019.00.278

Asbtract ( )

PDF (1002KB) ( )

References | Related Articles | Metrics

Medical consortium is an important part of medical reform，and medical insurance payment reform is a major endogenous driving force of medical consortium reform.But the development of the two is not well coordinated，resulting in decreased effect of health insurance programs in promoting initial consultation in primary care，and lack of dynamic cooperation mechanism between the institutions within a medical consortium.Analysis the status of medical consortiums，and the medical insurance payment modes in Chongqing.Points out the existing problems of medical insurance payment in Chongqing medical association，puts forward the reform strategy of medical insurance payment suitable for Chongqing medical association，and provides policy suggestions for the improvement of medical association.The interview results showed that Chongqing has established three modes of medical consortiums（trustee model，branch mode and county technical assistance mode），pooled health insurance funds from the municipal government agencies successfully，established mixed medical insurance payment modes，and reduced the threshold for using medical insurance payment for those transfered treatment.However，many problems are needed to be solved，such as medical insurance funds can not be mobilized from the institution with a surplus to that with a deficit within the medical consortium，lack of linkage between the medical consortium and medical insurance payment，the imperfect payment mode of medical insurance，and lack of corresponding performance appraisal methods.In view of this，we put forward the following suggestions：building a compact type of medical consortium，allowing the appropriate mobilization of the medical insurance funds from an institution with a surplus to that with a deficit within the medical consortium，improving the healthcare quality and performance appraisal system and incentive and restraint mechanisms for healthcare providers，formulating relevant medical insurance policies if needed，rationally determining the total budget for medical insurance programs，and improving the payment modes of medical insurance.All these contribute to the exploration of new modes of medical insurance payment reform，and of policy recommendations for the development of medical consortium at the national level.

Cognition of Hierarchical Medical System among Residents and Its Influencing Factors in Henan Province　

CHEN Zhengxu，MENG Lingchao，YUAN Liufei，CHANG Zhu，ZHANG Wang，LIANG Shimin，TIAN Yuhui

2020, 23(7): 799-802. DOI: 10.12114/j.issn.1007-9572.2019.00.620

Asbtract ( )

PDF (1027KB) ( )

References | Related Articles | Metrics

Background　The deployment of hierarchical diagnosis and treatment policy has been comprehensively promoted by Henan provincial government.The level that hierarchical diagnosis and treatment policy implemented will directly determine the effect of the new healthcare reform.Precise understanding of the current status of residents' cognition of hierarchical medical system will be helpful in the promotion of the policy.Objective　To have a great understanding on the cognition level of residents for hierarchical medical system and to further explore its influencing factors in Henan Province.Methods According to researchers' family location，residents who were 16 years old or older with good communication levels and were willing to cooperate with the survey were selected as the respondents in 14 prefecture-level cities from Henan Province using convenient sampling method.A self-designed questionnaire was used to conduct the survey from November 2017 to March 2018.The main contents of the questionnaire were basic information of residents，residents' cognition to hierarchical medical system，suggestions on the implementation of the hierarchical medical system，and access to medical policy information.A total of 1 200 questionnaires were distributed and 1 137 valid questionnaires were returned with an effective recovery rate of 94.75%.Results　As for the hierarchical medical system，among 1 137 valid questionnaires，41（3.61%）residents chose "strong understanding"；141（12.40%）residents chose "clear understanding"；181（15.92%）residents chose "understanding"；542（47.67%）residents chose "little understanding"；232 （20.40%） residents chose "never heard of".The difference in the orthogonal comparison of diverse educational levels，types of registered permanent residence，and health care types among residents with different cognition levels of hierarchical medical system was statistically significant（P<0.05）．The results of binary Logistic regression analysis showed that the educational level and health care type were relevant factors affecting residents' cognition of hierarchical medical system（P<0.05）．The main ways for residents to gain medical policy information were broadcasting and television （59.19%，673/1 137）．Conclusion　Residents in Henan Province have insufficient understanding of the hierarchical medical system.It is proposed to further reinforce the promotion of hierarchical medical system and carry out personalized propaganda for residents in different situations ，so as to achieve the maximum publicity effect．

Number and Disease Profile of Patients Discharged from Community Health Centers in Shanghai's Rural-urban Fringe　

RU Xueying，PAN Zhigang，WANG Tianhao，GAO Junling

2020, 23(7): 803-807. DOI: 10.12114/j.issn.1007-9572.2019.00.609

Asbtract ( )

PDF (1034KB) ( )

References | Related Articles | Metrics

Background　Most of the community health centers（CHCs） in Shanghai have retained the system of hospital wards，which alleviates the problem of poor access to inpatient services to a considerable extent.However，how to deal with the patients having a long duration of hospitalization，and to improve the imbalance between insufficient inpatient services and residents' needs of inpatient services，have become the challenges faced by CHCs.Objective　To survey the number and disease profile of patients discharged from CHCs in Shanghai's rural-urban fringe.Methods　Data of 25 CHCs in Shanghai's Jiading District and Minhang District were collected in January 2017，including the number of doctors，number of serving people，and use of beds in 2016 obtained via a survey with these CHCs using a self-developed "Community Health Center Information Questionnaire"，and the diagnosis and hospitalization information of patients discharged in 2016 obtained via the health information management system.In the end，the data of 22 institutions was eligible and included.Results　In 2016，the 22 CHCs had 11 839 discharges in total.The bed rotation rate and occupancy rate were 3.86 and 85.96%，respectively.The average age of the discharged patients was（82.3±4.6） years old.The numbers of GPs and beds were associated with the number of discharges（P<0.05）.66.31%（7 851/11 839） of the discharged patients had at least 2 diagnoses.The top 3 principal diagnoses among these patients were cerebral infarction（n=1 117，9.43%），hypertension（n=698，5.90%） and coronary heart disease（n=661，5.58%）.Conclusion　In these CHCs，the majority of inpatients are old people，mostly have cardiovascular or cerebrovascular diseases，with a high prevalence of multimorbidity.The number of beds and GPs may influence the discharges.

Effect of Smoking on the Risk of Acute Pancreatitis: a Prospective Cohort Study　

SUN Qiu，ZHU Guoling，ZHANG Bing，JI Ruigeng，ZHAO Li，LI Guangjian，REN Qingshuai，MA Yihan，WU Shouling

2020, 23(7): 808-812. DOI: 10.12114/j.issn.1007-9572.2019.00.698

Asbtract ( )

PDF (1084KB) ( )

References | Related Articles | Metrics

Background　Current studies have shown that smoking is a risk factor not only for the chronic pancreatitis but also for the pancreatic cancer.However，there is still no research on the impact of smoking on the risk of acute pancreatitis（AP）.Objective　To explore the impact of smoking on the risk of AP.Methods　The prospective cohort research method was adopted in this paper.The on-the-job and retired Kailuan Group employees going through the 2006—2007 annual health check-ups with no AP history but complete smoking information were selected as the observational cohort.A total of 98 287 cases were included in the analysis finally.The study population was divided into the smoking group（n=39 635） and non-smoking group（n=58 652）.The incidence of AP was compared between the two groups.The survival curves were created using the Kaplan-Meier method to calculate the cumulative incidence which was verified through the Log-Rank method.Furthermore，a multivariate analysis was done by Cox proportional hazard regression model about the impact of smoking on new-onset AP events.Results　During the mean follow-up period of（9.7±1.4） years，a total of 158 AP cases occurred.The AP incidence density of the total population stood at 1.56/10 000 persons-year.The AP incidence for the smoking and non-smoking groups were 1.98/10 000 persons-year and 1.45/10 000 persons-year，respectively.As verified by the Log-Rank method，the cumulative incidence of the smoking group was higher than that of the non-smoking group〔0.19%（76/39 635） vs. 0.14%（82/58 652），P<0.05〕］．The Cox proportional hazard regression model showed that the onset risk of AP in the smoking group was 1.82 times higher than that in the non-smoking group〔95%CI（1.39，2.38）〕.After adjusting the indicators（gender，age，systolic pressure，waist circumference，hip circumference，total cholesterol，triglyceride，high-density lipoprotein cholesterol，uric acid，creatinine，alcohol consumption，physical exercise，and history of hypertension） with statistical differences between the two groups at baseline，the onset risk of AP in the smoking group was 1.58 times higher than that in the non-smoking group〔95%CI（1.05，2.38）〕.Conclusion　Smoking is a key risk factor for AP.Early smoking cessation is recommended as the part of the clinical treatment of AP patients.

Comparison of the Value of Anthropometric Indicators and Triglycerides Glucose Index in the Diagnosis of Metabolic Syndrome　

CHEN Haijing，XIN Zhong，WANG Xuhong，YU Caiguo

2020, 23(7): 813-818. DOI: 10.12114/j.issn.1007-9572.2019.00.789

Asbtract ( )

PDF (1117KB) ( )

References | Related Articles | Metrics

Background　Metabolic syndrome（MS） is significantly associated with chronic diseases such as coronary heart disease and diabetes with an increasing prevalence year by year.However，the diagnostic criteria of MS are not uniform and the diagnostic conditions are complicated currently difficult for grassroots medical staff to operate.Objective　To compare the difference between the correlation of anthropometric indicators〔waist-to-height ratio（WHtR），waist-hip ratio（WHR），waist circumference（WC），and body mass index（BMI）〕，triglycerides glucose（TyG）index，triglyceride glucose-body mass index（TyG-BMI），and triglyceride glucose-waist circumference（TyG-WC） and MS，and its value in the diagnosis of MS in Chinese population，in order to determine the simple screening indicators of MS.Methods　The study was carried out with the participation of 2 972 adults who took the regular health check from Maizidian Village in Tongzhou District of Beijing.The questionnaire survey，physical examination，and blood examination were conducted to get their WHtR，WHR，BMI，TyG index，TyG-BMI and TyG-WC.MS patients were identified according to diagnostic criteria set by Chinese Diabetes Society（CDS）.SPSS 18.0 software was used to draw the ROC curves of the above indicators and calculate the AUC.The comparisons of AUCs were performed by MedCalc 16.8 software.Results　There was no significant difference in the prevalence of MS between different genders〔206/1 044 vs. 368/1 928，P>0.05〕.WHtR，WHR，WC，BMI，TyG index，TyG-BMI and TyG-WC were higher in patients with MS than those without（P<0.05）.The AUCs of BMI，WHtR，WHR and WC for male patients with MS were 0.81，0.77，0.68 and 0.77，and those for female patients with MS were 0.78，0.76，0.66 and 0.76.Comparing with WHtR，WHR and WC，the difference of AUC of BMI in diagnosing male and female patients with MS was higher（P<0.05）.The cut-off point of BMI for MS diagnosis was 25.00 kg/m2 for males and 25.30 kg/m2 for females.The AUCs of TyG index，TyG-BMI and TyG-WC in diagnosing male patients with MS were 0.88，0.89 and 0.88，and those for female patients with MS were 0.88，0.88 and 0.87.There was no significant difference in AUCs of TyG index and other two indexes in diagnosing MS（P>0.05）.The cut-off point of TyG index for MS diagnosis was 8.87 for males and 8.80 for females.The AUC of TyG index in male and female MS was higher than BMI（P<0.05）.Conclusion　Anthropometric indicators and TyG index and its related indicators are significantly associated with MS.BMI has a better correlation with MS than other anthropometric indicators which can be used to screen large-scale population for MS preliminarily.TyG index is better than BMI in the diagnosis of MS which can be used as a simple indicator for primary medical staff to identify risks of MS.

Incorrect Use of DPI and Associated Factors among Stable COPD Patients　

HE Shengdong，YANG Shudong，HE Xinbing，LUO Jinwei，HUANG Zhijian

2020, 23(7): 819-823. DOI: 10.12114/j.issn.1007-9572.2019.00.705

Asbtract ( )

PDF (1068KB) ( )

References | Related Articles | Metrics

Background　Chronic obstructive pulmonary disease（COPD） is a leading cause of mortality and disability worldwide.Inhaled medication is the mainstay of COPD management，but inhaler mishandling remains common and is associated with reduced disease control.To date，few studies have investigated factors affecting incorrect use of dry powder inhalers（DPIs） in patients with COPD.Objective　To investigate the prevalence of incorrect use of DPIs and associated factors in stable COPD outpatients，putting forward targeted intervention strategies.Methods　From March to August 2018，91 adult outpatients with stable COPD form Cardiopulmonology Department，Xianhu Hospital，the First Affiliated Hospital of Guangxi University of Chinese Medicine were included.Incorrect use of DPIs among them were analyzed，and possible risk factors were explored by Logistic analysis.Results　The overall prevalence of incorrect use of DPIs was 42.9%（39/91）.The three most common types of incorrect use were inadequate inhalation（41.8%，38/91），inadequate exhalation before inhalation（34.1%，31/91），and too short breath-holding duration（28.6%，26/91）.The prevalence of incorrect preparation in patients with budesonide and formoterol inhalation was lower than that of those with salmeterol/fluticasone inhalation or tiotropium bromide inhalation（P<0.017）.However，these three groups showed no significant difference in the prevalence of errors made in each operation during the inhalation and in mouth washing after inhalation（P>0.05）.Binary Logistic analysis showed that education level，prevalence of smoking，and the time spent using the DPI were associated with incorrect use of DPIs（P<0.05）.Conclusion　Low education level，smoking and short time spent using the DPI are associated with increased risk of incorrect use of DPIs.To reduce such errors，targeted health education for the patients should be intensified.

Meridian-sinew Theory-based Treatment for Cervical Tinnitus with Blade Needle Therapy：a Randomized Controlled Trial　

LIANG Weili，LI Wenchun，PAN Qingdong，ZENG Wenbi，HE Caihui

2020, 23(7): 823-827. DOI: 10.12114/j.issn.1007-9572.2019.00.337

Asbtract ( )

PDF (1067KB) ( )

References | Related Articles | Metrics

Background　Cervical tinnitus is a disease that demands professional rehabilitation treatment as well as otolaryngological treatment，which is easy to be neglected or misdiagnosed as nervous tinnitus clinically.Therefore，it is of great practical significance to develop an effective treatment method for cervical tinnitus.Acupuncture-moxibustion is a treatment commonly used for cervical tinnitus，but studies about blade needle therapy for this disease are few.Objective　To explore the clinical efficacy of blade needle in the treatment of cervical tinnitus based on meridian-sinew theory.Methods　We enrolled 60 cases of cervical tinnitus treated in Shunde Hospital of Guangzhou University of Chinese Medicine from July 2017 to July 2018.They were equally divided into observation group and control group by use of a random digital table，treated with blade needle therapy，usual acupuncture therapy，respectively，for 15 consecutive days.The clinical efficacy，Northwick Park Neck Pain Questionnaire（NPQ） score，Tinnitus Handicap Inventory（THI） score and Tinnitus Severity Assessment Scale（TSIS） score in both groups were observed before and after treatment.Results　In the control group，4，7，13，6 showed complete，marked，effective and ineffective clinical response to the treatment，respectively，while in the observation group，7，12，9，2 showed complete，marked，effective and ineffective clinical response，respectively，indicating that the former group had better clinical response（Z=-2.084，P=0.037）．Before treatment，there were no significant differences in NPQ score，THI score，and TSIS score between the two groups（P>0.05），but after treatment，the scores of these three indicators were significantly lower in the observation group（P<0.05）．Conclusion　Meridian-sinew theory-based blade needle therapy can effectively relieve the neck pain and tinnitus degree of the cervical tinnitus patients，the curative effect is better than that of ordinary acupuncture therapy.

Clinical Value of Artificial Intelligence in the Diagnosis of Pulmonary Nodules　

LI Tian，LI Xiaodong，LIU Jingyu

2020, 23(7): 828-831. DOI: 10.12114/j.issn.1007-9572.2020.00.052

Asbtract ( )

PDF (1426KB) ( )

References | Related Articles | Metrics

Background　Lung cancer is the most malignant tumor with the highest morbidity and mortality in the world.Early CT screening can reduce the mortality of patients with lung cancer，but at present，there are problems such as the large number of screenings，the heavy workload of doctors and a high rate of missed diagnosis.Artificial intelligence（AI） is an emerging method to screen early lung cancer.It is of great clinical significance to study its diagnostic value for pulmonary nodules.Objective　To explore the effect and clinical value of the application of AI in the diagnosis of pulmonary nodules.Methods　From July 2017 to July 2019，120 patients with pulmonary nodules diagnosed in the Third Affiliated Hospital of Jinzhou Medical University were selected as the study objects，and 256 pulmonary nodules were screened out.The positive rates of ground glass nodules（GGN） diagnosed by AI reading and physician reading of chest CT were compared，and the consistency of two methods was evaluated by Kappa test.Taking pathological examination results as the "gold standard"，the sensitivity，specificity，positive predictive value，negative predictive value and area under the receiver operating characteristic（ROC） curve of the diagnosis results by two methods in the malignant pulmonary nodules were calculated.Results　The positive rate of GGN diagnosed by AI reading〔87.2%（95/109）〕 was higher than that by physician reading〔68.8%（75/109）〕（χ2=10.686，P=0.001）.The coincidence of two diagnostic methods was weak，with a Kappa coefficient of 0.019.Of the 54 pulmonary nodules examined pathologically，47 were malignant and 7 were benign.The sensitivity of the diagnosis by AI reading and physician reading in malignant pulmonary nodules were 91.5% and 87.2%；the specificity were 57.1% and 85.7%；the positive predictive value were 93.5% and 97.6%；the negative predictive value were 50.0% and 50.0%，and the area under the ROC curve were 0.743 and 0.845.Conclusion　The AI reading in the diagnosis of GGN has a higher positive rate，which can be used to reduce the rate of missed diagnosis of GGN in clinical practice.Meanwhile，the sensitivity of AI reading in the diagnosis of malignant pulmonary nodules is higher than that of physician reading，but its specificity is lower.It is suggested that AI reading combined with physician reading should be used in clinical practice.

Effect of Isosorbide Mononitrate on Exercise Tolerance and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction　

DING Liqun*，LIU Chao，FAN Jie，ZHANG Jin，ZHANG Xi，GAO Tian，LIU Rui，GUO Jia

2020, 23(7): 832-836. DOI: 10.12114/j.issn.1007-9572.2019.00.707

Asbtract ( )

PDF (1073KB) ( )

References | Related Articles | Metrics

Background　Epidemiologic studies have found that the morbidity of heart failure with preserved ejection fraction（HFpEF） is increasing significantly，approximately accounting for one-half of those with symptomatic heart failure，with a mortality similar to that of heart failure with reduced ejection fraction.Yet，up to now，we lack proven therapies to improve the outcomes.Objective　To evaluate the effects of isosorbide mononitrate on exercise tolerance and quality of life in patients with HFpEF.Methods　From the First People's Hospital of Yunnan Province from September 1，2016 to April 30，2018，92 chronic heart failure inpatients（NYHA classⅡ-Ⅲ） meeting the diagnostic criteria of HFpEF were enrolled，and were equally and randomly stratified into the control group and the isosorbide mononitrate group，treated with basic treatment，previous pharmacological treatment plus isosorbide dinitrate sustained-release tablets（30 mg once daily），for 4 consecutive weeks，respectively.The primary end points were exercise capacity and quality of life，assessed by 6-minute walk test，symptom-limited cardiopulmonary exercise testing（peak VO2，anaerobic threshold，maximum workload and maximum exercise time），the Minnesota Living with Heart Failure Questionnaire（MLHFQ） score，and N-terminal pro-B-type natriuretic peptide（NT-proBNP）.During the intervention，five cases in the isosorbide mononitrate group dropped out the trial within one week due to intolerant headache caused by taking the isosorbide mononitrate，so the remaining 87 cases were finally included.Results　There were no significant differences in sex ratio，mean age，body mass index，heart rate，systolic blood pressure，diastolic blood pressure，distribution of NYHA class，early mitral filling velocity/early diastolic mitral annular velocity ratio，left atrial volume index，left ventricular mass index，left ventricular ejection fraction，the prevalence of three chronic diseases（diabetes，hypertension，coronary heart disease） and use of two types of drugs（diuretics，calcium antagonists） between the two groups（P>0.05）.Furthermore，no significant differences were found in mean pre- and post-treatment peak VO2，VO2AT，maximum exercise power，maximum exercise time，6-minute walk distance，MLHFQ score and NT-proBNP level in either group，and between the two groups（P>0.05）.Conclusion　Oral administration of isosorbide mononitrate 30 mg once daily did not improve the exercise tolerance and quality of life in patients with HFpEF.

Construction of Quality Control Evaluation System for Community Diabetes Management in Different Disease Stages　

CHEN Xubo，JIANG Minmin，GU Wenjuan，WANG Yan，YE Jianhua，LIU Jie，ZHANG Ming，FAN Liangliang，HONG Bo，FAN Qingsong

2020, 23(7): 837-843. DOI: 10.12114/j.issn.1007-9572.2019.00.761

Asbtract ( )

PDF (1070KB) ( )

References | Related Articles | Metrics

Background　At this stage，the community health service center in China has successively formulated indicators such as high-risk population screening rate and blood glucose control rate to manage community diabetes prevention and treatment.However，it has not managed the high-risk groups，pre-diabetic groups and diabetic patients based on the development stage of diabetes.Objective　To establish a quality control evaluation system of community diabetes management in different disease stages in order to guide the quality control and evaluation of community diabetes management.Methods　A quality control evaluation system of community diabetes management was initially designed through literature review，including basic information of body surface characteristics，life behaviors，biochemical indicators and health interventions.Among them，there were 18 primary indicators and 52 secondary indicators.On this basis，experts in the field of diabetes prevention and treatment were invited to evaluate the importance of each indicator in the quality control evaluation system of community diabetes management from April to June in 2018，and further screening of this indicator system was conducted.Results　A total of 22 consultation questionnaires were distributed and all were recovered with a recovery rate of 100%.The average age of consultants was （39.1±5.2）；their average length of service was （15.7±6.7） years，and their average length of service in the diabetes fields was （13.7±5.9） years.After expert consultation，the quality control evaluation system of community diabetes management was finally constructed as follows：for the quality control evaluation system of diabetes management for high-risk groups，there were four indicator classifications including 13 primary indicators and 40 secondary indicators；for the quality control evaluation system of pre-diabetic groups，there were four indicator classifications including 14 primary indicators and 39 secondary indicators；for the quality control evaluation system of diabetes patients，there were four indicator classifications including 15 primary indicators and 45 secondary indicators.The quality control evaluation indicators of diabetes management for high-risk groups，pre-diabetic groups and diabetic patients were basically the same in body surface characteristics，lifestyle and biochemical indicators，but there were significant differences in health intervention indicators.In the management of high-risk groups of diabetes，health intervention indicators only included file-building，two-way referral，follow-up，blood glucose awareness and diabetes knowledge，and there were blood sugar monitoring rate and（oral） medication guidance in the management of pre-diabetic population while it did not include the blood glucose awareness.In the management of diabetic patients，there were insulin injection guidance and screening for diabetic complications in health intervention indicators.Conclusion　The quality control evaluation system of community diabetes management in different disease stages should be different，which can provide basis for guaranteeing the quality of community diabetes management.

Patient Self-management of Diabetes Using the Mobile Terminal APP：a Self-controlled，Comparative Study in Fangzhuang Community Health Service Center　

WANG Qi，WU Hao，WEI Xuejuan，GAO Wenjuan，LIU Xinying，JIA Hongyan

2020, 23(7): 844-848. DOI: 10.12114/j.issn.1007-9572.2019.00.674

Asbtract ( )

PDF (1065KB) ( )

References | Related Articles | Metrics

Background　In recent years，the application of intelligent terminal APP in diabetes management has become a new form of chronic disease management.With the national policy support，it will become a trend for community health centers to widely develop mobile medicine.Objective　To evaluate the effect of APP in patient self-management of type 2 diabetes.Methods　Type 2 diabetes patients who signed a contract with Fangzhuang Community Health Service Center from June 1，2016 to May 31，2017 and used the "doctor by your side" APP software for at least one year were selected as the research object. A on-site questionnaire survey was carried out in these patients in a face-to-face manner from July to August 2018 to collect ease of use，communication with doctors，willingness to use and so on，for "doctor by your side" APP.Moreover，the background data of patients with effective questionnaire before and after using "doctor by your side" APP，including follow-up times，blood glucose，glycosylated hemoglobin，were collected to evaluate the clinical management effect of type 2 diabetes.Results　A total of 205 cases were selected，and 198 of them returned responsive questionnaires，with an effective recovery rate of 96.6%.The most common reason（proposed by 26.5% of the participants） for using the management with APP was "It is a convenient way to communicate with the general practitioner"，the most commonly used function of patients was "communication interface with doctors"（20.7%），and 71.7% of the participants preferred this kind of management.After using APP，the standardized management rate（annual follow-up≥4 times） increased from 65.7% to 86.9%.The fasting blood glucose，postprandial blood glucose and glycosylated hemoglobin levels were improved compared with those before use，and the blood glucose control rate（82.3%） was improved compared with those before use（53.5%）（P<0.05）.Conclusion　By use of the intelligent mobile terminal APP，the effect of patient self-management of type 2 diabetes increases.

Knowledge of Stroke Prevention and Treatment and Associated Factors among Hospitalized Diabetic Patients：a Questionnaire Survey　

XU Hongbo，YANG Lilei，XUE Fang，ZHANG Haigang，CHEN Libo，WU Jinglan

2020, 23(7): 849-854. DOI: 10.12114/j.issn.1007-9572.2019.00.458

Asbtract ( )

PDF (1081KB) ( )

References | Related Articles | Metrics

Background　Diabetic patients are at high risk of stroke，and are an important target group for stroke prevention and treatment.Previous research suggests that correct understanding of stroke prevention and treatment can significantly reduce the occurrence of treatment delay and improve the treatment efficiency.However，there are few reports on cognitive characteristics of stroke prevention and treatment knowledge in diabetic patients.Objective　To assess the awareness level of stroke prevention and treatment among diabetic patients and analyze the associated factors.Methods　This study was performed in Shenzhen Nanshan Hospital between December 2016 and September 2017.A face-to-face questionnaire survey was conducted among 500 diabetic patients hospitalized in Department of Endocrinology，and 435（87.0%） of them responded.The questionnaire designed by our research team includes socio-demographic data，knowledge of stroke prevention and treatment （location of stroke，common risk factors and warning symptoms，emergency treatment，thrombolytic therapy，prevention，and so on），and expected ways to acquire the knowledge.Stepwise multivariate regression analysis was performed to identify key factors possibly related to the awareness level of stroke knowledge.Results　This investigation showed that：the awareness rate of stroke risk factors ranged between 5.3% and 80.7%.Among the controllable stroke risk factors，the awareness rate of hypertension was the lowest〔80.7%（351/435）〕，while that of hyperhomocysteinemia was the lowest〔10.3%（45/435）〕．Among the uncontrollable stroke risk factors，the awareness rate of age was the highest〔65.8%（286/435）〕，while that of race was the highest〔5.3%（23/435）〕.The awareness rate of common stroke warning symptoms ranged between 13.1% and 76.8%.Unilateral limb numbness or weakness was known to the largest percent of respondents〔76.8%（334/435）〕，while convulsion was known to the least percent of respondents〔13.1%（57/435）〕.76.6%（333/435） of the respondents reported that they would dial 120 to call an ambulance in case the stroke symptom occurred.15.4%（67/435） of the respondents knew thrombolytic therapy for acute ischemic stroke，but only 43.3%（29/67） of them knew the time window of thrombolytic treatment （within 4.5 hours of stroke onset）.57.7%（251/435） of the respondents correctly identified the brain as the organ affected in stroke.64.4%（280/435） of the respondents believed that stroke was preventable．The top three expected ways to acquire stroke knowledge were guidance from the community physician〔74.0%（322/435）〕，expert lectures〔53.8%（234/435）〕，and watching television〔38.6%（168/435）〕.The results of univariate analysis indicated that there was a statistically significant difference in the level of knowledge of stroke prevention among patients with household monthly income per person，personal or familial history of stroke（P<0.05）.Multivariate analysis found that education level，household monthly income per person，personal cerebrovascular disease history or familial history of stroke，and duration of diabetes were associated with the awareness level of stroke prevention and treatment knowledge（P<0.05）.Conclusion　The awareness level of stroke prevention and treatment knowledge among diabetic inpatients was low education level，poor，no personal cerebrovascular disease history or low income subgroup，especially in the newly diagnosed.Stroke education guided by the community doctor may be efficient to improve the stroke knowledge of diabetic inpatients.

Effects of Extraesophageal Symptoms on the Anxiety and Depression，Quality of Life and Treatment Effect in Patients with Gastroesophageal Reflux Disease　

OUYANG Hao，XUE Qian，WANG Jingtong

2020, 23(7): 855-860. DOI: 10.12114/j.issn.1007-9572.2019.00.615

Asbtract ( )

PDF (1055KB) ( )

References | Related Articles | Metrics

Background　In recent years， along with the in-depth study of the epidemiology and pathophysiology of gastroesophageal reflux disease（GERD），it is found that GERD has a high incidence of anxiety and depression，and its typical symptoms（acid reflux， heartburn）are often closely related to the patient's mood.Extraesophageal symptoms are common types of GERD syndromes，which aggravate the anxiety and depression of patients，reduce their quality of life，and affect the treatment effect to some extent.Objective　By investigating the symptoms，emotions and quality of life of GERD patients with or without extraesophageal symptoms，the effects of extraesophageal symptoms on the emotions and quality of life of GERD patients were explored，and the risk factors of refractory GERD were explored through the follow-up of GERD patients after eight weeks of proton pump inhibitor（PPI） treatment.Methods　From January to December 2018，a questionnaire survey was conducted on 1 013 inpatients and outpatients.GERD was diagnosed by gastroscopy，24-hour PH monitoring and GERD-Q scale;anxiety and depression were evaluated by SAS and SDS scales;and quality of life was evaluated by SF-36 scale.Logistic regression was used to analyze the risk factors affecting the efficacy of GERD treatment.Results　A total of 1 013 questionnaires were distributed in this survey，and 937 valid questionnaires were returned with an effective recovery rate of 92.5%.The incidence of anxiety and depression in GERD patients with extraesophageal symptoms was higher than that in GERD patients without extraesophageal symptoms（42.6% vs 33.1%）.The improvement rate of symptoms，anxiety and depression status and quality of life in GERD patients with extraesophageal symptoms and anxiety and depression after PPI treatment was lower than that in other groups（P<0.05）.Multivariate analysis showed that BMI，GERD subtype, anxiety and depression, and/or absence of extraesophageal symptoms were the influencing factors for the therapeutic effect of GERD patients.Conclusion　Extraesophageal symptoms aggravate the occurrence of anxiety and depression in patients，reduces the quality of life of patients，and affects the therapeutic effect．

Gender Differences in the Effects of Sleep Deprivation on Emotional Reactivity　

LIANG Jingyu，CAO Qian

2020, 23(7): 861-865. DOI: 10.12114/j.issn.1007-9572.2019.00.450

Asbtract ( )

PDF (1288KB) ( )

References | Related Articles | Metrics

Background　According to the World Health Organization，about 27% of people around the world have sleep quality problems.Sleep deprivation can lead to a significant decline in cognitive abilities such as working memory，judgment in decision-making，task conversion and emotional processing.There are significant differences in emotional awareness，treatment，expression and experience between men and women.Objective　To investigate the effect of sleep deprivation on emotional reactivity on the basis of gender.Methods　By use of convenience sampling，33 non-psychology students from a university in Guangdong Province were enrolled from 6th to 26th May，2018，including 15 males and 18 females.The experiment gives male and female subjects nine levels of scores from 1 to 9 on the wake-up（i.e.，the emotional experience intensity of the subjects：calm/excitement） before and after sleep deprivation.By assessing emotional intensity（arousal） towards negative，neutral and positive emotional pictures（selected from International Affective Picture System，IAPS） before and after sleep deprivation，the influence of sleep deprivation on emotional reactivity was examined by sex.Results　Gender was associated with the main effect of sleep deprivation on emotional arousal，the results indicated that females showed higher level of arousal than males after sleep deprivation（P<0.001）.Post-sleep deprivation emotional arousal was much higher than that before sleep deprivation，indicating the main effect of sleep deprivation was evident（P<0.001）.The main effect of sleep deprivation on individual emotion titer was significantly different（P<0.001）.The interaction effect between gender and sleep deprivation was significant，females showed higher levels of arousal in recognition of the negative，neutral and positive pictures after sleep deprivation（P<0.001）.There is significant interaction between gender and emotional titer，males showed higher level of arousal in recognition of the negative pictures than the neutral pictures（P<0.001），and showed higher level of arousal in recognition of the neutral pictures than the positive pictures（P<0.001）.Females showed higher level of arousal in recognition of the negative pictures than the neutral pictures（P<0.001），while showed similar levels of arousal in the assessment of neutral and positive pictures（P>0.05）.There was significant interaction between emotional titer and sleep deprivation，sleep deprivation was related to higher level of arousal in the assessment of the neutral and positive pictures（P<0.001）.There is marginal significant interaction among gender，titer and sleep deprivation（P=0.08）.Conclusion　Sleep deprivation has an effect on individual emotional reactivity.The results of this study show that the experience of emotional intensity is not only related to gender，but also has significant correlation with sleep deprivation.

The Standardized Diagnosis and Treatment of Children's Fever in Primary Health Care Institutions　

QIN Hongli，REN Jingjing

2020, 23(7): 866-869. DOI: 10.12114/j.issn.1007-9572.2019.00.640

Asbtract ( )

PDF (1087KB) ( )

References | Related Articles | Metrics

Fever is one of the clinical manifestations of many diseases，and fever in children is more common in primary health care institutions.By reviewing relevant literature at home and abroad，this article summarizes the characteristics and assessment contents of fever in children，and points out that the etiological treatment is fundamental.It is not recommended to use physical methods to lower the temperature，and antipyretic drugs，such as paracetamol or ibuprofen，are recommended to relieve the discomfort of children caused by fever.This article aims to guide general practitioners to standardize the treatment of children's fever in primary health care institutions.

Progressive Retinopathy Shortly after Treatment of New-onset Diabetes Mellitus: a Case Report and Literature Review　

LUO Bei，MENG Bihui，HUANG Song

2020, 23(7): 870-873. DOI: 10.12114/j.issn.1007-9572.2019.00.448

Asbtract ( )

PDF (1397KB) ( )

References | Related Articles | Metrics

There are very few studies about new-onset type 2 diabetic patients who have pre-treatment normal fundus examination results but develop diabetic retinopathy（DR） within several months after diabetes treatment.We reported the clinical features and outcome of a case of new-onset type 2 diabetes who had progressive diabetic retinopathy at 6 months after short-term intensive insulin treatment，and discussed the possible pathogenesis based on the reviewing of related studies.Insulin therapy may induce severe retinopathy in some individuals with heterogeneous type 2 diabetes mellitus.Before the treatment of new type 2 diabetes mellitus，the fundus should be checked regularly.Within one year after the short-term intensive insulin treatment，it is recommended to check the fundus every 3-4 months.If there is any visual change in the patient，the fundus should be checked at any time.Once defined as DR, we should timely adjust the hypoglycemic program and carry out effective specialized treatment to prevent disease progression and save patients' vision.

Recent Advances in Treatment Burden of Multimorbidity in Elderly Patients　

DOU Liyuan，HUANG Juan，ZHANG Zhenxiang，YE Sen，ZHANG Mengke

2020, 23(7): 874-879. DOI: 10.12114/j.issn.1007-9572.2019.00.621

Asbtract ( )

PDF (1075KB) ( )

References | Related Articles | Metrics

The advent of era of aging means that the number of elderly people increases dramatically.Older adults have a high prevalence of multimorbidity，which is worthy of attention，because it can bring a heavier treatment burden than just one chronic illness，but it is rarely studied in China.This article reviews the concept and theoretical models of treatment burden，evaluation tools for multimorbidity in the elderly，and the research status of treatment burden in elderly patients with multimorbidity，with a view to providing a reference for focus areas for research and interventions for reducing treatment burden in this group in China.

Advances in Research on Comorbidities in Elderly Cancer Patients　

LI Sisi，ZHANG Yan，LI Hongjie，DU Cancan，ZHAO Jing

2020, 23(7): 880-883. DOI: 10.12114/j.issn.1007-9572.2019.00.619

Asbtract ( )

PDF (1343KB) ( )

References | Related Articles | Metrics

Comorbidity refers to two or more kinds of chronic non-communicable diseases coexisting in the same patient.In recent years，the incidence of comorbidities in elderly cancer patients has been high，which has drawn extensive attention of many scholars.Therefore，the purpose of this study was to summarize the concept，form and category of the comorbidity，expound its incidence and pattern in elderly cancer patients，introduces tools for its measurement，and describe its effects on elderly cancer patients.This study found that although the incidence of comorbidity in elderly cancer patient was high，had a great impact on the diagnosis，treatment，quality of life and survival for elderly cancer patients，there was no consensus and unified assessment tool on the comorbidity model in the world.It was recommended that elderly cancer patients with comorbidities be included in clinical trials later to understand patient needs and solve existing problems.

Advances in Current Situation of Elder Abuse and Its Influencing Factors in Rural Areas of China　

DU Yage，PEI Li，DOU Haoying，TIAN Xinyu

2020, 23(7): 884-888. DOI: 10.12114/j.issn.1007-9572.2019.00.459

Asbtract ( )

PDF (1048KB) ( )

References | Related Articles | Metrics

With the continuous increase of the elderly population，a series of problems of supporting the elderly have emerged in China.Among them，the most significant problem is elder abuse，which is more common in rural areas than in cities.Elder abuse not only infringes rights of the elderly，but also seriously affects their physical and mental health.It is more likely to increase the risk of diseases in the elderly and accelerate their death.In general，most researchers categorize elder abuse into five types：physical abuse，mental abuse，economic abuse，negligent care and sexual abuse.Among them，mental abuse is the most common type in rural areas of China，followed by negligent care.In this paper，we elaborate on the current situation and the prevalence of elder abuse in rural areas of China.And then we make a summary of influencing factors of elder abuse，including own factors of the elderly，such as female，the advanced age，low education level，poor physical health，depression and so on，and other factors，such as caregiver stress，family intergenerational support and social factors in order to provide the reference for reducing elder abuse in the future.

Table of Content