Chinese General Practice

Recommendations for Supplementing and Revising the Contents and Standards of Standardized General Practice Residency Training Program（2019 Revised Edition）　

General Practitioner Branch of Chinese Medical Doctor Association

2020, 23(16): 1967-1971. DOI: 10.12114/j.issn.1007-9572.2020.00.378

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The implementation of the Contents and Standards of Standardized General Practice Residency Training Program（2019 Revised Edition） issued by Chinese Medical Doctor Association in 2019 has greatly promoted the development and quality improvement of the standardized training for general practitioners（GPs） in China. Primary healthcare workers play a crucial role in containing and preventing the COVID-19 pandemic that broke out in December 2019.However，during the process，weaknesses of them，such as lack of sufficient knowledge and experience of containing and preventing infectious diseases have been exposed，which indicate that domestic research and practice of fostering GPs should be further deepened，and the training for GPs in primary care with prevention and response knowledge and skills associated with public health emergencies should be strengthened.For this，the General Practitioner Branch of Chinese Medical Doctor Association has initiated the studying on recommendations for supplementing and revising the Contents and Standards of Standardized General Practice Residency Training Program（2019 Revised Edition），and proposed the following suggestions based on the overall status of fostering GPs and GP system development in China as well as the containment and prevention of the COVID-19 pandemic：appropriately extending the training time in primary care practice settings；enriching the contents of training；standardizing the clinical rotation time of infectious diseases；enriching the rules and regulations of training；strengthening the studying of public healthcare system.

Interpretation of 2019 Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management from the National Institute for Health and Care Excellence（1）　

LI Zhenghuan，SONG Xueli，LIU Xin，WANG Fei，CHEN Yang

2020, 23(16): 1972-1976. DOI: 10.12114/j.issn.1007-9572.2020.00.264

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The National Institute for Health and Care Excellence（NICE） published its guidelines on stroke and transient ischaemic attack（TIA） as early as July 2008，but the management of stroke is changing now.New evidence has emerged in areas such as thrombectomy in ischaemic stroke.In addition，there are some uncertainties about the use of Aspirin for the first suspected diagnosis of TIA，the role of traditional risk stratification in TIA，and the best practice to intracerebral imaging after TIA.Therefore，in May 2019，NICE released the latest guidelines Stroke and Transient Ischaemic Attack in over 16s：Diagnosis and Initial Management to update recommendations on these specific issues，and it offered the best clinical recommendations for the diagnosis and treatment of acute stroke and TIA in 48 hours after onset of symptoms.There are nine recommendations in the NICE guidelines and this article interprets the recommendations in "1.1.1~1.4.8" based on the relevant research progress，including rapid recognition of symptoms and diagnosis，imaging for people who have had a suspected TIA or acute non-disabling stroke，specialist care for people with acute stroke，and pharmacological treatments and thrombectomy for people with acute stroke.The interpretation of this guideline can provide reference for the practical work of clinicians in Emergency Department，Department of Neurology and other departments in China，and optimize the clinical efficacy.

Interpretation of 2019 Hypertension：the Clinical Management of Primary Hypertension in Adults from the National Institute for Health and Care Excellence　

CHEN Kai

2020, 23(16): 1977-1981. DOI: 10.12114/j.issn.1007-9572.2020.00.174

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Hypertension is a major risk factor for stroke，heart disease，chronic renal failure and other diseases.The timely treatment and comprehensive management of hypertension is of great significance.In August 2019，the National Institute for Health and Care Excellence（NICE） of the United Kingdom issued the Guidelines for Hypertension in Adults：Diagnosis and Management，which was the third update since the 2004 NICE guidelines for the diagnosis and management of hypertension.It not only followed concepts of previous guidelines，but also added some new contents.The new edition of the guidelines for hypertension management provided a comprehensive and detailed description of blood pressure measurement，hypertension diagnosis，cardiovascular risk，target organ damage assessment，antihypertensive treatment，blood pressure monitoring and what kinds of patients require specialist diagnosis and treatment.In particular，the timing of starting drug treatment of hypertension，the choice of treatment options and the concept of comprehensive management are worthy of learning by clinicians.

Evaluation of Chronic Disease Patients on Community Health Services and Its Influence on the Selection of Medical Institutions under the Medical Treatment Alliance　

HU Wenshuang，ZHANG Ning，FENG Guosheng

2020, 23(16): 1982-1988. DOI: 10.12114/j.issn.1007-9572.2020.00.029

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Background　The "Healthy China 2030 Planning Outline" proposes to build an integrated health service system.The hierarchical medical system is the basis for the realization of integrated health service，and chronic disease management is the key content and point of promotion breakthrough in hierarchical medical system.However，medical service capacity is insufficient in community and fails to meet the medical needs of patients with chronic diseases，which makes it unable to effectively guide patients to use grassroots medical services.Objective　To analyze the relative satisfaction and perceived importance of community patients with chronic diseases in terms of medical service，and to investigate the key factors influencing patients' choices of medical institutions，in order to provide reference for improving the construction of medical treatment alliance.Methods　Each two community health service centers were selected both inside and outside the Beijing Chao-Yang Hospital Medical Treatment Alliance in July 2018，and the questionnaire survey was conducted on patients with chronic diseases to understand their medical choices，satisfaction and perceived importance with community medical services.Factor analysis method was used to extract the common factors of community medical services，and the coordinate axes were established to explore the relationship between relative satisfaction and the importance of various factors.Multivariate Logistic regression model was applied to analyze the main factors influencing patients' medical choices.Results　Factor analysis extracted three common factors，quality perception of medical services，medical service accessibility and medical expenses.In terms of quality perception of medical services，the score of both patients inside and outside the medical treatment alliance was（6.4±2.3）-（8.3±1.7） for relative satisfaction with the same order，and（8.3±1.5）-（9.0±1.2） for the importance with the same factors.In terms of medical service accessibility，the score of relative satisfaction was（8.1±1.8）-（9.0±1.3），in which the "waiting time" within the alliance was shorter than that outside the alliance（P<0.05），and the score of importance was（8.0±1.7）-（8.5±1.4）.In terms of medical expenses，both patients inside and outside the alliance had lowest relative satisfaction；in scores of the importance，patients within the alliance rated the lowest score，while patients outside the alliance gave the medium scores.The quality perception of medical services，age，education level，monthly per capita income and whether patient's community was in the medical treatment alliance were the main factors affecting patients' medical choices（P<0.05）.Conclusion　The quality of community medical services has not reached the expectations of patients.It should be improved from the aspects of supplementing health personnel，exploring individualized management methods and enhancing drug allocation capability.The medical service accessibility is high，but patients have a relatively low sense of gain of waiting time.The resource allocation should be scientifically measured to address the challenges posed by the growth of community visits.Patients in the sample area are less sensitive to community medical expenses.It is necessary to improve the medical insurance policy and patient management model.

Status Quo of Active Aging among Rural Elderly and Its Influencing Factors　

LI Hongjie，ZHANG Yan，YU Zijuan，WANG Ronghua，ZHAO Jing，DU Cancan，TIAN Yutong，LIU Zhen

2020, 23(16): 1989-1995. DOI: 10.12114/j.issn.1007-9572.2020.00.120

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Background　Active aging，an important index to measure the quality of life，advocates that the elderly should maintain physical and mental health and realize their self-value in the later years.The problem of rural aging in China is severe in recent years，so it is urgent to investigate and analyze the level of active aging among rural elderly to provide a reference for improving their quality of life.Objective　To investigate the current status of active aging among the elderly in some rural areas of Henan Province and analyze its influencing factors.Methods　Adopting drawing lots method，two towns were randomly selected from five townships governed by Qi County of Hebi City in Henan Province，and each town randomly selected three administrative villages from November 2018 to January 2019.Rural elderly who met inclusion criteria were selected to conduct the questionnaire survey.The questionnaire included demographic characteristics and the Active Ageing Questionnaire in Rural Areas，which was revised from Chinese version of Active Ageing Scale（AAS） developed by the research group at an earlier stage.A total of 670 questionnaires were distributed and 625 valid questionnaires were collected with the effective recovery rate of 93.3%.Results　The total score of active aging among rural elderly was 70.00（30.00）.The highest score was found in "promote own matters" dimension，3.00（1.71）."Establishing economic balance" got the lowest score，1.00（1.00）.Spearman rank correlation analysis showed that gender，age，religious belief，education level，marital status，living conditions，personal monthly income，quality of sleep，exercise frequency，family support for social participation，participation in labor，and fitness facilities in the village were correlated with the total score of active aging（P<0.05）.Multiple linear regression analysis showed that age，marital status，living conditions，personal monthly income，quality of sleep，weekly exercise times，family support for social participation，and fitness facilities were the factors influencing active aging（P<0.05）.Conclusion　The active aging among the rural elderly is still at a lower level compared with that among the urban elderly.According to the factors affecting the active aging，targeted measures should be taken，such as promoting active aging education for the rural elderly，providing mutual assistance and support for the poor elderly，publicizing an open and inclusive concept of old-age marriage and love，encouraging the elderly to make independent decisions，creating cultural and sports activities for the elderly，popularizing healthy work and rest habits，and emphasizing the power of family support，so as to empower the rural elderly and help them achieve active aging.

Needs Assessment of Pediatric Outpatient Clinic in Community for Children Aged 0-3　

LIU Yuchun，DU Xueping，DING Jing，DING Lan，WU Lin

2020, 23(16): 1996-2001. DOI: 10.12114/j.issn.1007-9572.2019.00.704

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Background　Lacking GPs and facilities in the communities lead to the difficulties for Children's medical treatment is a common problem in pediatric medicine in China.The community health center mainly undertakes the work of vaccination and child health care for children in the communities.The diagnosis and treatment of common diseases in children are in the state of "de-rooting".It is imperative to add pediatric clinics to community health centers.Objective　To investigate the needs of pediatric outpatient clinics for parents aged 0-3 in a community in Xicheng District of Beijing and explore the remaining problems in order to provide a basis for the establishment of pediatric outpatient clinics in the local communities.Methods　From March to July 2018，a simple random sampling method was used to select children aged 0 to 3 at Yuetan Community Health Center，Community Health Station of Sanlihe District 2，and Muxidi Community Health Station and 280 children were selected.The parents of selected children were surveyed using the questionnaire designed by the research team.The main contents were demographics information about children and their demand for community pediatric clinics.Results　A total of 270（96.4%） valid questionnaires were collected.And 94.4%（255/270） of the parents thought that it was necessary to open a pediatric outpatient clinic in the local community.If there was a pediatric outpatient clinic in the community，92.6%（250/270） of the parents were willing to bring the children to see a doctor.At present，73.7%（199/270） of the parents preferred to visit a tertiary hospital（including children's hospital），and 20.7%（56/270） of the parents preferred to visit a community health center.The top two reasons why children's parents chose to visit the community health institutions were the close distance（55.9%，151/270） and fewer patients（53.3%，144/270）.The parents believed that the top three problems in the community pediatric outpatient clinic were the low level of GPs' skills（77.4%，209/270），incomplete medicines（56.3%，152/270），and lack of equipment（55.9%，151/270）.A total of 61.5%（166/270） of the parents hoped to communicate with the GPs for 6~10 min at the time of the visit；81.8%（221/270） of the parents thought that the children should go to the community health centers first when they felt ill，and GPs would decide whether to transfer them to a tertiary hospital according to their conditions.Conclusion　Children aged 0-3 have a great need for community pediatric outpatient clinics in their local communities.Most parents are willing to take children to visit GPs in community health centers and support the mode of hierarchical medical treatment.However，the overall environment of community health service organizations，equipment configuration，the level of diagnosis and treatment and drug supply restrict the community pediatric diagnosis and treatment，which needs to be improved from different levels such as the state，hospitals and community health institutions.

The Construction of Essential Elements of Standard Complex and Establishment of Comprehensive Standardization Path for Community Health Services　

WANG Kouzhu，YANG Weina，MA Xuedong，WEI Xinping，TANG Chunhong

2020, 23(16): 2002-2006. DOI: 10.12114/j.issn.1007-9572.2020.00.193

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Background　The community health services in China is still under continuous development and improvement，and the construction of its comprehensive standardization will play an important role in the urban planning and operation.As the first research and construction unit in Shanghai，Gumei Community Health Service Center in Minhang District has accumulated rich experience in this regard and achieved certain results.Objective　To carry out the construction of comprehensive standardization with community health services as the object，and summarize the relevant methods and experience of element construction and path construction in the construction process in order to provide a reference for peers to carry out relevant comprehensive standardization construction.Methods　From April to October in 2015，the overall goal of comprehensive standardization for community health services was clarified through the literature review and policy review.The overall framework of the comprehensive standardization system for community health services was formed through the systematic analysis.The relevant elements of the comprehensive standardization system was drafted through the expert consultation.From November 2015 to March 2016，the relevant elements were matched with elements in the current international and domestic standards through standard bench marking.Finally，the specification and manual of a standard construction path of the standard complex for community health services was formed through the standardized construction of experts.Results　The community health services standard complex finally constructed was divided into three basic systems：a basic standard system for general services with 6 sub-systems，including standardization guidelines，terminology and acronym standards，symbol and sign standards，and a total of 165 standards；a service guarantee standard system with 9 sub-systems，including environmental standards，safety and emergency standards，contract management standards，and a total of 196 standards；and a service provision standard system with 5 sub-systems，including service specifications，service provision specifications，and quality control specifications，and a total of 370 standards.Conclusion　It is feasible to construct a comprehensive standard complex for community health services in China.The construction of this standard complex should meet the work requirements of comprehensive standardization while embodying industry characteristics.With reference to the experience of advanced standards at home and abroad，such as the evaluating standards of the Joint Commission International，the actual environment and work requirements of community health service centers in China should also be considered.

Development of Enterprise Standards for Community Health Services Based on PDCA Cycle　

YANG Weina，WANG Kouzhu，MA Xuedong，WEI Xinping，TANG Chunhong

2020, 23(16): 2007-2011. DOI: 10.12114/j.issn.1007-9572.2020.00.191

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Background　The development of enterprise standards for community health services is an important part of comprehensive standardization，which plays an important role in guiding the development of characteristic work in community health service institutions.In the absence of corresponding and applicable standards，how to develop enterprise standards in a standardized and efficient manner is a key issue for the work of comprehensive standardization.Objective　To develop enterprise standards for community health services based on PDCA cycle，and elaborate standardization requirements and methods in each stage of PDCA cycle in order to provide a reference for peers.Methods　From April to October in 2015，the PDCA cycle method was used to identify the object，goal and plan of enterprise standards for community health services through the group discussion，expert discussion and brain storming.From November 2015 to February 2016，enterprise standards were prepared through the literature review，expert consultation and expert review.From March to December in 2016，enterprise standards were improved through self-evaluation，social evaluation，and self-rectification.From January 2017 to July 2018，enterprise standards were continuously improved through continuous operation and evaluation.Results　A total of 420 enterprise standards for community health services were constructed.Taking the Regulations for Community Colorectal Cancer Screening as an example，the enterprise standards included screening methods，inclusion requirements，screening procedures，health education，referral requirements，data management and quality control of community screening for colorectal cancer in Shanghai.Conclusion　The enterprise standards for community health services based on PDCA cycle provide a clear basis and reference for various tasks of primary medical institutions and are of great significance for improving the scientific management.
Community health services；Comprehensive standardization；Enterprise standard；PDCA cycle

Application Research on Systematic Evaluation of Enterprise Standards for Community Health Services：Taking the Colorectal Cancer Screening as an Example　

YANG Weina，WANG Kouzhu，MA Xuedong，WEI Xinping，TANG Chunhong

2020, 23(16): 2012-2019. DOI: 10.12114/j.issn.1007-9572.2020.00.194

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Background　In the process of building the comprehensive standardization for community health services，a systematic evaluation of enterprise standards is the prerequisite and basis for ensuring that the comprehensive standard system is standardized，effective and complete.How to conduct immediate and long-term evaluation of enterprise standards? How does the evaluation result affect the comprehensive standardization construction？ These are two key problems that need to be resolved，but there are few related studies.Objective　Taking the colorectal cancer screening as an example，a systematic evaluation of enterprise standards for community health services was conducted to provide a reference for peers to carry out enterprise standard evaluation.Methods　From July to December in 2015，relevant experts were organized to conduct the immediate evaluation of text standardization，practice compatibility and system completeness for colorectal cancer screening.From January to April in 2016，the data on the number and cost of colorectal cancer screening services in Gumei Community Health Service Center from 2013 to 2015 were collected.The long-term evaluation of enterprise standards for colorectal cancer screening was completed with the help of system dynamics method.Results　The immediate evaluation results showed that the content described in the Regulations for Community Colorectal Cancer Screening was basically consistent with practice and the language expression was standardized.The long-term evaluation results showed that the number of participants in health education，the number of participants in risk questionnaire assessment，the number of participants in risk questionnaire assessment with positive results，the number of participants in two fecal occult blood tests（FOBT），the number of patients with precancerous lesions and the number of patients with cancer showed a trend of decline year by year.The number of participants with positive FOBT results，the number of participants with comprehensive positive results and the number of participants with enteroscopy showed an upward trend and then a downward trend.A round of colorectal cancer screening for residents aged 40 and over in Gumei Community could be completed by 2025.The prediction results of service cost showed that the average investment of the colorectal cancer screening in Gumei Community Health Service Center was about 120 000 yuan annually，and the community investment decreased with the decrease of screening service each year.The cumulative community investment after the screening round was about 1 638 205.19 yuan.Conclusion　Although the enterprise standards for colorectal cancer screening is in line with practice，they also indicate that there are loopholes in the screening system.Because the application effectiveness of the system dynamics method used in the long-term evaluation is limited by the incompleteness of the information，a more accurate long-term evaluation still needs to be further improved after the information system is improved.

Main Practices and Results of Comprehensive Standardization Construction for Community Health Services in Minhang District of Shanghai　

WANG Kouzhu，YANG Weina，MA Xuedong，WEI Xinping，TANG Chunhong

2020, 23(16): 2020-2024. DOI: 10.12114/j.issn.1007-9572.2020.00.192

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The standardization of community health services is an important means to establish and improve the community health service system in China.Gumei Community Health Service Center as the only pilot unit of comprehensive standardization in Shanghai，has been exploring the comprehensive standardization construction since 2011.Based on the definition of What，Who，and How to comprehensively standardize community health services，the standardization construction was carried out by means of the PDCA cycle，and a set of standard system for community health services was formed，which was composed of 3 first-level directories，20 second-level directories，2 international standards，127 national standards，170 industry standards，11 local standards，1 association standard，and 420 institution standards.The standardization construction of community health services has improved the satisfaction of contracted family doctor services and the efficiency of services in Child Health Management Center to a certain extent.It is recommended that when carrying out related work，the scientific organizational structure design，the construction of standardized talents echelon，and the standardized work plans should be rationally formulated.In addition，with the deepening of community health service reform，the standardization for community health services needs to be continuously improved in accordance with the actual needs of community health service development.

Development from Helicobacter Pylori Infection，Gastritis and Gastric Intraepithelial Neoplasia to Gastric Cancer：an Individual-level Dynamic Study　

SUN Ke，XU Mengqing，CAO Chong，WANG Xiaojun，YIN Qihang，WANG Lijie，ZHANG Wenjie

2020, 23(16): 2025-2029. DOI: 10.12114/j.issn.1007-9572.2020.00.076

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Background　The early diagnosis of gastric cancer is difficult without screening and the treatment efficacy is unsatisfactory for late stage GC.Therefore，GC presents a high incidence and mortality in China.Analyses of big data，follow-up，disease progress，and survival have clinical significance in the identification of causes，evaluation of disease course，and early diagnosis and treatment for GC.Objective　To perform an individual-level dynamic study of the development from gastritis，gastric intraepithelial neoplasia to gastric cancer based on analyzing the pathological data among 13 962 multiple gastroscopic follow-up biopsies.Methods　We collected a total of 98 241 cases who underwent gastroscopic biopsies with definitive pathological diagnoses from First Affiliated Hospital，School of Medicine，Shihezi University，spanning from November 2007 to December 2017.Among them，13 962 were followed-up and biopsied multiple times under endoscopy，and 216 of them with continuous disease progression were selected as the sample of a database incorporated with their demographic information，disease location，follow-up，disease progression，histologic diagnosis，and Hp infection.We compared the development time of different stages of gastric conditions，and age and Hp infection prevalence by stage of gastric disease progression.Results　The median progression time of 176 cases of gastritis to gastric intraepithelial neoplasia was 30 months（with 89 months as the longest interval），and that of 12 cases of gastric intraepithelial neoplasia to gastric cancer was 6 months（with 26 months as the longest interval），indicating that that the former was longer than the latter（P<0.05）.The time span of gastritis progression to gastric cancer was shorter than that of gastritis progression to gastric intraepithelial neoplasia，but was longer than that of gastric intraepithelial neoplasia progression to gastric cancer（P<0.05）.Shorter mean time span of disease progression was found in patients with gastritis progression to gastric cancer without the stage of gastric intraepithelial neoplasia instead of those with three stages of progression（from gastritis to gastric intraepithelial neoplasia，and eventually to gastric cancer）（P<0.05）.The time from atrophic gastritis to gastric intraepithelial neoplasia was longer than that from non-atrophic gastritis（P=0.017）.In the course of gastritis progressing to gastric intraepithelial neoplasia（no progression to gastric cancer has been observed yet），the Hp-positive rate decreased（P<0.001）.Conclusion　The time from gastritis progressing to gastric intraepithelial neoplasia is much longer than that from gastric intraepithelial neoplasia progressing to gastric cancer.Compared with non-atrophic gastritis，the time for atrophic gastritis developing into gastric intraepithelial neoplasia is longer.It is thus conceivable that active follow-up and treatment for non-atrophic gastritis and gastric intraepithelial neoplasia are important measures for preventing gastric cancer.

Effects of a 30% Low-carbohydrate Diet on Patients with Type 2 Diabetes　

ZENG Ting，LIN Chuhui，YE Xiaofang，DENG Yuhong

2020, 23(16): 2030-2033. DOI: 10.12114/j.issn.1007-9572.2019.00.686

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Background　With the increasing prevalence of diabetes in China，effective and consistent dietary interventions are needed to control the current situation of blood glucose level.Low carbohydrate diet may benefit type 2 diabetic patients， but it is still controversial.Objective　To evaluate the effects of a 30% low-carbohydrate diet on patients with type 2 diabetes.Methods　During period between May 2017 and October 2018，32 patients with type 2 diabetes mellitus who did not have history of using insulin were selected from the Department of Clinical Nutrition of the Second Affiliated Hospital of Guangzhou Medical University.Selected patients were prescribed with a 30% low-carbohydrate dietary intervention for six months.Patients were monitored for body mass index（BMI），fasting insulin（INS），fasting blood glucose（FBG），2 h postprandial blood glucose（2 hPG），glycosylated hemoglobin（HbA1c），total cholesterol（TC），triglyceride（TG），high-density lipoprotein cholesterol（HDL-C），and low-density lipoprotein cholesterol（LDL-C） before and at third and sixth months of the intervention.The number of patients with reduction and withdrawal of drug usage after six months of intervention were obtained.Results　A total of 30 patients with type 2 diabetes completed the 6-month low-carbohydrate diet with a completion rate of 93.8%（30/32） and a withdrawal rate of 6.2%（2/32）.The difference of BMI，FBG，2 hPG，HbA1c，TG and LDL-C before and after the intervention were statistically significant（P<0.05）.Further pair-wise comparison showed that BMI，FBG，2 hPG，HbA1c，TG and LDL-C decreased significantly after three and six months of dietary intervention（P<0.05）.Compared with those at three months after intervention，the levels of FBG，2 hPG，HbA1c and TG decreased significantly at 6 months after intervention（P<0.05）.After six months of intervention，10（52.6%） patients reduced their drug intake while 1（5.2%） patient withdrew drug intake among 19 patients who were taking oral hypoglycemic drugs，so the total reduction/withdrawal rate was 57.9%（11/19）.Conclusion　The three and six months of low-carbohydrate dietary（30% of total energy intake） intervention can significantly improve blood sugar and lipids levels of patients with type 2 diabetes but without history of using insulin.Moreover，the reduction or withdrawal rate of diabetes drugs is significant.Additionally，good compliance is observed with this dietary intervention.All these indicate that this method is worth for further long-term implementation and observation.

Application of Intra-hospital + Home-based Continuous Cardiac Rehabilitation Model in Patients with Acute Myocardial Infarction after Emergency Coronary Intervention　

ZHAO Dongjing，TANG Wei，CAO Shujun，SUN Pengyu，HU Shuoqiang，TONG Zichuan

2020, 23(16): 2034-2039. DOI: 10.12114/j.issn.1007-9572.2020.00.058

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Background　At present，the participation rates of phaseⅡ outpatient cardiac rehabilitation both at home and abroad are low.Foreign studies have shown that the clinical benefits of home-based cardiac rehabilitation are equivalent to that of outpatient cardiac rehabilitation，and are reliable and safe.However，there are few researches on home-based cardiac rehabilitation in China.Objective　To explore the effect of intra-hospital+home-based continuous cardiac rehabilitation model on patients with acute myocardial infarction after percutaneous coronary intervention（PCI）.Methods　From June in 2018 to February in 2019，80 patients with acute myocardial infarction who were hospitalized in the Department of Cardiovascular Medicine of Daxing Teaching Hospital of Capital Medical University and underwent emergency PCI were selected as the study objects.The subjects were divided into observation group（n=40） and control group（n=40） according to the method of random number table.The observation group adopted intra-hospital+home-based continuous cardiac rehabilitation model for three months，and the control group was intervened by routine intervention for three months.The body mass index（BMI），blood pressure，total cholesterol（TC），low-density lipoprotein cholesterol（LDL-C），6-minute walk distance（6MWD），left ventricular ejection fraction（LVEF） and smoking status were compared between the two groups at admission and three months after intervention.According to the results of 6-min walk test before discharge，the patients in the observation group and the control group were divided into 6MWD≥400 m group and 6MWD<400 m group，and the 6MWD before and after the intervention was further compared between the two groups.Results　There was no significant difference in blood pressure，TC，LDL-C，LVEF and BMI between the two groups at admission（P>0.05）.There was no significant difference in 6MWD between the two groups before discharge（P>0.05）.The systolic blood pressure，diastolic blood pressure，TC，LDL-C and BMI in the observation group after three months of intervention were lower than those before the intervention，6MWD in the observation group after three months of intervention was higher than those before the intervention.The TC，BMI in the control group after three months of intervention were lower than those before the intervention，6MWD in the control group were longer than those before the intervention（P<0.05）.After three months of intervention，TC，LDL-C and 6MWD in the observation group were higher than those in the control group with a statistically significant difference（P<0.05）.The difference value of TC，LDL-C，BMI and 6MWD in the observation group before and after the intervention were higher than those in the control group（P<0.05）.The rate of quitting smoking was 70.6%（24/34） in the observation group and 39.4%（13/33） in the control group after three months of intervention，and the difference was statistically significant（P=0.010）.There was no significant difference in 6MWD between 6MWD≥400 m groups in the observation group and the control group at discharge and three months after intervention（P>0.05）.The 6MWD in the two groups increased significantly after three months of intervention（P<0.05）.The 6MWD between 6MWD<400 m groups in the observation group and the control group after three months of intervention was significantly longer than that at discharge（P<0.05）.The 6MWD in the observation group was significantly longer than that in the control group after three months of intervention（P<0.05）.Conclusion　The intra-hospital and home-based continuous cardiac rehabilitation model is beneficial for patients with acute myocardial infarction after PCI to control risk factors（blood pressure，blood lipid，smoking and BMI），change behavior and improve daily physical activity ability，especially for patients in the 6MWD<400 m groups.

Blood Pressure Characteristics of Residents Based on Accurate Pressure Measurement　

ZHOU Feng，CAI Huiyong，GAO Jiabao，REN Ling，DING Lijin

2020, 23(16): 2040-2043. DOI: 10.12114/j.issn.1007-9572.2019.00.592

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Background　Accurate manometry was introduced in Dapuqiao Community Health Service Center of Huangpu District in Shanghai in April 2018，that is，community residents were guided by volunteers to use internationally certified automatic blood pressure meter for blood pressure measurement.The analysis of accurate pressure measurement results is of great significance for judging whether the technique is worth popularizing and applying in the community.Objective　To analyze the data characteristics of blood pressure by accurate pressure measurement in order to provide the basis for the application and promotion of accurate pressure measurement technology.Methods　The data used in this paper were from the health management information system and manometric data storage system of the Center for Disease Control and Prevention in Huangpu District of Shanghai.In September 2018，demographic information and accurate manometric results of community residents who received accurate manometry at Dapuqiao Community Health Service Center of Huangpu District in Shanghai were collected from May 1，2018 to August 14，2018.Relevant data of 4 686 community residents were obtained.Results　The number at the end of values of systolic and diastolic blood pressures measured accurately ranged from 0 to 9，and the proportion of each number at the end of values of data was concentrated at 9.65% to 10.32%.Among 945 community residents without history of hypertension，the abnormal blood pressure rate was 15.66%（148/945）．The abnormal blood pressure rate of male was higher than that of female（P<0.05），and the abnormal rate of blood pressure increased with age（P<0.05）.Among 3 741 community residents with history of hypertension，the control rate was 72.55%（2 714/3 714）.The control rate of male was lower than that of female（P<0.05），and the difference of the control rate of blood pressure among all age groups was with statistical significance（P<0.05）.A total of 1 131 community residents participated in double arm measurements.The systolic and diastolic pressure of right upper arm were higher than those of the left upper arm（P<0.05）；the difference rate of systolic blood pressure between the left and right arms was 35.63%（403/1 131），and the difference of diastolic blood pressure was 6.90%（78/1 131）.The difference rate of systolic blood pressure obtained from the right upper arm first was higher than that from the left upper arm first（P<0.05）.Conclusion　The number at the end of values of blood pressure by accurate pressure measurement is evenly distributed.The application of accurate pressure measurement in the community residents with or without history of hypertension reflects the general rule of blood pressure distribution，and it can recognize the difference between left and right arms，which has important guiding significance in the screening and management of hypertension and the prevention of hypertension complications.

Correlation between Severity of Chronic Obstructive Pulmonary Disease and Skeletal Muscle Malnutrition　

LI Hongyue，WEN Youfeng，LIAN Jie，PAN Dianzhu

2020, 23(16): 2044-2050. DOI: 10.12114/j.issn.1007-9572.2020.00.088

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Background　Chronic obstructive pulmonary disease（COPD） is one of the world's leading lethal chronic diseases，which continues to the increase of global economic burden.Skeletal muscle malnutrition，as one of the common complications of COPD，seriously affects patient's quality of life and prognosis，but the research on its mechanism，prevention and treatment is currently incomplete.Objective　To explore the correlation between the severity of COPD and skeletal muscle malnutrition.Methods　From September in 2017 to June in 2019，205 COPD patients who treated in the First Affiliated Hospital of Jinzhou Medical University were selected as the case group，and 125 healthy people who underwent physical examination at the same period were selected as the control group（gender and age matched to case group）.Various body composition indexes and pulmonary function after diastole were measured in two groups.Univariate analysis was used to compare the body composition indexes of two groups.Pearson correlation analysis and Spearman's rank correlation were used to explore the correlation between percentage of forced expiratory volume in 1 second（FEV1%） predicted，inspiratory capacity and total lung capacity ratio（IC/TLC），and various body composition indexes.Results　The BMI，fat-free mass（FFM），total muscle mass，trunk muscle mass，double upper limb muscle mass，double lower limb muscle mass，limb muscle mass，grip strength，skeletal muscle index，and fat-free BMI of male patients with COPD were lower than those of male patients in control group（P<0.05）.Female patients with COPD had lower BMI，FFM，total muscle mass，trunk muscle mass，double upper limb muscle mass，double lower limb muscle mass，limb muscle mass，grip strength，skeletal muscle index，and fat-free BMI than females in the control group（P<0.05）.The correlation analysis showed that IC/TLC had positive correlation with FFM，total muscle mass，trunk muscle mass，double upper limb muscle mass，double lower limb muscle mass，limb muscle mass，grip strength，skeletal muscle index，and fat-free BMI in male COPD patients（P<0.05），and IC/TLC had positive correlation with BMI，FFM，total fat mass，total muscle mass，trunk muscle mass，double upper limb muscle mass，double lower limb muscle mass，limb muscle mass，grip strength，skeletal muscle index，fat-free BMI，and fat BMI in female COPD patients（P<0.05）.Except that FEV1% in male COPD patients had a linear positive correlation with grip strength（P<0.05），FEV1% had no correlation with other body composition indexes in male and female COPD patients（P>0.05）.Conclusion　BMI，FFM，muscle mass，and grip strength of COPD patients are lower than those of healthy people.Body composition indexes of COPD patients are not related to FEV1%，but have significant correlation with IC/TLC，another index that reflects the severity of the disease.

Clinical Effect of Ginger and Citri Reticulatae Stomach-warming Ointment Combined with Tropisetron and Dexamethasone in Preventing Chemotherapy-induced Nausea and Vomiting　

JIANG Mei，ZHOU Daihan，GUO Ran，ZHANG Jing，ZHANG Qilu

2020, 23(16): 2051-2056. DOI: 10.12114/j.issn.1007-9572.2020.00.177

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Background　Chemotherapy-induced nausea and vomiting（CINV） is one of the common adverse reactions in the treatment of tumors.Acupoint application，as a characteristic therapy of traditional Chinese medicine，can play a certain role in the prevention and treatment of CINV.The study on acupoint application in preventing CINV is of great significance for improving the quality of life of cancer patients during chemotherapy.Objective　To explore the clinical efficacy of acupoint application of ginger and citri reticulatae stomach-warming ointment combined with Tropisetron and Dexamethasone in preventing CINV.Methods　A total of 140 patients with chemotherapy of gastrointestinal tumors who were hospitalized in the Department of Oncology in the First Affiliated Hospital of Guangzhou University of Chinese Medicine and the General Hospital of Guangzhou Military Region were selected as the study objects from May to December in 2018.They were divided into the ginger and citri reticulatae stomach-warming ointment group（75 cases） and the control group（65 cases） using the random number table method（excluding those were unable to continue the study before the first chemotherapy）.In the follow-up process，10 cases in ginger and citri reticulatae stomach-warming ointment group and 4 cases in control group dropped out.The control group received the conventional CINV prevention plan（intravenous injection of tropisetron and dexamethasone） during chemotherapy，and the other group was added with acupoint application of ginger and citri reticulatae stomach-warming ointment on the basis of conventional prevention plan.Nausea and vomiting and related adverse reactions were recorded daily from the first day to the fifth day of chemotherapy.The EORTC core quality of life questionnaire（QLQ-C30） was used to evaluate the quality of life on the fifth day of chemotherapy.Results　There was no significant difference in the effective control rate （ORR） of CINV between ginger and citri reticulatae stomach-warming ointment group and control group（98.5% vs 91.2%，P=0.10）.The ORR of delayed CINV in the ginger and citri reticulatae stomach-warming ointment group was higher than that in the control group（100.0% vs 81.3%），and the difference was statistically significant（P=0.02）.The incidence of vomiting in ginger and citri reticulatae stomach-warming ointment group was lower than that in the control group with a statistically significant difference on the second，third and fourth days （P<0.05）.The incidence of nausea in ginger and citri reticulatae stomach-warming ointment group was lower than that in the control group from the first day to the fifth day（P<0.05）.The overall quality of life of the patients in ginger and citri reticulatae stomach-warming ointment group was significantly improved compared with the control group（P<0.05），which was mainly manifested in fatigue and gastrointestinal symptoms such as nausea and vomiting，loss of appetite，diarrhea，and constipation（P<0.05）.However，there was no significant difference in the utilization rate of salvage treatment between the two groups（P>0.05）.Conclusion　The acupoint application of ginger and citri reticulatae stomach-warming ointment combined with Tropisetron and Dexamethasone is effective for delayed CINV.It can relieve fatigue and gastrointestinal symptoms and improve the overall quality of life of patients，which can be further studied and promoted.

Current Situation of Doctor-patient Communication Competence Training Based on the Post Competency of General Practitioners and Corresponding Countermeasures　

PANG Jianxin，WANG Yongchen

2020, 23(16): 2057-2061. DOI: 10.12114/j.issn.1007-9572.2019.00.701

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Doctor-patient communication competence is the essential quality of general practitioners（GPs）.Good communication between doctors and patients is not only the basis of patients' trust but also an important guarantee for the smooth implementation of GPs' community health service.At present，the influence of communication competence on doctor-patient relationship has attracted more and more attention and the training for doctor-patient communication competence has become one research focus.However，the increasingly tension of doctor-patient relationship indicates that the communication between doctors and patients is still not satisfactory.Therefore，this paper illustrates the current situation of training for doctor-patient communication competence at home and abroad，and emphasizes the necessity of improving the doctor-patient communication competence among GPs.Moreover，this paper draws on relevant foreign experience to explore concrete measures to improve the doctor-patient communication competence of GPs，such as setting up communication courses，applying various training forms，and strengthening the assessment of doctor-patient communication competence，in order to provide the theoretical reference for the education and training of doctor-patient communication competence of GPs in China.

Effect of ISBAR Communication Training Model on Communication Skills and Teamwork Ability of General Practitioners Participating in Standardized Residency Training　

CAO Meng，WANG Tao，ZHAI Qianqian，QIN Yan

2020, 23(16): 2062-2066. DOI: 10.12114/j.issn.1007-9572.2019.00.700

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Background　One of the training objectives of the Standardized Residency Training is good communication and cooperation，so it is of great importance to improve the communication awareness and skills and teamwork ability of residents participating in the Standardized Residency Training.ISBAR communication training model has been proved that it could effectively improve the communication skills and teamwork ability of doctors in clinical settings，so it is theoretically feasible to apply this communication training model to the Standardized Residency Training.Objective　To explore the effect of ISBAR communication training model on the interpersonal communication skills and teamwork ability of general practitioners participating in the Standardized Residency Training.Methods　A total of 100 general practitioners who participated in the Standardized Residency Training in the First Affiliated Hospital of Xinxiang Medical University in September 2017 were randomly selected and divided into observation group（n=50） and control group（n=50） by simple random grouping method.General practitioners in the control group were trained by traditional clinical education model，whereas based on this model general practitioners in observation group were also trained by ISBAR communication training model.The Interpersonal Communication Ability Evaluation Scale and Teamwork Ability Evaluation Scale were used to assess general practitioners in the two groups before and after two weeks of training.The Attitudes towards Cooperation between Doctors and Nurses Scale and Attitudes towards Cooperation among Doctors Scale were used to assess general practitioners in the two groups before and after three and six months of training.The Interpersonal Communication Ability between Doctors and Nurses Questionnaire and Interpersonal Communication Ability among Doctors Questionnaire were used to survey the medical workers who cooperated with the general practitioners in two groups.Results　There were no statistical differences in the scores of interpersonal communication ability and teamwork ability between two groups before the training（P>0.05）.After two weeks of training，the scores of interpersonal communication ability and teamwork ability in both two groups were higher than those before the training（P<0.05），and the scores of interpersonal communication ability and teamwork ability in the observation group were higher than those in the control group（P<0.05）.There were significant differences in the scores of attitudes towards cooperation and communication ability between doctors and nurses（P<0.05）.The differences were statistically significant at different time points（P<0.05）.Groups and time had notable interaction effect on the scores of attitudes towards cooperation and communication ability between doctors and nurses（P<0.05）.There were significant differences in the scores of attitudes towards cooperation and communication ability among doctors（P<0.05）.The differences were statistically significant at different time points（P<0.05）.Groups and time had notable interaction effect on the scores of attitudes towards cooperation and communication ability among doctors（P<0.05）.Conclusion　Applying ISBAR communication training model during the Standardized Residency Training may significantly improve the interpersonal communication skills and teamwork ability of general practitioners.

The Effect of Reform Measures in Primary Health Care on the Effectiveness of Diabetes Management in China　

JIANG Wei，ZHANG Yanchun，DONG Yali，LI Xinfang，QIN Jiangmei

2020, 23(16): 2067-2071. DOI: 10.12114/j.issn.1007-9572.2020.00.345

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Background　The effect of innovative reform measures in primary health care on the management effectiveness of patients with chronic diseases is a matter widely concerned by policymakers，executors and researchers，especially measures as grassroots informatization construction and contracted family doctor services carried out in the past three years.Objective　To explore the effect of grassroots health reform measures such as contracted family doctor services and the application of information technology on the effectiveness of diabetes management，in order to provide recommendations for improving the management of patients with diabetes at grassroots level.Methods　According to the principle of combining purposive sampling and random sampling，658 diabetic patients were selected from 7 community health service centers in 4 cities of 3 provinces in the eastern，central，and western regions of China from August to October in 2018.The data of social demography，health behaviors and acceptance of primary health care reform measures were investigated，among which indicators for primary health care reform measures included whether patients were embedded in the outpatient reimbursement system for chronic diseases，whether they had contracted with family doctors，whether they made appointments for treatment at different period of time，whether they had received Internet plus follow-up，whether they had received cardiovascular and cerebrovascular risk assessment，and whether they had received telemedicine and electronic pill box reminder service.Multivariate Logistic regression was used to analyze the factors influencing blood glucose control in diabetic patients.Results　The glycemic control rate was 43.9%（289/658）.The results of multivariate Logistic regression analysis showed that age，education level，city，medication compliance，whether to contact with a family doctor，and whether to have cardiovascular and cerebrovascular disease risk assessment were influencing factors of the blood glucose control in diabetic patients（P<0.05）.Among them，the glycemic control rate of the patients with university education and above was 2.531 times higher than that of those without schooling〔95%CI（1.147，5.582）〕；the glycemic control rate of patients in Kunshan was 1.822 times higher than that of patients in Changzhou〔95%CI（1.049，3.167）〕；the glycemic control rates of patients who missed the medication occasionally according to the instructions and took medication strictly according to doctor's orders were 3.363 times〔95%CI（1.314，8.610）〕 and 3.876 times〔95%CI（1.629，9.220）〕 higher than that of those who never took the medicine，respectively；the glycemic control rate of patients with contracted family doctors was 2.466 times higher than that of those without contracted family doctors〔95%CI（1.523，3.991）〕；the glycemic control rate of patients who had received the risk assessment of cardiovascular and cerebrovascular diseases was 2.334 times higher than that of patients who had not receive the risk assessment〔95%CI（1.363，3.999）〕.Patients with contracted family doctors had better medication compliance than those without contracted family doctors，and a higher proportion of receiving the risk assessment of cardiovascular and cerebrovascular diseases（P<0.05）.Conclusion　Primary health care reform measures，such as contracted family doctor services and innovative technologies of Internet plus，have shown the effect in the management of diabetic patients，and they mutually promote each other.The information technology led by grassroots medical staff is more likely to play an important role in the healthcare reform，so it is suggested to further promote it.

The Content Construction of Dementia Management in Community Based on Delphi Method　

ZHANG Haina，WANG Meirong，CHEN Xiaolei，XU Xiaojingyuan，LI Jing，WANG Huali，DU Juan

2020, 23(16): 2072-2079. DOI: 10.12114/j.issn.1007-9572.2020.00.031

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Background　With the aging of the population being intensifying，dementia has become a major public health problem worldwide.Many countries have gradually attached importance to the role of primary care and emphasized the importance of general practitioners in the early identification of dementia and its follow-up management.Some countries in the world have established guidelines and consensus on the management of dementia in community，while there are still no guidelines or consensus on community dementia management for general practitioners in China currently.Objective　To explore the content construction of dementia management in community health service institutions，in order to provide evidence for future dementia management in community.Methods　From August 2018 to January 2019，the core group of the project was first established to initially formulate indicators for the community management of dementia.And then 28 experts including general practitioners and nurses were selected from the Department of Neurology，Department of Psychiatry，Department of Geriatrics，General Department，and communities.After two rounds of expert consultation using the Delphi method，the authoritative degree，coordination coefficient and positive coefficient were applied for evaluation，and finally the indicator system of the content of dementia management in community was established.Results　The positive coefficients of the experts in two rounds of consultation were 100%，and the mean authoritative degree of first-level indicators was 0.729.The expert coordination coefficients of the importance of evaluation indicators in two rounds of consultation were 0.130 and 0.179（P<0.01），and the expert coordination coefficients of the feasibility were 0.195 and 0.207（P<0.01）.The indicator system of the content of dementia management in community included two first-level indicators，seven second-level indicators，and 20 third-level indicators.The two first-level indicators were the identification and screening of dementia and its follow-up management.The seven second-level indicators were the screening for cognitive performance，the assessment through cognitive screening scale，the referral during screening，the frequency of follow-ups，the content of clinical follow-ups，the scale assessment，and the referral during follow-up.Conclusion　Experts have a high degree of enthusiasm and authority，and after two rounds of consultation，the opinions of experts tend to be consistent.The opinions of experts are in good coordination and the results are credible.The content of dementia management in community constructed by Delphi method provides reference for the future community management of dementia.

Exercise Status of Elderly Patients with Type 2 Diabetes and Its Influencing Factors in Community　

WANG Zhuo，YE Tong，LIU Huihui

2020, 23(16): 2080-2084. DOI: 10.12114/j.issn.1007-9572.2019.00.190

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Background　Physical exercise plays an important role in the comprehensive management of patients with type 2 diabetes.However，there are few studies on the exercise status of diabetic patients in China，especially the investigation on the exercise status of elderly patients with type 2 diabetes.Objective　To investigate the exercise status of elderly patients with type 2 diabetes in community，and analyze its influencing factors so as to provide a basis for formulating targeted interventions.Methods　A convenient sampling method was used to select elderly patients with type 2 diabetes who were treated at Xiaobailou Street Community Health Service Center of Heping District of Tianjin from June to September in 2017.A General Information Questionnaire and an Exercise Assessment Scale for Elderly Patients with Diabetes were used.A total of 230 questionnaires were distributed and 224（97.4%） valid questionnaires were recovered.Results　The mean score of exercise was（116.70±8.24）.The mean scores of items in five dimensions of exercise knowledge，exercise willingness，exercise behavior，social support，and professional support were（4.12±0.35），（3.44±0.38），（2.93±0.70），（2.89±0.71），and（2.59±0.67），respectively.Multivariate linear stepwise regression analysis showed that BMI，main source of life，number of children，family history of diabetes，duration of diabetes，the occurrence of hypoglycemia，and the presence of osteoarthropathy were main factors influencing the exercise status of elderly patients with type 2 diabetes in community（P<0.05）.Conclusion　The professional support and social support of exercise is poor in elderly patients with type 2 diabetes in community.Both living conditions and illness conditions will affect their exercise status.The medical staff，patients' family members and the community should strengthen the importance of exercise in the prevention and control of diabetes，and provide targeted and professional health guidance for different individuals.At the same time，the corresponding help and support should be provided to improve the quality of life of patients.

Research Advances in Right Ventricular Dysfunction in Heart Failure with Preserved Ejection Fraction　

GOU Chunli，LIU Yongming

2020, 23(16): 2085-2089. DOI: 10.12114/j.issn.1007-9572.2020.00.113

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Right ventricular dysfunction（RVD） has been widely confirmed and recognized in heart failure with reduced ejection fraction（HFrEF），but it has not been paid much attention and made description in heart failure with preserved ejection fraction（HFpEF）.Studies in recent years have shown that RVD accounts for a large proportion of HFpEF and is independently associated with poor prognosis in heart failure.In addition，comorbidities such as pulmonary hypertension and atrial fibrillation，type 2 diabetes，hypertension and coronary heart disease are pathogenic or contributing factors of RVD，and are also associated with poor clinical prognosis of heart failure.Meanwhile，improved recognization of the interaction between the right and left ventricular is crucial to further understand RVD.This article reviews the prevalence of RVD and the relationship between RVD and multiple comorbidities and the left ventricular in HFpEF，in order to provide guidance for clinical intervention and treatment decision-making though the assessment of right ventricular function in patients with HFpEF.
Heart failure；Heart failure with preserved ejection fraction；Right ventricular dysfunction；Prevalence；Comorbidity；Review

Research Progress on the Relationship between Stroke Environment and Social Participation　

WANG Wenna，ZHANG Leyun，FU Bo，LIN Beilei，ZHANG Zhenxiang

2020, 23(16): 2090-2094. DOI: 10.12114/j.issn.1007-9572.2020.00.086

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Stroke is a serious threat to the health of residents globally，and eliminating or reducing environmental barriers may have a rapid and positive impact on the social participation of patients.This paper introduces the related concepts and assessment tools of stroke environment and social participation，summarizes the research progress of the relationship between stroke environment and social participation，and finds that the stroke environment is closely related to the social participation of patients.However，the specific relationship between stroke environment and social participation still needs to be further explored.The future research should pay attention to and optimize the stroke environment，so as to improve the level of social participation of community stroke patients，and then promote patients' rehabilitation.

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