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June 2020, Volume 23,No18 Abstracts(B)

Effectiveness of Family Doctor-led Team-based Early Kidney Disease Management in Elderly People with Chronic Kidney Disease CHEN Liang,ZHANG Weiwei*,LI Qiang
Anting Town Huangdu Community Health Center,Shanghai 201804,China
*Corresponding author:ZHANG Weiwei,Attending physician;E-mail:zhangyuyicheng@163.com
【Abstract】 Background At present,chronic kidney disease (CKD) has become one of the diseases that seriously threaten human health.Early detection,diagnosis and treatment of CKD,prevention and treatment of various reversible factors and delay of progression of kidney disease,are the problems that medical workers must face.Objective To explore the effect of family doctor-led team-based early kidney disease management in elderly CKD patients.Methods From November to December 2017,by the lottery number drawn subjectively,400 eligible patients with confirmed early CKD were selected from Huangdu Community Health Center,and were equally divided into control group(routine examination) and intervention group(family doctor-led team-based early kidney disease management,including health education,health management,individualized drug treatment and regular examination) by tossing a coin.The intervention for both groups lasted for 18 months.Comparisons were made between pre- and post-intervention anthropometry indices 〔body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP)〕 and blood biochemical indicators 〔(fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),serum creatinine (Scr),blood urea nitrogen (BUN),serum uric acid (SUA),estimated glomerular filtration rate (GFR),urine albumin(ALB),urine creatinine (Ucr),total cholesterol (TC),triglyceride (TG),high-density lipoprotein (HDL),and low-density lipoprotein (LDL)〕.End of June 2019,the end-point events (including all-cause death,all-cause hospitalization and dialysis) of patients were recorded.Results Except that,1 case in the intervention group and 2 cases in the control group were lost to follow up,other cases were included in the final analysis.After intervention,the intervention group showed lower mean levels of BMI,SBP,DBP,FPG,HbA1c,Scr,BUN,SUA,ALB,Ucr,TC,TG,and LDL,and higher mean levels of GFR and HDL than the control group (P<0.05).Mean levels of BMI,SBP,DBP,FPG,HbA1c,Scr,BUN,SUA,ALB,Ucr,TC,TG,and LDL decreased significantly and mean levels of GFR and HDL increased significantly in the intervention group compared with baseline levels(P<0.05).By the end of June 2019,37 patients(9.3%) had end-point events,including 4 all-cause deaths (1 due to respiratory failure and 3 due to heart failure).20 patients were hospitalized for all causes,mainly due to the deterioration of basic diseases,poor blood pressure and blood glucose control,and the onset of cardiovascular diseases.Dialysis was performed in 13 patients.The intervention group had higher all-cause hospitalization rate,but lower all-cause mortality rate and dialysis rate than the control group (P<0.05).Conclusion Family doctor-led team-based early kidney disease management has a good effect in elderly CKD patients,which is manifested as improving the blood biochemical indices,reducing the all-cause mortality and dialysis rate,and enhancing the quality of life.
【Key words】 Chronic disease;Nephrosis;General practitioners;Community health centers;Management model
 
Preference and Influencing Factors of Community Home-based Elderly Care in Community-living Elderly People in Nanning XU Mingjiang1,ZHAO Yunxian2,YOU Jianpeng1*,WANG Biyan1,LI Zhao3
1.Guangxi University of Chinese Medicine,Nanning 530200,China
2.Faculty of Chinese Medicine Science Guangxi University of Chinese Medicine,Nanning 530200,China
3.Xiamen University,Xiamen 361005,China
*Corresponding author:YOU Jianpeng,Professor,Chief physician;E-mail:yjp2816600@163.com
【Abstract】 Background Community home-based elderly care is expected to become the most appropriate choice for the elderly because it makes up for the shortage of institute-based elderly care.Accurate identification of the needs of community home-based elderly care may help the government to provide targeted and focused elderly services for special groups.Objective To explore the demand of community home-based care and influencing factors in Nanning based on the demand-side perspective.Methods From March to May 2019,a cross-sectional survey was conducted in Nanning City among a convenience sample of 505 community-dwelling elderly individuals(≥60 years old) who were eligible for the study.A self-made questionnaire consisting of 3 major aspects〔demographic data,demands for community home-based elderly care,choice of elderly care(home-based elderly care,community home-based elderly care,and institution-based elderly care)〕 was used in the survey,and was completed by the participants with the assistance of the investigators using a question-and-answer approach.For ease of exploring the influencing factors of the intention of choosing community home-based elderly care,home-based care was included into community home-based elderly care.Results A total of 505 sets of questionnaires were distributed,and 486 responsive ones were collected,with a response rate of 96.2%.Among the 486 respondents,91.3%(444/486) did not know whether there was a home-based elderly care center or day-care center in their own community,53.1%(258/486) knew whether there was a community health center in their own community,54.7%(266/486) were not aware of the daily care services provided by the community health center in their own community,34.0%(165/486) knew that the community health center could provide diagnostic and therapeutic services.41.3%(201/486) expected to be provided with expanded activity venues and increased elderly care services,and 39.3%(191/486) did not need any community-based daily care services,66.7%(324/486) expected to be provided with community-based medical examination,rehabilitation,and elderly care services,60.0%(292/486) expected to be provided with community-based health counseling and health guidance,48.0%(233/486) expected to be provided with home-based medical care and medication care.60.9%(296/486) of the elderly chose home-based elderly care,followed by community home-based elderly care,accounting for 20.0%(97/486),and 19.1%(93/486) of the elderly chose institutional pension.Those chose institution-based elderly care accounted for the least〔19.1%(93/486)〕.Education level 〔high school or special(or technical) secondary school:OR=3.379,95% CI(1.307,9.802),second- or three-year college and above level:OR=3.955,95% CI(1.508,10.371)〕,occupation before retirement〔OR=5.097,95% CI(2.382,10.908)〕,number of children 〔 two:OR=8.198,95% CI(2.982,22.537),more than three:OR=3.607,95% CI(1.521,8.552)〕,self-care situation 〔complete dependence:OR=4.165,95% CI(1.570,11.050)〕 and care situation 〔nanny care:OR=0.046,95% CI(0.010,0.209)〕 were the influencing factors associated with the choice of community home-based elderly care(P<0.05).Conclusion In Nanning,home-based elderly care is still the first choice for urban elderly people and those choosing community home-based elderly care is increasing,and it seemed that community home-based elderly care may become a major elderly care form.Good economic conditions(high education and having an occupation before retirement),good family support conditions(living with the spouse and having multiple children),and poor health status are associated with the choice of community home-based elderly care.
【Key words】 Health services for the aged;Community home-based elderly care;Way of old-age care;Influencing factors
 
Prevalence and General Practice-based Interventions of Hypertension:a Community-based Study in Haikou ZENG Wangyuan1,ZHOU Suyun2,GU Shenhong1*
1.Department of General Practice,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China
2.Department of General Practice,Haikou People's Hospital,Haikou 570208,China
*Corresponding author:GU Shenhong,Professor,Chief physician;E-mail:1574063710@qq.com
ZENG Wangyuan and ZHOU Suyun are co-first authors
【Abstract】 Background In China,hypertension prevalence is increasing,and hypertension-related cardiovascular and cerebrovascular diseases have become the leading causes of death.However,the rates of hypertension awareness,treatment and control are relatively low in residents.Moreover,hypertension problems have imposed great burden on the government and residents.So it is necessary to carry out efficient and inexpensive hypertension-related prevention and treatment interventions.Objective To analyze hypertension control,antihypertensive medication status,and responses to general practice care in hypertensive patients from Haikou communities based on analyzing hypertension management data of community health centers in Haikou,providing a theoretical basis for promoting community-based prevention and treatment of hypertension in this area.Methods Data were collected from 4 community health centers(Dayuan Community Health Center,Jinpan Community Health Center,Binhai Community Health Center,and Jinmao Community Health Center) in Haikou.And from he health records system of these centers,a simple random sample of 200 cases were selected(50 from each center) out of those who lived in the communities within the serving areas of the above-mentioned health centers during August 2017 to January 2018,with health records documenting,hypertension management and follow-up data,and without interventions from hypertension trials.They were equally randomized into test group and control group,treated with 6-month general practice-based interventions and self-management interventions,respectively.Demographic characteristics (including gender,age,education level,family history of hypertension,cardiovascular and cerebrovascular complications,medications,and approaches for medications),hypertension control,and medication type and regimen were collected.Post-intervention effect was evaluated by hypertension control,BMI,medication compliance,correction of unhealthy life habits,and satisfaction with general practice care.Results Hypertension control status differed significantly by family history of hypertension,cardiovascular and cerebrovascular complications,medication,and administration method(P<0.05).The most commonly used antihypertensive monotherapy was calcium channel blockers,followed by β-receptor blockers,angiotensin Ⅱreceptor blockers,compound preparations,angiotensin converting enzyme inhibitors and diuretics.For combined use,β-receptor blockers + calcium channel blockers were the primary combination,followed by angiotensin Ⅱ receptor blockers + calcium channel blockers,calcium channel blockers + angiotensin converting enzyme inhibitors.After intervention,compared with the control group,test group had higher hypertension control rate(P<0.05),lower average BMI(P=0.004),and greater improvements in correcting unhealthy habits such as heavy drinking,little exercise and high-salt diet(P<0.05).Moreover,test group showed higher average level of satisfaction with general practice care(P<0.05),because they spent sufficient time on communicating with the physicians,based on which the physicians provided comprehensive preventive,diagnostic and/or therapeutic services(including the explanation of the purposes of examination and treatment),and were willing to listen to patients' opinions about their own regimens.Conclusion The control rate of hypertension in the communities in Hainan is still not ideal.Rational use of antihypertensive drugs should be improved.General practice-based interventions are beneficial to controlling hypertension.
【Key words】 Hypertension;Health education;Community health centers;Intervention studies;General practice
 
Outpatient Consultation Skills in General Practices in the UK YAN Hongmei1,JIANG Yue2,3*,LI Tianzi4
1.Changying Community Health Center,Beijing 100024,China
2.Gaobeidian Community Health Service Center,Chaoyang District,Beijing 100124,China
3.School of General Practice and Continuing Education,Capital Medical University,Beijing 100069,China
4.Beijing Chao-yang Hospital,Capital Medical University,Beijing 100020,China
*Corresponding author:JIANG Yue,Chief physician;E-mail:redtealook9@sina.com
【Abstract】 Outpatient consultation is the most important part of a diagnostic and therapeutic process in general practice,whose quality reflects the professional ability of the general practitioner.It is also an important aspect of research in general practice.We analyzed the dialogue in a demonstrated outpatient consultation and the whole process in a general practice in the UK using a step-by-step approach,and summarized the results,concluding that the consultation is patient-centered,complete and efficient,and it also reflects the high quality of the general practitioner.
【Key words】 General practitioners;General practice;Interviewing;Consulting skills
 
Granulomatosis Polyangiitis with Diffuse Alveolar Hemorrhage:a Case Report and Literature Review LU Cui1,SU Yutong2,TENG Jialin2,YANG Chengde2,YE Junna2*
1.Department of Hematology and Rheumatology,Shanghai Songjiang District Central Hospital,Shanghai 201600,China
2.Department of Rheumatology and Immunology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China
*Corresponding author:YE Junna,Attending physician;E-mail:yjn0912@qq.com
【Abstract】 Background Granulomatous polyangiitis(GPA)is a rare systematic disease that mainly affects the upper respiratory tract,lung and kidney.Diffuse alveolar hemorrhage(DAH)is a rare manifestation of the disease.Once it occurs,the situation is critical with a high mortality rate.Objective To investigate the clinical manifestations,laboratory and imaging features,diagnosis and treatment as well as prognosis of GPA with DAH,enhancing clinicians' understanding of this disease to perform a diagnosis and deliver appropriate treatment early to improve the patient prognosis.Methods The clinical data of a GPA patient with DAH admitted to Department of Rhrumatology and Immunology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,was reviewed and analyzed.Besides,publicly published reports on GPA or GPA with DAH during January 1980 to February 2019 were retrieved from electronic databases of Wanfang Data Knowledge Service Platform,CNKI,and PubMed using "Wegener,vasculitis,granulomatous polyangiitis,pneumorrhagia,and alveolar hemorrhage" as keywords.Results 12 cases were reported,combined with our case,there were 13 cases of GPA with DAH,including 7 males and 6 females,with an average age of(38.6±19.3)years,and an average duration of(72.1±62.7)days.Most of them were treated with high-dose intravenous corticosteroid pulse therapy combined with cyclophosphamide.The rate of mortality was 23.1%(3/13).Commonly seen clinical manifestations were cough(83.3%),dyspnea(83.3%),and hemoptysis(42.7%).Chest X-rays or CT scans showed multiple patches,ground-glass opacities or bilateral diffuse alveolar infiltrates and consolidations.Bronchoscopy may show airway hemorrhage,and elevated number of hemosiderin-laden macrophages could be found in bronchoalveolar lavage fluid.Conclusion DAH is a rare manifestation of GPA,characterized mainly by dyspnea,cough,hemoptysis,rapid progress,and high mortality rate.Early treatment may improve the prognosis.
【Key words】 Vasculitis;Granuloma;Granulomatous polyangiitis;Hemorrhage;Pulmonary alveoli;Diffuse alveolar hemorrhage;Case reports

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