January 2014, Volume 17, No.1 Abstracts

Performance Evaluation of Urban Community Health Services with A Rough Set-based Approach

LI Li-qing,ZHOU Xiao-jun,LI Zhong-jie.Jiangxi Science & Technology Normal University,Nanchang 330031,China

    Abstract  Objective  To evaluate the performance of urban community health services in Nanchang city,Jiangxi,China.Methods  Data were collected from five administrative districts in the city of Nanchang.The performances of community health services in these five districts was assessed with a rough set reduction theory-based approach with weighed importance values calculated for key variables.Results  Qingyunpu district had the highest performance score,followed by Xihu district,Qingshanhu district,Donghu district,and Wanli district.Conclusion  The performance of community health services in the five administrative districts assessed objectively reflects the actual overall(including social-economic status) situations of these districts in Nanchang.It is urgently needed to promote the development of community health service system in a more harmonious and uniform fashion among various districts in Nanchang so as to better serve residents in the entire city.

    Key words  Community health services;Service performance evaluation;Rough set


Establishment of A Resident Satisfaction Evaluation Index System for Community Health Services

WANG Fei,CHI Mo-han,YUE Feng-lian,et al.Harbin Medical University,Harbin 150081,China

    Abstract  A resident satisfaction index system to evaluate community health services was developed based on the conceptual framework of the American Customer Satisfaction Index (ACSI).A set of questionnaire on resident satisfactions of community health services were designed.It is anticipated that this newly developed evaluation system will offer a useful tool to collect feedback information from community residents on community health services,thereby allowing objective evaluations of the health services delivered to the community.

    Key words  Community health services;Community residents;Satisfaction;Evaluation index system


Limitations of Two-way Referral Management from the Prospective of Project Management

WANG Ling-feng,LI Zhao-you,LI Jun-liang.Arts and Law College of the Northeastern University,Shenyang 110819,China

    Abstract  The current Two-way Referral system was assessed from the prospective of project management.The major limitations identified included an incomplete organizational structure,the lack of complimentary and supporting regulations,and the absence of effective supervision and inspection.We propose to introduce some of the target management concepts and technologies (e.g.,matrix organization structure,work breakdown structure,organization breakdown structure,project control,and information management) into the Two-way Referral management.We believe that the introduction of these new components would make the current problematic Two-way Referral management more scientific and more efficient.

    Key words  Project management;Two-way referral;Community health services


Management of Suburban Community Health Services  within A Family Doctor-based Community Healthcare System

WU Huan-yun,ZHANG Wei-dong,WU Jing,et al.Community Health Service Center of Jinshan Industrial District,Shanghai 201506,China

    Abstract  Objective  To assess the family factor-based community healthcare mode in suburban areas in Shanghai,aiming at laying foundations for future modification and improvement.Methods  Documents on the performance of the family doctor-based so-called "service regionalized,team cooperation-enforced,and responsibility-individualized" system in Jinshan Industrial Zone of Shanghai city during its trial implementation between 2011 and August,2012 were collected.Data on various performance variables were analyzed.Results  By the end of August,2012,a total of 19 630 (73.5%) local residents in studied zone signed contracts for health services provided within the test system.Medical records of outpatients were documented exclusively electronically.All (100.0%) contracted residents had theirhealth records achieved.The systematic management rates were all improved for obstetrics and gynecology,pediatrics,hypertension and diabetes as compared with 2010P0.05.The satisfaction score of community health service center was 94.4.Conclusion  Family doctor-based service system may be a trend of the development of community health service mode,which can better maintain the residents' health and enhance the public service capacity.However,currently this system is associated with numerous limitations including shortage of family doctors,low doctor salaries,and big service radius,which must be resolved urgently.

    Key words  Family doctor system;Community health services;Suburb;Service model


A Model of Whole-population Health Management within Family Doctor System

WU Hui-fangWANG Ji-ping.Zhangyan Community Health Service Center of Jinshan District,Shanghai 201514,China

    Abstract  Objective  Since the beginning of 2011,a family doctor-based so-called "service regionalized,team cooperation-enforced,and responsibility-individualized"community healthcare system has been implemented as a pilot experiment in Zhangyan community health service center in Jinshan district of Shanghai.This study aimed to evaluate the whole-population health management under this this test system.Methods  Data on various variables measuring the whole-population management were collected and analyzed.Results  In 2012,78.5% of residents in the experimental area signed a health service contract with family doctors in the Zhangyan community health service center,and health records of 92.7% of the residents were electronically archived.More than two third (70.1%) of the residents were aware of the core health literacy information.The overall satisfaction rate in the community residents was substantially high (98.8%).Conclusion  Family doctor-based service system is a trend of the future development of community health services,which is capable of better protecting community residents and improving public service capacity.

    Key words  Family doctor system;Community health services;Health management;Zhangyan model


Performance of Team-based Community Healthcare in Prevention and Control of Hypertension

WANG Su-ping,GONG Rui-jieBAO Yong,et al.School of Public Health,Medicine School of Shanghai Jiaotong University,Shanghai 200025,China

    Abstract  Objective  To evaluate the performance of team-based community healthcare in the prevention and control of hypertension.Methods  A total of 541 hypertension patients who were managed under a team-based model between October,2011 and September,2012 in Changqiao Community Health Service Center in Shanghai were included in the study.Their blood pressure data before and after the team-based care.Results  Through a one-year management under the team-based model of community healthcare,the percentage of patients under in the "high" and "extremely high" risk categories was reduced from 41.2% to 29.9%.The average systolic pressure was reduced from 128±8 mm Hg to 126±7 mm Hg (t=5.43,P0.05),and the diastolic pressure was reduced from 78±5 mm Hg to 76±5 mm Hg (t=5.84,P0.05).Conclusion  The team-based model of community healthcare enables more reasonable allocation of available and a better control of hypertension than the conventional healthcare model.Its wider application would significantly impact community health services in a positive manner.

    Key words  Family doctor system;Team-based model;Hypertension management in community


Practice and Thinking of Family Doctor Studio

XIAO Feng,ZHANG Xing-yuan,YU Ai-hua.Zhoujiaqiao Community Health Service Center,Changning District,Shanghai 200051,China

    Abstract  The first studio of family doctor--"Chen Hua's studio" in Shanghai was established by Zhoujiaqiao Community Health Center in April 2011.After more than two years' pilot and practice,the understanding and awareness of the family doctor studio had continued to deepen by constantly summing up,improving and standardizing.In this article,we will interpret the meaning and essence of the family doctor studio from six aspects,i.e.,family doctor studio firstly as a brand name,a fixed clinic needed,as a platform,as a carrier mode,as a team,and as a model of service.

    Key words  Community health services;Family doctor;Family doctor system service;Family doctor studio


Clinical Characteristics and Prognostic Factors of Primary Pulmonary Carcinoid Tumors

LIU Guang-jieLIU Qing-yiXIE Shao-nanet al.Department of Thoracic Surgerythe Fourth Hospital of Hebei Medical UniversityShijiazhuang 050011China

    Abstract  Objective  To investigate the clinical characteristics and prognostic factors of primary pulmonary carcinoid tumorsPPCT through a retrospective analysis.Methods  Clinical records of 31 patients with PPCT undergoing thoracic surgery in the Surgery Department of Hebei Medical University Affiliated Fourth Hospital between May 2002 and May 2012 were reviewedand the prognostic value was analyzed for various factors including sexagesmoking historytumor locationtumor sizelymph node metastasishistological typepathological staging and adjuvant treatment regimen.Results  In the 31 patients analyzed1-year3-yearand 5-year survival rates were 90.3%28/31),67.7%21/31 and 54.8%17/31 respectively.The 5 year survival rate of typical carcinoid,atypical carcinoid tumor were 78.6%11/14 and 35.3%6/17.5 year survival rates were 28.6%2/7 and 58.3%14/24 in lymph node metastasis group and no lymph nodemetastasis group.Univariate analyses showed that the pathological typepathological TNM stagetumor sizepresence or absence of lymph node metastasis were the major factors influencing the prognosis.Multivariate analyses revealed that tumor pathological typeb=1.711 and pathology TNM stagingb=1.928 were independent prognostic factors of PPCT.Conclusion  Patients with PPCT have a higher survival rate than patients with other types of lung cancer following surgical treatment.Pathological type and stage are independent prognostic factors of PPCT.

    Key words  Lung neoplasmsPrimary pulmonary carcinoidTypical carcinoidAtypical carcinoidPrognosisNeuroendocrine tumors


Cerebral Small Vessel Disease:Distributions,Clinical Manifestations and Their Relations

GAO Tian-li,LIU Chun-jie,LI Ying.Department of Neurology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China

    Abstract  Objective  To investigate the lesion distributions and clinical manifestations of cerebral small vessel disease (CSVD) as well as the distribution-manifestation relationship through a retrospective analysis.Methods  Medical records of 145 patients with MRI-confirmed CSVD were reviewed.The relationships of the MRI-revealed distributions of CSVD lesion with various clinical variables were analyzed.Results  According to ratings in age-related white matter changes (ARWMC),the patients fell into three lesion severity-different groups:mild (n=79),moderate (n=47),and severe (n=19).There were no differences in gender,history of stroke and TIA,diabetes,hypertension prevalence between the three groups(P0.05).The average age was significantly different between groups(P0.05).The incidence rates of mild cognitive impairment,stroke and TIA history,dizziness,vertigo,and gait disorder were significantly different in patients with lesions in the subcortex,basal ganglia,brainstem and cerebellum between groups(P0.05).The incidence rate of urinary incontinence was not significantly different (P0.05).Conclusion  In CSVD,the lesion distributions are associated major clinical manifestations.A better understanding may help identify cognitive impairment and basal dysfunctions in the elderly,thereby resulting timely management.

    Key words  Cerebral small vessel disease;Lesions topography;Clinical manifestations;Risk factors


Relationship of Major Measurements in Ambulatory Blood Pressure Monitoring with Circulating Cystatin C Levels in Essential Hypertension

GUO Hao,YUAN Yong,GUO Li,et al.The First Affiliated Hospital of Kunming Medical University,Kunming 650032,China

    Abstract  Objective  To investigate changes in blood levels of whether cystatin C,a marker of kidney function,in association with 24 h mean systolic BP (24 hSBP),24 h mean diastolic BP (24 h DBP),24 h mean pulse pressure (24 hPP) and pulse pressure index (PPI) during ambulatory blood pressure monitoring(ABPM).Methods  A total of 270 patients with essential hypertension without overt proteinuria were enrolled.A 24 h ABPM was performed,serum levels of cystatin C were measured,and estimated glomerular filtration rate(eGFR) was estimated using the abbreviated Modification of Diet in Renal Disease equation.The demographic,clinical and conventional analytical variables were documented.Subjects were stratified into two categories:PPI above and below the median (0.437).Partial correlation and multiple stepwise regression analyses were performed to confirm determine the relationship between ABPM' parameters and cystatin C.Results  Subjects with a PPI above the median had worse values of renal function parameters (serum cystatin C,creatinine and eGFR),had increased 24 hSBP and 24 hPP but decreased 24 hDBP,as compared with subjects with a PPI below the median.Partial correlations test showed that 24 hSBP,24 hPP,and PPI were positively correlated with cystatin C (r=0.409,0.583 and 0.515 respectivelyP0.05)but negatively correlated with eGFR(r=-0.264,-0.322 and-0.249 respectively,P0.05).There was no close correlation between 24 hDBP and cystatin C,eGFR.The stepwise multiple linear regression analysis showed that 24 hSBP,24 hPP,and PPI were each correlated independently with cystatin C (β=0.412,0.577,0.514 respectively,P0.05);each 1 mg/L increase in cystatin C,24 hSBP,24 hPP and PPI would increase by 17 mm Hg,16 mm Hg and 0.06 respectively.Conclusion  Values of 24 hSBP,24 hPP,and PPI are each independently correlated with cystatin C,whereas there is no significant correlation between 24 hDBP and cystatin C in patients with essential hypertension.

    Key words  Hypertension;Ambulatory blood pressure monitoring;24 h mean blood pressure;24 h mean pulse pressure;Pulse pressure index;Cystatin C


Association of White Blood Cell Count with Troponin I and Cardiac Function in Elderly Patients with ST-Segment Elevation Myocardial Infarction

LI Gang.Shaoxing People's HospitalShaoxing 312000,China

    Abstract  Objective  To detect the peripheral blood leukocyte count (WBC) in elderly patients with ST-segment elevation myocardial infarction (STEAMI),and explore the association of the WBC with serum cardiac troponin I (cTnI) levels and cardiac function.Methods  Totally 100 elderly inpatients with STEAMI in the cardiology department of our hospital were enrolled from December 2010 to November 2012.They were divided according their levels of WBC as WBC normal group (n=48,WBC<10.0×109/L) and WBC elevated group (n=52,WBC10.0×109/L).They were given tests of blood creatine kinase MB isoenzyme (CK-MB) and cTnI.And about one week after admission,they received the examinations of echocardiography,left ventricular fractional shortening (FS),left ventricular ejection fraction (EF),left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV).Their conditions of arrhythmia within 2 weeks after admission were detected.Results  Compared with the WBC normal group,in the WBC elevated group the levels of cTnI and CK-MB were significantly higher,prevalence of sinus tachycardia,atrioventricular block,atrial ibrillation,and ventricular premature beats,as well as the total prevalence of arrhythmia were significantly higher;the parameters of EF,FS were significantly lower,while the values of LVESV,LVEDV were significantly higher (P0.05).Conclusion  The elderly patients with STEAMI and elevated WBC have higher levels of cTnI and CK-MB as markers indicating myocardial injury and necrosis,severer inflammatory reaction,and increased incidence of malignant arrhythmia,which has a certain value to cardiac function.

    Key words  Myocardial infarction;White blood cell count;Cardiac troponin I;Aged


Clinical Manifestations and Lung Function of Chronic Obstructive Pulmonary Disease Patients with Different Levels of Progression Risk during the Course of Smoking Cessation

WANG Cong-yingZHANG QingWANG Shao-feiet al.Chengde Medical College Affiliated HospitalChengde 067000China

    Abstract  Objective  To study the effect of smoking cessation on clinical manifestations and lung function of chronic obstructive pulmonary diseaseCOPD patients at different levels of risk of progression.Methods  A total of 109 smoking COPD patients at different levels of risk of progression to acute exacerbation were randomly divided into a control group and a smoking cessation intervention group.According to the recorded lung function test results and the frequency of acute exacerbation one prior to the studypatients in each of the two groups were further divided into two sub-groups:low progression risk and high progression risk.Patients in the control group underwent conventional treatment and those in the intervention group underwent smoking cessation intervention.Both at the beginning and at the end of one year post-treatment follow-upclinical symptoms were scored and lung function test and forced expiratory volume in 1 secondFEV1 measurement were performed.Results  At the end of one year post-treatment follow-upthe clinical symptom score was2.23±0.86 in the low-risk intervention groupn=30 and 1.39±0.70 in the low-risk control groupn=33.The degree of the symptom score improvement was greater in the low-risk intervention group and in the low-risk control groupP0.001.The FEV1 was0.060±0.429L in the low-risk intervention group and0.335±0.406L in the low-risk control group.The decrease in the FEV1 was more pronounced in the low-risk control group than in the low-risk intervention groupP=0.011.The clinical symptom score was 2.72±0.89 in the high-risk intervention groupn=25 and 1.86±0.65 in the high-risk control group n=21.The degree of the symptom score improvement was greater in the high-risk intervention group and in the low-risk control groupP=0.001.The FEV1 was 0.012±0.138L in the high-risk intervention group and 0.127±0.144L in the high-risk control group.The decrease in the FEV1 was more pronounced in the high-risk control group than in the high-risk intervention group P=0.008.Conclusion  Interventional smoking cessation measures may can improve clinical symptoms and slow down lung function deterioration in smoking COPD patients.These effects are more significant in COPD patients at high-risk of acute exacerbation progression.

    Key words  Pulmonary diseasechronic obstructiveSmoking cessationLung function


Effectiveness and Safety of Glucose Sensor-augmented Insulin Pump Therapy for Type 1 Diabetes

LUO PeiLYU Xiao-fengCHENG Qian-penget al.General Hospital of Beijing Military AreaBeijing 100700China

    Abstract  Objective  To evaluate the effectiveness and safety of glucose sensor-augmented insulin pump SAP therapy in patients with type 1 diabetes.Methods  40 patients with type 1 diabetes mellitus were randomized to receive one of the flowing two treatments for 6 days:SAP therapy and continuous subcutaneous insulin infusion therapy.In the first treatment groupthe insulin does was calculated using the Bolus Wizardreal-time continuous glucose monitoring was performed with the high or low glucose alarm onand individualized patient education was carried out through the CareLinkTm Personal software.In the second treatment groupthe monitoring data were retrieved once a dayand the insulin dosing was adjusted accordingly.Results  On the last day day 6 of treatmentmean glucose concentration MBG,(6.80±0.72mmol/L vs.7.87±0.88 mmol/L〕,standard deviation of blood glucose SDBG,(1.19±0.33 mmol/L vs.1.85±0.62 mmol/L〕,mean amplitude of glycemic excursions MAGE 3.73±0.64 mmol/L vs.4.71±1.27 mmol/L〕,fasting blood glucose FBG,(6.68±0.85 mmol/L vs.7.31±1.02 mmol/L〕,postprandial blood glucosePPG,(7.89±1.12 mmol/L vs.8.44±1.26 mmol/L〕,low blood glucose index LBGI,(0.48±0.35 vs.1.11±0.84)〕,frequency of hypoglycemia 〔(0.90±0.85


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