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March 2014, Volume 17, No.7 Abstracts

Construction of Evaluating Index System Based on the AHP on the Competence of Urban General Practitioner in Guangxi

YE Teng-fei,PAN Xiao-yan.School of Public Health,Guangxi Medical University,Nanning 530021,China

    Abstract  Objective  Based on the AHP to establish a set of evaluating index system on the competence of urban general practitioners and to provide a theoretical guidance for scientific evaluation and active cultivation of general practitioners.Methods  Literature review and expert consultation were used to determine the evaluating indexes for the general practitioners in Guangxi urban areas.AHP was used to determine the index weight.Results  A provincial level for evaluating index system was established including 5 first-level indicators and 31 second-level indicators and each index weight was also determined.The 5 first-level indicators were "Basic medical service ability" and the weight was 0.252 7,"Public health service ability" and the weight was 0.193 7,"Humanistic practice ability" and the weight was 0.181 8,"Occupation accomplishment" and the weight was 0.207 7," Studying and learning ability" and the weight was 0.164 1.Conclusion  The author constructed a set of scientific,suitable and convenient evaluating index system on the competence of urban general practitioner.The basic medical service ability and professional quality is much more important.By contrast,the education learning ability is not the working emphasis of general practitioners.

    Key words  General practitioner;Professional competence;Index system;Analytic hierarchy process

 

Application of Balanced Scorecard and Effective Working Hours System in Family Doctor Performance Management System

DU Li-jun,LIN Wei-liang.Baihe Street Community Health Service Center of Jiangdong District,Ningbo 315040,China

    Abstract  Objective   To discuss the application of balanced scorecard and the effective working hours system in the family doctor performance management system.Methods  A family doctor performance management system of balanced scorecard and the effective working hours was established through literature review.The system included the indicators of performance evaluation,the allocation principles,quality control,the implantation process of the system,the application of its results and feedbacks.The effects of the whole system on the family doctor's performance were evaluated.Results  Since the application of the system in 2011,the total quantity of basic medical service and public health service had increased from 512 633 in 2010 to 573 032 in 2012,and the year-on-year growth rate had increased from 3.34% to 6.68%.The rate of hypertension control increased from 72.15% in 2010 to 77.66% in 2012;the resident's satisfaction rates with family doctors increased from 90.10% to 93.50%;the proportion of the prescription of intravenous drip decreased from 9.27% to 7.53%;the rate of qualified medical documents increased from 92.21% to 96.40%;and the year-on-year grouth rate of the proportion of family doctors with middle or higher professional titles increased from 5.00% to 11.11%;the number of published academic paper increased from 3 to 15.Conclusion  The new performance evaluation system could promote the service efficiency and quality of the family doctors,and bring more benefits to the health service units.An effective performance evaluation system should be with specific indicators,workable,and with the support of the scientific information system.

    Key words  Balanced scorecard;Effective working hours system;Family doctor;Performance management

 

Cost Analysis of Community Public Health Service Items and Its Processed Management

WU Song-tao.Yuetan Community Health Service Center of PekingBeijing 100038,China

    Abstract  Objective  To provide reference to cost control and management of community public health service itemshereinafter shortened as CPHSI and performance evaluation and financial compensation of some government relevant departments through investigating some Community Health Service Centershereinafter shortened as CHSC in Peking.Methods  With the stratified typical sampling method,we extracted 10 CHSC and collected the data of CPHSI which were really carried out and the data of finance of 2010 by questionnairefield survey and work record collection.Results  161 subprojects(89.7%) in the 10 centers had really been carried out with 7 subprojects not(10.3%);8 in the 61 subprojects had been carried out only 1-2 centers,and the summation of the two accounted for 22.1% of the total.2Single total cost distribution of 68 subprojects:2 over million project,13 over 1 000 yuan,30 over one hundred yuan,16 below a hundred yuan,7 subprojects not carried out.342 subprojects were carried out more than 4 times per year(i.e.subproject frequently carried out);14 were carried out 1-3 times per year;5 were carried one time or less than one time per year.Conclusion  The CHSC offer many kinds and the lower cost of CPHSI.Processed management is a better way to improve the social benefit and economic benefit from the community public health services.

    Key words  Community health servicesPublic healthCost of service itemsProcessed management

 

Service Mode and Incentive Mechanism about Community Family Doctor Service System in Beijing

ZHANG Xiang-dong,ZHAO Jing,LAN Li-na,et al.Beijing Community Health Service Management Center,Beijing 100053,China

    Abstract  In the situation of the new medical reform,popularizing family doctor service system is deepening and pushing the community health service.This study,by integrating domestic and foreign family doctor service situation,introduces Beijing family doctor service system,analyzes existing difficultand explores a new service pattern and inspiriting mechanism about Beijing family doctor service system.

    Key words  Family doctor service system;Service mode;Incentive mechanism

 

Exploration of Localized Management Model of Family Doctor Service System

ZHANG Chen-li.Gulou Street Community Health Service Center of Ningbo,Ningbo 315010,China

    Abstract  Gulou Street Community Health Service Center implemented the local government's work of offering localized community health service in 2007,and started the family doctor service system in 2012 and up to now has made obvious achievements.This article took Gulou subdistrict in Haishu as an example and investigated the definitions and the mode of operation and management of "the localized management" and "the family doctor service system".The aim was to try to search an appropriate localized and government participated management model of family doctor service system.In other words,the targeted heath services provided benefited both government and people.

    Key words  Community health service;Localization management;Family doctor

 

Construction and Effect of the Family Doctor Service Model in Fangzhuang

WU HaoJIA Hong-yanLIU Xiu-meiet al.Fangzhuang Community Health & Center General Medicine of Capital Medical University School and Continuing EducationBeijing 100078China

    Abstract  Objective  To explore the construction and effect of  the family doctor service model at Fangzhuang community from January 2008 to December 2012.Methods  By using a questionnaire,community residents were investigated of the community hospital conditions and the satisfaction of community health services;the team members were investigated of their career satisfaction at the same time.By analyzing the survey resultsthe implementation effects of the family doctor service model were evaluated.Results  15 health service teams were founded to meet the health needs of community residents at Fangzhuang community.A new community health service management system and operational mechanism were formed.A new family doctor team service model was established.A series of rules and regulations suitable for the new service model were developed providing a system guarantee of sustainable development for community health service.Community residents feeling the disease was mild,the ratio choosing community hospitals was as high as 74.3%(736/991);residents' satisfaction rate with community health services was 76.7%(760/991)in general diagnosis,73.7%(730/991) in chronic disease management reached,81.0%(803/991) in vaccination,74.4%(737/991) in community nursing,89.1%(883/991) in health education and promotion,79.0%(783/991) in TCM rehabilitation,68.1%(675/991) in family planning guidance of,71.1%(705/991) in visiting services and 58.6%(581/991) in referral services.The rate of the family doctors' satisfaction with the current treatment was 66.9%(85/127),with the content of the work 81.1%(103/127),with the working environment and culture atmosphere 85.8%(109/127),with occupation development 88.2%(112/127),with occupation identity 74.0%(94/127) and with their worth sense in their work 71.7%(91/127).Conclusion  Fangzhuang community health service center has established the perfect family doctor service team.

The family doctor-style team model can make the community health service obtain good results.

    Key words  Community health servicesFamily-doctor teamService model

 

Five-year Follow-up Study of Prognosis of Maintenance Hemodialysis Patients

BIAN Xiao-huiLIU Da-junZHENG Huaet al.Department of NephrologyShengjing HospitalChina Medical UniversityShenyang 110004China

    Abstract  Objective  To investigate the mortality-related risk factors in maintenance hemodialysisMHD patients.Methods  A prospective cohort study was followed-up among the 53 stable hemodialysis patients treated in our center during December2006 and January2007 until 31 January 2012.By using Cox proportional analysis the predictors for death were examined according to the data about postmortem interval and cause of death recorded in the study.Results  During the 60-month follow-upa total of 26 patients died.Cumulative survival rates of 13 and 5 years were 90.6%64.2%50.9% respectively.Cox proportional hazards analysis showed that age,ALB and CRP were the independent risk factors for all-cause mortality HR=3.3100.4163.296and CRP was the independent risk factor for cardiovascular mortality in MHD patientsHR=4.269.Conclusion  In MHD patients,age and CRP were independent risk factors for deathwhile ALB was protective factor.

    Key words  Maintenance hemodialysisMortalityRisk factorsProspective cohort study

 

The Relationship between Vitamin D and Essential Hypertension in the Elderly

DONG Yu-jieHAN LuREN Shu-ronget al.Department of Hypertension,the First Affiliated Hospital of Xingjiang Medicial University,Urumqi 830000,China

    Abstract  Objective  To investigate the effect of vitamin D supplementation to elderly hypertensive patients suffering from vitamin D deficiency on the systolic blood pressure (SBP),diastolic blood pressure (DBP) and fasting blood glucose(FPG).Methods  A random sample of 199 elderly residents at Six Bay community in Urumqi city in Sept,2012,were examined the serum levels of vitamin D,calcium and fasting plasma glucose,the height,the weight and the blood pressure.According to whether the risk of high blood pressure was divided into 98 cases of hypertension group and 101 cases of normal group.According to the levels of serum vitamin D lack and deficiency,60 patients with essential hypertension randomly selected were asked to continuously take Luogaiquan (Calcitriol capsule) besides conventional therapy for three months and afterwards compare the above indexes of pre-treatment and post-treatment respectively.Self-control designed was adopted in the experiment.Results  The data suggested that body mass index(BMI),blood pressure and fasting plasma glucose in abnormal blood pressure group were higher than normal blood pressure groupFPG(6.1±0.5) vs. (5.8±0.5) mmol/LBMI(25.7±4.1) vs. (23.6±3.1) kg/m2,while vitamin D level and blood calcium were lower than those in the normal blood pressure group vitamin D(14±8) vs. (18±10) μg/Lblood calcium (2.26±0.10) vs. (2.29±0.13) mmol/L and the differences were all significantP0.05.Compared with the relative deficiency group and adequate group,in the vitamin D deficiency group FPG was higher,serum calcium was lower FPG(6.1±0.5)vs. (5.8±0.6) vs.(5.7±0.5) mmol/Lblood calcium:(2.26±0.11) vs.(2.32±0.09) vs. (2.31±0.12) mmol/Lall P0.05.Pearson correlation analysis showed that serum vitamin D level was negatively correlated with FPG level(r=-0.192,P0.01) and positively with serum calcium (r=0.247,P0.01).After supplying Vitamin D,systolic blood pressure,diastolic blood pressure and fasting plasma glucose levels were lower than the original level,vitamin D and calcium were higher than the original level SBP:(131±13) vs. (141±13) mm Hg,DBP:(83±10) vs. (89±11) mm Hg,FPG:(5.9±0.5) vs. (6.1±0.6) mmol/L,Vit D:(16±5) vs. (14±5) μg/L,blood calcium:(2.34 ± 0.14) vs. (2.28 ± 0.14) mmol/Lall P0.05.Conclusion  Elderly essential hypertensive patients' fasting plasma glucose is higher than that of normal blood pressure people,and are more susceptible to vitamin D deficiency.Vitamin D supplements can reduce blood pressure and fasting plasma glucose levels in elderly patients with essential hypertension.

    Key words  Vitamin D;Essential hypertension;Fasting plasma glucose

 

Effects of the Glucose Fluctuation on the Oxidative Stress Status of T2DM Patients Combined with Acute Cerebral Infarction and Its Significance

ZHANG Ming-yang,LYU Xiao-feng,ZHANG Wei-wei,et al.Department of Endocrinology,Beijing Military General Hospital,Beijing 100700,China

    Abstract  Objective  To investigate the effects the glucose fluctuation on the oxidative stress status in type 2 diabetes mellitus(T2DM) patients with acute cerebral infarction(ACI)and its significance.Methods  50 cases hospitalized in Beijing Military General Hospital from Oct.2012 to Apr.2013 were selected in the study,including 20 T2DM patients without ACI in Department  of Endocrinology as control group,and 30 T2DM patients with ACI in Department of Neurology as observed group.All the patients' blood glucose was determined by the Continuous Glucose Monitoring System(CGMS) for 72 hours,so were malondialdehyde(MDA)8-iso-prostaglandin F2α(8-iso-PGF2α)blood fat,glycosylated hemoglobin(HbA1c) of all the patients simultaneously.High frequency ultrasound was used to detect the intima-media thickness(IMT).All the detection indexes were compared between the control group and the observed group;correlation analysis was conducted among every index.Results  (1)The mean amplitude of glycemic excursions(MAGE)blood glucose standard deviation(SDBG)mean postprandial glycemic excursions(MPPGE)TCTGLDL-CHbA1cMDA8-iso-PGF2α,IMT were statistically different between the two groups(P0.05). (2)The MAGESDBGTGLDL-Cand systolic blood pressure(SBP)8-iso-PGF2α  and MDA were correlated with the IMT(P0.05)SDBGLDL-CSBP8-iso-PGF2α,MDA and IMT were correlated with MAGEP0.05.(3)With IMT scores as the dependent variable,the indicators above as the independent variables,the multiple stepwise regression analysis showed that the 8-iso-PGF2α,MAGELDL-C came into the final equation.Conclusion  The blood glucose fluctuation and oxidative stress level being significantly increased in T2DM patients with ACI,the blood glucose may generate oxidative stress reaction and aggravate the injuries of atherosclerosis(AS).Therapy for lowering glucose smoothly should be emphasized so as to reduce the incidence of AS.

    Key words  Diabetes mellitus,type 2;Brain infarction;Glucose fluctuation;Oxidative stress

 

Expression of the Platelet Activating Factor in Different Types of Coronary Heart Disease and Correlation between It and the Coronary Gensini Score

HAI Qi-min,SHEN De-liang,LIU Cong-lin,et al.Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052China

    Abstract  Objective  To investigate the expression level of human plasma platelet activating factor(PAF) in different types of coronary heart disease and the correlation between PAF and coronary Gensini Score.Methods  140 subjects with suspected CHD were,according to diagnostic criteria of coronary disease,divided into two groups including 32 normal healthy control subjects and 108 patients with CHD which was further divided into subgroups including 30 patients with acute myocardial infarction(AMI),41 unstable angina pectoris(UAP) and 37 stable angina pectoris(SAP).The plasma PAF concentrations were determined by ELISA and the degree of coronary stenosis was illustrated by Gensini Score.Concentrations of PAF were compared within the groups and the correlation between the concentrations and Gensini Score was analyzed.Results  Plasma concentrations of PAF were higher in patients with CHD(12.26±2.02)μg/L than those in normal healthy control group(6.27±1.35) μg/L(P0.05) and the difference was significant.Plasma concentrations of PAF were(13.31±1.36)μg/L in AMI group,(13.01±1.48)μg/L in UAP group and(10.61±1.97)μg/L in SAP group;the difference within the three groups was significant(P0.05).Multiple Comparison among the subgroups showed significance between UAP group and SAP group,AMI group and SAP groupP0.05 and no significance between UAP group and AMI groupP0.05.Strong positive correlations existed between the plasma PAF concentrations and Gensini Score(r=0.642,P0.05),and differences were statistically significant.Conclusion  Human plasma PAF concentrations were different in every type of coronary heart diseases and were correlated with coronary Gensini Score,which suggests that PAF may serve as an available index for CHD.

    Key words  Coronary disease;Coronary stenosis;Platelet activating factor;Gensini score

 

Correlation between Fetal Hemoglobin mRNA Abundance in Maternal Peripheral Blood And Gestational Age

LIU Hong-ying,YANG Li-li,YANG He-jun,et al.Department of Genetics,Weifang Medical University,Weifang 261053,China

    Abstract  Objective  To investigate changes in fetal hemoglobin (HbF) mRNA abundance in maternal peripheral blood in association with gestation age.Methods  Peripheral blood was collected from 30 normal pregnant women (7-16 weeks) undergoing regular prenatal examinations in Weifang People's Hospital between October,2008 and November,2009.Total RNA was extracted from the whole blood First-strand HbF cDNA was synthesized through reverse transcription and subsequently amplified by PCR using primers designed based on the human HbF gene.The PCR products were visualized by gel electrophoresis.The abundance of HbF mRNA was accordingly determined with the ImageJ software and its correlation with gestation age was analyzed by Pearson's correlation test.Results  The RNA mass concentration is 0.983.19 (1.87±0.76) g/L,the OD value is 1.79.And we detected ε hemoglobin gene mRNA in 30 samples,7 are positive and 23 are negative.And the average concentration of ε hemoglobin gene mRNA in maternal peripheral blood is 1.241 μg/ml,A strong negative correlation (r=-0.75,P0.05) was observed between the amount of HbF mRNA in the maternal blood and gestation age.Conclusion  The abundance of fetal hemoglobin mRNA in maternal peripheral blood decreases with gestation age in 7-16 week of pregnancy.

    Key words  Pregnant womenFetal hemoglobinRNA`messengerGestational age

 

Relationship between Dynamic Change of Inflammatory Factors and Prognosis in Elderly Male Patients with Ischemic Stroke

LIU Run,ZHOU Nong.Department of Neurologythe First Affiliated Hospital of Anhui Medical UniversityHefei 230000China

    Abstract  Objective  This study investigated the dynamic changes of serum IL-6high-sensitivity C-reactive proteinhs-CRP and estradiol hormoneE2 levels in the male patients with ischemic stroke and their relationships with NIH Stroke ScaleNIHSSso as to discuss the association of these changes with the prognosis of patients.Methods  49 elderly male ischemic stroke patients treated in the author's neurology department from April 2011 to June 2012 were assigned to case group and 38 healthy men who received physical examination at the same time were assigned to control group.The serum levels of IL-6hs-CRP and E2 and NIHSS were observed on the 1 d3 d7 d14 d and 30 d after the onset respectively.All the results were compared with that of healthy men.The attention was paid to the change law of these observed indexes and their relationship with the prognosis of patients.Results  1 In the acute phase of incidence on 1 d3 d and 7 dthe group effects were significantly differenP0.05);the serum IL-6 and hs-CRP levels in the patients were higher than that of control groupwhile E2 levels were lower than that of control group and both were significantP0.05);Time effects were significantP0.05.2In the recovery phase of the incidence on 14 d and 30 d,interactive effects of time and groups didn't existP0.05);Group effects and time effects were not significantP0.05.

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