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 Peking，Beijing 100038,China
【Abstract】 Objective To provide reference to cost control and management of community public health service items（hereinafter shortened as CPHSI） and performance evaluation and financial compensation of some government relevant departments through investigating some Community Health Service Centers（hereinafter 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 questionnaire，field survey and work record collection.Results （1）61 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.（2）Single 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.（3）42 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 services；Public health；Cost of service items；Processed 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 difficult，and 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 Hao，JIA Hong-yan，LIU Xiu-mei，et al.Fangzhuang Community Health & Center General Medicine of Capital Medical University School and Continuing Education，Beijing 100078，China
【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 results，the 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 services；Family-doctor team；Service model
Five-year Follow-up Study of Prognosis of Maintenance Hemodialysis Patients
BIAN Xiao-hui，LIU Da-jun，ZHENG Hua，et al.Department of Nephrology，Shengjing Hospital，China Medical University，Shenyang 110004，China
【Abstract】 Objective To investigate the mortality-related risk factors in maintenance hemodialysis（MHD） patients.Methods A prospective cohort study was followed-up among the 53 stable hemodialysis patients treated in our center during December，2006 and January，2007 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-up，a total of 26 patients died.Cumulative survival rates of 1，3 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=3.310；0.416；3.296）and CRP was the independent risk factor for cardiovascular mortality in MHD patients（HR=4.269）.Conclusion In MHD patients,age and CRP were independent risk factors for death，while ALB was protective factor.
【Key words】 Maintenance hemodialysis；Mortality；Risk factors；Prospective cohort study
The Relationship between Vitamin D and Essential Hypertension in the Elderly
DONG Yu-jie，HAN Lu，REN Shu-rong，et 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 group〔FPG：(6.1±0.5) vs. (5.8±0.5) mmol/L；BMI：(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/L；blood calcium (2.26±0.10) vs. (2.29±0.13) mmol/L〕 and the differences were all significant（P＜0.05）.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/L，blood calcium:(2.26±0.11) vs.(2.32±0.09) vs. (2.31±0.12) mmol/L；all P＜0.05〕.Pearson correlation analysis showed that serum vitamin D level was negatively correlated with FPG level(r=-0.192,P＜0.01) and positively with serum calcium (r=0.247,P＜0.01).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/L；all P＜0.05〕.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)，TC，TG，LDL-C，HbA1c，MDA，8-iso-PGF2α，IMT were statistically different between the two groups(P＜0.05). (2)The MAGE，SDBG，TG，LDL-C，and systolic blood pressure(SBP)，8-iso-PGF2α and MDA were correlated with the IMT(P＜0.05)，SDBG，LDL-C，SBP，8-iso-PGF2α，MDA and IMT were correlated with MAGE（P＜0.05）.(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，MAGE，LDL-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 450052，China
【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(P＜0.05) 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(P＜0.05).Multiple Comparison among the subgroups showed significance between UAP group and SAP group,AMI group and SAP group（P＜0.05） and no significance between UAP group and AMI group（P＞0.05）.Strong positive correlations existed between the plasma PAF concentrations and Gensini Score(r=0.642,P＜0.05),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 0.98～3.19 (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,P＜0.05) 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 women；Fetal hemoglobin；RNA，`messenger；Gestational age
Relationship between Dynamic Change of Inflammatory Factors and Prognosis in Elderly Male Patients with Ischemic Stroke
LIU Run,ZHOU Nong.Department of Neurology，the First Affiliated Hospital of Anhui Medical University，Hefei 230000，China
【Abstract】 Objective This study investigated the dynamic changes of serum IL-6，high-sensitivity C-reactive protein（hs-CRP） and estradiol hormone（E2） levels in the male patients with ischemic stroke and their relationships with NIH Stroke Scale（NIHSS）so 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-6，hs-CRP and E2 and NIHSS were observed on the 1 d，3 d，7 d，14 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 d，3 d and 7 d，the group effects were significantly differen（P＜0.05）；the serum IL-6 and hs-CRP levels in the patients were higher than that of control group，while E2 levels were lower than that of control group and both were significant（P＜0.05）；Time effects were significant（P＜0.05）.（2）In the recovery phase of the incidence on 14 d and 30 d,interactive effects of time and groups didn't exist（P＞0.05）；Group effects and time effects were not significant（P＞0.05）.（