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February 2018, Volume 21, No.4 Abstracts

Framework of the Referral System in Primary Care Practice YU Ming-jie1,LI Li2,KUANG Li1*
1.School of Public Health,Sun Yat-sen University,Guangzhou 510080,China
2.Department of Family Medicine and Community Health,Case Western Reserve University,Cleveland 44106,America
*Corresponding author:KUANG Li,Professor,Master supervisor;E-mail:kuangli@ mail.sysu.edu.cn
  【Abstract】 Clinical referral,frequently occurred in general practice,is an important component of the hierarchical medical system. A high-quality referral system ensures patients' access to continuous,coordinated and integrated medical services. The development of a comprehensive analytical framework of the referral system will facilitate the researchers and policy makers to comprehensively evaluate the relationship among all elements in the referral system,and guide them to establish and improve a referral system. In this study,based on the systematical review of the researches on referral systems in foreign countries,we constructed a framework of referral system in primary care practice by employing systems theory,of which the four key elements with expounded connotations are:individuals involved in the referral and their responsibilities,referral decision-making,transmission and integration of referral information and referral management system. Finally,three suggestions were put forth for further referral study in China:(1) attaching importance to and giving full play to the role of the referral letter;(2) developing referral guidelines;(3) paying attention to management attributes of the referral system and exploring the function of referral management system.
  【Key words】 General practice;Hierarchical medical system;Referral system
 
Community-based Diabetes Health Education in Canada and its Enlightenment to China TANG Jing-jing,SHI Rong*
School of Public Health,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China
*Corresponding author:SHI Rong,Professor,Master supervisor;E-mail:shirong61@163.com
  【Abstract】 The prevalence of diabetes is increasing largely in the world year by year,which has caused a heavy burden on the health service system of all countries. As one of the most effective means of diabetes management,community-based diabetes health education is carrying more and more weight all over the world. This article summarizes the implementation and strategies of the community-based diabetes health education in Canada,and analyzes its successful experience which is worth learning. In order to improve community-based diabetes health education in our country,it is suggested that the government should increase the policy support and encourage more people to participate in this education in community. The community health service center should strengthen the training of professional personnel and further enrich the strategies of health education,as well as make full use of the new technology of “Internet +” to increase the use of communication tools and means. The whole society should strengthen the construction of supportive environment to consolidate the achievements of health education.
  【Key words】 Diabetes mellitus;Health education;Community health services;Canada;Enlightenment
 
Efficiency of Community Health Service Centers in China during 2013—2015:a Synchronic and Diachronic Study ZHAO Lin1,ZHANG Yao2,HOU Ya-bing2,YAN Gui-ming3*
1.International Medical School,Tianjin Medical University,Tianjin 300070,China
2.School of Public Health,Tianjin Medical University,Tianjin 300070,China
3.School of Nursing,Tianjin Medical University,Tianjin 300070,China
*Corresponding author:YAN Gui-ming,Lecturer;E-mail:yan791010@126.com
  【Abstract】 Objective We explored the efficiency of community health service centers (CHSCs) in China from 2013 to 2015,providing policy suggestions for optimizing the allocation of health resources. Methods From 3 volumes of China's Health and Family Planning Statistical Yearbook (2014—2016),we collected the data about the efficiency of CHSCs in 30 provinces (autonomous regions/municipalities) in mainland China (except Tibet) from 2013 to 2015. Data envelopment analysis (DEA) and Malmquist index analysis were performed to investigate the dynamic changes in the efficiency of these CHSCs during this period at the national level as well as the provincial level. The input indicators include the numbers of CHSCs,primary care providers and beds. The output indicators consist of visits,number of inpatients,occupancy rate of beds and average length of stay. Results In 2015,the average national comprehensive technical efficiency,average national pure technical efficiency and average national scale efficiency of CHSCs were 0.715,0.705 and 0.972 respectively;Eight regions (Guangdong,Guizhou,Hainan,Ningxia,Qinghai,Shanghai,Zhejiang and Chongqing,accounting for 26.7%) owned effective comprehensive technical efficiency with a value of 1.000,the other 22 regions had an average surplus 131 CHSCs,5 573 primary care providers and 2 086 beds. Compared with 2013,in 2015,the average national technical efficiency change index of CHSCs was 0.990,decreased by 1.0%,average national technical change index of CHSCs was 1.034,increased by 3.4%,average national pure technical efficiency change index of CHSCs was 1.002,increased by 0.2%,average national scale efficiency change index of CHSCs was 0.988,decreased by 1.2%,the total factor productivity of CHSCs was 1.024,increased by 2.4%. Conclusion From 2013 to 2015,the efficiency of CHSCs generally presented a rising trend at the national level,but it also displayed obvious provincial-specific differences. In the areas owning inefficient CHSCs identified by DEA analysis,there was a problem of coexistence of insufficiency and waste of community health resources. In view of this,targeted measures should be taken to optimize the allocation of community health resources,and the management level of CHSCs should be strengthened in order to improve the efficiency of these institutions.
  【Key words】 Community health service center;Data envelopment analysis;Efficiency;Total factor productivity
 
Causes and Countermeasures for Inefficient Development of "1+1+1" Hierarchical Diagnosis and Treatment Pattern in Western China WANG Hui1,MENG Mei-fen1*,FAN Lu-ming2,ZHANG Li-ping1
1.Department of Burn Surgery,The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China
2.School of Nursing,Kunming Medical University,Kunming 650500,China
*Corresponding author:MENG Mei-fen,Chief superintendent nurse,Master supervisor;E-mail:1391590159@qq.com
  【Abstract】 The "1 +1+ 1" hierarchical diagnosis and treatment pattern refers to that for easy access to medical services,residents first sign a contract with a family doctor team,then with a voluntarily self-selected district-level hospital (secondary hospital) and a municipal-level hospital (tertiary hospital) located near their residence. In a sense,it is an integrated signing contract pattern,which aims to solve the problem of "It is difficult and expensive to see a doctor" for urban and rural residents,and achieve a scientific and reasonable pattern of medical treatment by allocating medical resources reasonably,saving medical cost and improving service efficiency. Based on the current status of hierarchical diagnosis and treatment in western China,we analyzed government-,medical institutions- and patient-specific factors associated with the inefficient development of "1 +1+ 1" hierarchical diagnosis and treatment pattern in this area,and put forward targeted suggestions,in order to boost the sustainable development of hierarchical medical system in western China.
  【Key words】 Hierarchical medical system;"1+1+1" hierarchical diagnosis and treatment pattern;Western China
 
Community Residents' Awareness and Willingness towards Contractual Services from Family Doctors WANG Liang-chen1,GE Min2,JIANG Ping2,ZHU Min-jie2,ZHAO Xin-ping1,LIANG Hong3,4,HUANG Jiao-ling3,LIU Shan-shan4,ZHANG Yi-min4*
1.School of Public Health,Fudan University,Shanghai 200032,China
2.Health and Family Planning Commission of Changning District,Shanghai 200050,China
3.School of Social Development and Public Policy,Fudan University,Shanghai 200433,China
4.Pudong Institute for Health Development,Shanghai 200129,China
*Corresponding author:ZHANG Yi-min,Associate research fellow;E-mail:zym_03730@sina.com
  【Abstract】 Objective To investigate community residents' awareness and willingness towards contractual services from family doctors. Methods In December 2013,using multistage random sampling,we selected 3 040 community residents from 10 neighborhoods/townships in Changning District,Shanghai,and surveyed them using a questionnaire designed by our research group for collecting the data about socio-demographic characteristics,awareness of community health service centers (CHSCs),awareness of family doctors,status of contract signing,as well as intention and associated factors of signing a contract with family doctors among those did not sign. Data were analyzed for 2 750 who returned responsive questionnaires. Then,in June 2016,we conducted a follow-up survey among these residents with the same questionnaire,among whom 2 004 responded validly. Results Compared with 2013,the awareness level of the difference between CHSCs and secondary /tertiary hospitals in the residents was differernt with 2016 (P<0.05). To be specific,higher proportion of residents (83.1%,1 653/1 989) in 2016 knew that CHSCs are different from secondary /tertiary hospitals,among them,28.7% (474/1 653) considered that the main difference between CHSCs and secondary/tertiary hospitals was levels of skills and techniques,and the latter had higher level;37.5% (620/1 653) thought that the difference lay in their scope of treatment,i.e.,the secondary/tertiary hospitals mainly treat difficult miscellaneous diseases while CHSCs mainly treat common and frequently-occurring diseases. In 2016,83.9% (1 681/2 004) of residents knew family doctors,and 67.1% (1 345/2 004) knew that family doctors can provide contractual services,and both rates were higher compared with 2013 (P<0.05). The rate of signing contracts with family doctors was 32.5% (651/2 004) in 2016,which was also higher than that in 2013 (P<0.05). In 2016,27.9% (374/1 339) of the unattached residents had the intention of signing,and the three leading factors that affected the willingness to sign include lack of demand for family doctor services (45.3%,437/965),worrying that they could not access to the services delivered by other medical institutions after being attached to the designated medical institutions (13.1%,126/965),and thought that the professional skills of family doctors were low (9.4%,91/965). Conclusion Community residents have a good understanding of CHSCs and family doctors,but the level needs to be deepened and their willingness to sign contracts with family doctors needs to be improved. In view of this,family doctor services should be publicized intensively,capabilities of family doctors and standards of their services should be improved,and their valuable contractual services should be promoted.
  【Key words】 Family doctor contractual services;Cognition;Willingness;Residents
 
Effects of Contractual Services from Family Doctors on the Healthcare-seeking Behavior among Community Residents LIU Shan-shan1,GE Min2,JIANG Ping2,ZHU Min-jie2,LIANG Hong1,3,HUANG Jiao-ling3,FANG Shuai3,ZHAO De-yu3,ZHANG Yi-min1*
1.Pudong Institute for Health Development,Shanghai 200129,China
2.Health and Family Planning Commission of Changning District,Shanghai 200050,China
3.School of Social Development and Public Policy,Fudan University,Shanghai 200433,China
*Corresponding author:ZHANG Yi-min,Associate research fellow;E-mail:zym_03730@sina.com
  【Abstract】 Objective To investigate the effects of contractual services from family doctors on the healthcare-seeking behavior among community residents. Methods In December 2013,by multistage cluster random sampling,we selected 3 040 community residents from 10 neighborhoods/townships in Changning District of Shanghai and surveyed them using a questionnaire developed by our research group for collecting the data mainly about the medical institution visited last time,reasons for choosing this medical institution,and the referral in community health service centers (CHSCs). Analysis was limited to the 2 750 who returned responsive questionnaires. Then,in June 2016,we conducted a follow-up survey among these 3 040 residents with the same questionnaire,among whom 2 004 responded effectively. Results The percentage of contracted residents visited CHSCs the last time for 2013 and 2016 was 51.4%(213/414),40.7%(209/514),respectively,indicating that in 2016 it decreased significantly (P<0.05). Both in 2013 and 2016,the percentages of contracted residents visited CHSCs the last time were much higher compared with those uncontracted (P<0.05). The three leading reasons for contracted residents seeking healthcare in CHSCs in 2016 were easy to access medical services (27.7%,180/649 ),light illness (13.4%,87/649) and low cost (11.6%,75/649 ). The rate of contracted residents who were referred from the community health service center to hospital in 2013 and 2016 was 7.6%(45/589),11.9%(77/649),respectively,demonstrating that in 2016 it increased significantly (P<0.05). Both in 2013 and 2016,the percentages of contracted residents who were referred from the community health service center to hospital were much higher compared with those uncontracted (P<0.05). In 2016,46.7% (36/77) of the contracted residents were referred to hospital by their contracted family doctor,83.3%(40/48) of those uncontracted were referred by the general outpatient doctor,which showed that the referral way between these two groups was significantly different (P<0.05). Conclusion The healthcare-seeking behavior was improved in the contracted community residents,but the rate of referral in primary care was low,and the hierarchical diagnosis and treatment pattern should be developed further.
  【Key words】 Family doctor contractual services;Healthcare-seeking behavior;Residents
 
Awareness and Utilization of the Contractual Services among Residents Signing a Contract with a Family Doctor LIU Shan-shan1,GE Min2,JIANG Ping2,ZHU Min-jie2,LIANG Hong1,3,HUANG Jiao-ling3,FANG Shuai3,ZHAO De-yu3,ZHANG Yi-min1*
1.Pudong Institute for Health Development,Shanghai 200129,China
2.Health and Family Planning Commission of Changning District,Shanghai 200050,China
3.School of Social Development and Public Policy,Fudan University,Shanghai 200433,China
*Corresponding author:ZHANG Yi-min,Associate research fellow;E-mail:zym_03730@sina.com
  【Abstract】 Objective To explore the awareness and utilization of the contractual services among residents signing a contract with a family doctor. Methods The enrolled residents were from 10 neighborhoods/townships in Changning District of Shanghai,all of them signed a contract with a family doctor and were responsive to a previous study carried out by us. Using a questionnaire developed by our research group,we conducted two rounds of survey (one was in December 2013 and the other in June 2016) among them for collecting information concerning awareness and utilization of contractual services from family doctors. Data were analyzed for those who returned responsive questionnaires in 2013 (591 cases),2016 (651 cases),respectively. Results In 2016,34 (5.8%),172 (29.6%) of the residents were "well-informed" "relatively informed" of the family doctor contractual service package,respectively,which was difference with that of 2013 (P<0.05). Compared with 2013,the awareness rates of 4 items included in the contractual service package (telephone-based consultation,personalized health assessment,guidance for healthy/subhealthy populations,and preventive treatment of disease by Chinese medicine) in the residents in 2016 were much lower (P<0.05),while those of other 4 items included in the package (outpatient appointment,return visits for down-referrals,post-discharge follow-up and health check-up) showed little changes (P>0.05). In 2016,of the residents,77.5% (464/599) sought medical care in community health service centers (CHSCs) after signing the contract,55.9% (333/596) visited their contracted family doctor,35.7% (214/600) made regular appointments before visiting,and 27.0% (161/597) willing to be referred to the hospital by their contracted family doctor. The distribution of visited medical institutions after signing a contract with a family doctor,visiting the contracted family doctor,making appointments before visiting and willing to be referred to hospital by the contracted family doctor among the residents in 2016 were significantly different from those of 2013 (P<0.05). Conclusion The contracted residents showed poor awareness of contractual services from family doctors,but relatively good medical adherence. Furthermore,the utilization rate of appointment and referral services among them need to be improved.
  【Key words】 Family doctor contractual services;Cognition;Signed residents
 
Effects of Coordinated Reform in the Delivery of Contractual Services by Family Doctors on the Orderly Diagnosis and Treatment Pattern GE Min1,JIANG Ping1,ZHU Min-jie1,WANG Liang-chen2,ZHAO Xin-ping2,LIANG Hong3,4,FANG Shuai3,HUANG Jiao-ling3,ZHANG Yi-min4*
1.Health and Family Planning Commission of Changning District,Shanghai 200050,China
2.School of Public Health,Fudan University,Shanghai 200032,China
3.School of Social Development and Public Policy,Fudan University,Shanghai 200433,China
4.Pudong Institute for Health Development,Shanghai 200129,China
*Corresponding author:ZHANG Yi-min,Associate research fellow;E-mail:zym_03730@sina.com
  【Abstract】 Objective To study the effect of the coordinated reform in the delivery of contractual services by family doctors on the orderly diagnosis and treatment pattern,and put forward targeted policy suggestions for the existing problems. Methods From the statistical reports and operational monitoring reports issued by Shanghai Changning District Health and Family Planning Commission and Shanghai Changning District Community Health Service Management Center during 2013—2016,we collected the data about signing a contract with a family doctor,seeking healthcare in the designated community health service center (CHSC),outpatient appointments and referrals among residents in Changning District,and calculated and comparatively analyzed the annual rates of signing contracts,seeking healthcare in the designated CHSC,visiting the contracted family doctor,making and implementing outpatient appointments,referred residents,successful referrals and so on during this period. Results From 2013 to 2016,among the residents,the annual rate of signing a contract with a family doctor was 23.3%,31.4%,43.1% and 47.0%,respectively,increasing by 23.7% percentage points in 2016 compared with 2013;the annual rate of seeking healthcare in the designated CHSC was 67.47%,68.35%,65.61% and 64.75% respectively,with a mean rate of 66.55%;the average annual rate of visiting the contacted family doctor was 31.52%,35.16%,36.01% and 32.54% respectively,with a mean rate of 33.81%;the annual rate of making outpatient appointments was 24.85%,38.71%,42.38% and 41.65% respectively,upping by 16.80 percentage points in 2016 compared to 2013;the annual rate of implementing outpatient appointments was 65.71%,75.85%,73.10% and 85.05% respectively,increasing by 19.34 percentage points in 2016 compared with 2013;the annual rate of residents referred by their contracted family doctor to hospital was 1.16%,0.47%,0.95% and 0.96%,respectively,dropping by 0.20 percentage points in 2016 compared with 2013;the annual rate of successful referrals was 57.35%,49.41%,45.65% and 41.82% respectively,downing by 15.53 percentage points in 2016 compared with 2013. Conclusion The rate of signing a contract with a family doctor among residents in Changning District has been steadily increasing,and the orderly diagnosis and treatment pattern has initially taken shape. However,their compliance to obtaining healthcare from the designated CHSC and contracted family doctor and referrals still need to be improved. Hence,publicity of information related to contractual services should be intensified;family doctor training system should be improved;systematic referral system and guidelines should be developed;coordinated capacities of medical institutions at all levels should be enhanced;the construction of community health information system and community health service platform should be strengthened.
  【Key words】 Family doctor contractual services;Hierarchical diagnosis and treatment system;Healthcare-seeking behavior;Effect assessment
 
Gait Characteristics under Single- and Dual-task Conditions and Their Relationships with Falls among Community-dwelling Elderly People WANG Li,YU Wei-hua*,XU Zhong-mei
The Third Affiliated Hospital of Anhui Medical University,Hefei 230000,China
*Corresponding author:YU Wei-hua,Associate professor;E-mail:ywh-zr@tom.com
  【Abstract】 Objective To explore the gait characteristics under single- and dual-task conditions and their relationships with the history of fall among community-dwelling elderly people,in order to provide a reference for the prevention of falls in this population. Methods From September 2015 to June 2016,we enrolled a convenience sample of 268 community-dwelling elderly people from 3 communities in Hefei city based on the inclusion and exclusion criteria of this study. Data were analyzed for 252 participants. According to history of fall,they were divided into non-fallers (134 cases),fallers A group (77 cases) and fallers B (41 cases). We used Demographic Questionnaire,Barthel Scale,Mini-Mental State Examination (MMSE),handgrip strength test,Timed Up and Go Test (TUGT) and 10-meter walk test under single-task and dual-task conditions with IDEEA LifeGait to collect the demographic data,Barthel Index,mental status,handgrip strength,comprehensive mobility and balance ability,and gait parameters at usual speed and in dual-task walking of the three groups. Results The distribution of age,exercising status,level of fear of falling,Barthel Index,handgrip strength and results of TUGT differed significantly between the groups (P<0.05). Compared with 10-meter walk test under single-task conditions,during 10-meter walk test under dual-task conditions,all the participants showed slower speed,lower cadence,shorter step length,shorter stride length,weaker ground impact and weaker foot fall except pre-swing angle in fallers B (P<0.05). During the 10-meter walk test under single-task conditions,three groups displayed significant different speed,step length,stride length,degree of foot fall,and pre-swing angle (P<0.05),in particular,compared with non-fallers and fallers A,fallers B had significant slower speed,shorter step length,shorter stride length ,weaker foot fall and smaller pre-swing angle (P<0.05). During the 10-meter walk test under dual-task conditions,three groups demonstrated obviously different step length,stride length,weaker ground impact and degree of foot fall (P<0.05),in particular,fallers B showed significant slower speed,shorter step length,weaker ground impact and weaker foot fall compared with other two groups (P<0.05). Conclusion The gait characteristics of community-dwelling elderly people during 10-meter walk test under single- and dual-task conditions were significantly different. During 10-meter walk test under dual-task conditions,those with a history of falls within the past year showed slower speed,shorter step length,weaker ground impuct and weaker foot fall. Therefore, we can conclude that gait parameters are helpful to recognize elderly people with a history of fall. 
  【Key words】 Gait;Accidental falls;Aged;Community
 
Value of TIMI Risk Score for the Prediction of Type 1 Cardiorenal Syndrome in Hospitalized Patients with ST-segment Elevation Myocardial Infarction WANG Yan-bo,GU Xin-shun*,HAO Guo-zhen,JIANG Yun-fa,FAN Wei-ze,FU Xiang-hua
Department of Cardiology Ward 5,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China
*Corresponding author:GU Xin-shun,Professor;E-mail:gunew369@163.com
  【Abstract】 Objective To evaluate the value of thrombolysis in myocardial infarction (TIMI) risk score in predicting type 1 cardiorenal syndrome (CRS) in hospitalized patients with ST-segment elevation myocardial infarction (STEMI). Methods Ninety-three consecutive STEMI patients who received inpatient treatment in Department of Cardiology,The Second Hospital of Hebei Medical University from August to November 2015 were enrolled,including 24 with type 1 CRS (CRS group) and 69 without type 1 CRS (non-CRS group). We collected the baseline clinical characteristics,laboratory findings,PCI treatment,and incidence of major adverse events (MACE) ,and calculated the TIMI risk score, global registry of acute coronary events (GRACE) risk score,and CRUSADE risk score. Logistic regression analysis was preformed to explore the associated factors for the incidence of type 1 CRS. ROC curve analysis was conducted to evaluate the TIMI risk score in predicting the incidence of type 1 CRS. Results Compared with non-CRS patients,CRS patients showed faster heartbeat,elevated creatinine and creatine kinase levels,and higher incidence of MACE,higher risk scores of TIMI,GRACE and CRUSADE (P<0.05). Logistic regression analysis showed that the TIMI risk score was significantly associated with type1 CRS in hospitalized patients with STEMI (P<0.05). For detecting type 1 CRS in hospitalized STEMI patients,the optimal cut-off value of TIMI risk score was 3,at which point its AUC was 0.905〔95%CI (0.840,0.969)〕,yielding a 97.9% sensitivity,62.3% specificity and 0.602 Youden index. Conclusion  TIMI risk score is a good tool for predicting type 1 CRS in hospitalized STEMI patients.
  【Key words】 Myocardial infarction;Cardiorenal syndrome;Thrombolysis in myocardial infarction risk score;Forecasting;Root cause analysis
 
Analysis of the Efficacy of Radiotherapy on Esophageal Cancer and Identification of Associated Prognostic Factors in Elderly Patients HE Hui-juan*,HU Wei
Department of Radiotherapy,Quzhou People's Hospital,Quzhou 324000,China
*Corresponding author:HE Hui-juan,Associate chief physician;E-mail:6824844@qq.com
  【Abstract】 Objective To investigate the efficacy of involved field irradiation (IFI) and elective nodal irradiation (ENI) in treating elderly esophageal cancer patients and identification of associated prognostic factors. Methods A total of 87 elderly esophageal cancer patients who underwent three dimensional (3D) conformal radiation therapy at the Quzhou People's Hospital between July 2011 and August 2013 were enrolled in this study. The patients were divided into IFI (n=45) and ENI groups (n=42). Within the IFI group,the gross tumor volume (GTV) included primary esophageal tumors and enlarged lymph nodes,while within the ENI group,the GTV included primary esophageal tumors and lymphatic drainage area of the corresponding esophageal segments. The radiation dosage in both groups was 50-60 Gy/time,5-6 times/week,and continued for 5-6 weeks. The patients were followed by telephone until December 2016. The 1-,2-,and 3-year overall survival (OS) rate,as well as adverse reactions in the two groups,were compared. The potential factors influencing patient prognosis were also analyzed. Results There were no significant differences in the 1-,2-,and 3-year OS between the two groups (P>0.05). The incidence of radiation pneumonitis in both groups was not significantly different (P>0.05). The incidence of radiation esophagitis in the IFI group was lower than the ENI group (P<0.05). Tumor site,KPS score,and radiotherapy approach did not significantly affect the 3-year OS (P>0.05),while the 3-year OS differed significantly among patients as a function of gender,age,T stage,and N stage (P<0.05). Multivariate Cox regression analysis suggested that age〔RR=2.334,95%CI (1.144,4.759)〕 and T stage 〔RR=0.361,95%CI (0.179,0.729)〕were independent prognostic factors for elderly patients with esophageal cancer (P<0.05). Conclusion IFI and ENI were shown to have comparable efficacy;however,IFI has the advantage of reducing the severity of radiation esophagitis compared with ENI. Age and T stage were shown to be independent prognostic factors for elderly patients with esophageal cancer. 
  【Key words】 Esophageal neoplasms;Radiotherapy;Involved field irradiation;Elective nodal irradiation;Prognosis;Root cause analysis
 
Effect of Insulin Combined with Different Antidiabetic Agents on Carotid Intima-media Thickness and the Carotid Artery Plaque Index HUANG Na-na1,CHEN Shu-lin2*
1.Weifang Medical University,Weifang 261000,China
2. Endocrinology Department,Yantai Yuhuangding Hospital,Yantai 264000,China
*Corresponding author:CHEN Shu-lin,Chief physician;E-mail:13573523696@163.com
  【Abstract】 Objective To study the effect of insulin combined with different antidiabetic agents on cartoid intima-media thickness (CIMT) and carotid artery plaque index (PI) in type 2 diabetic patients. Methods One hundred and thirty-seven type 2 diabetic patients who received inpatient treatment in Endocrinology Department,Yantai Yuhuangding Hospital from May to December 2014,were enrolled and divided into insulin group (55 cases),insulin combined with metformin group (46 cases) and insulin combined with acarbose group (36 cases) according to the hypoglycemic regimen. Three groups' data about sex,age,course of type 2 diabetes, history of smoking and prevalence of hypertension were compared before treatment,and BMI,systolic pressure,blood lipid [triacylglycerol (TG) ,total cholesterol (TC) ,low density lipoprotein cholesterol (LDL-C) ,high density lipoprotein cholesterol (HDL-C)],glycosylated hemoglobin (HbA1c),CIMT and carotid artery PI were compared before and after treatment. Results (1) The average BMI and TG and TC levels differed significantly between the groups either before or after treatment (P<0.05),to be specific,insulin combined with metformin group had higher average BMI than the other two groups (P<0.05);insulin combined with metformin group demonstrated lower average TG and TC levels than insulin group (P<0.05);insulin group showed higher average TG levels than insulin combined with acarbose group (P<0.05). (2) After treatment,the levels of TG,TC ,HDL-C and CIMT decreased significantly in insulin combined with metformin group (P<0.05);carotid artery PI increased significantly in insulin group (P<0.05). (3) The CIMT reduction from pre-to-post treatment did not differ significantly between the 3 groups (P>0.05). However,the difference between the two measured values of carotid artery PI varied substantially between the groups (P>0.05). Specifically,insulin group showed much greater difference between the two measured values of carotid artery PI than the other two groups(P<0.05). Conclusion  For type 2 diabetic patients,insulin combined with metformin can reduce the CIMT;the combination of insulin and metformin or acarbose can delay the progression of carotid artery plaque. 
  【Key words】 Diabetes mellitus,type 2;Carotid intima-media thickness;Plaque,atherosclerotic;Insulin;Metformin;Acarbose
 
Effects of Vitamin C Combined with Octreotide on the Prognosis of Patients with Cirrhosis and Gastrointestinal Bleeding and Changes in Serum Cholinesterase and Oxidative Stress YANG Xiao-yan1,2,GUO Chuan-yong3*,ZHANG Xu2,ZHONG Yu-quan2,TIAN Cheng2
1.The Third Affiliated Hospital of Soochow University,Changzhou 215000,China
2.Department of Gastroenterology,First People's Hospital of Neijiang,Neijiang 641000,China
3.Department of Gastroenterology,Shanghai Tenth People's Hospital,Shanghai 200072,China
*Corresponding author:GUO Chuan-yong,Chief physician,Professor;E-mail:2095764158@qq.com
  【Abstract】 Objective To investigate the changes in prognosis,serum cholinesterase levels,and oxidative stress of liver cirrhosis patients with gastrointestinal bleeding treated with vitamin C combined with octreotide. Methods In total,66 patients with liver cirrhosis and gastrointestinal bleeding who were treated at First People's Hospital of Neijiang between January 2014 and June 2016 were selected and randomly divided into a study group and control group,with 33 cases in each group. The control group was treated with octreotide as a routine treatment,and the study group was given an intravenous drip of 3 g of vitamin C daily in addition to octreotide. All patients were treated until hemostasis. The efficacy and mortality during hospitalization,as well as the levels of serum cholinesterase,superoxide dismutase (SOD),and malondialdehyde (MDA) before hospitalization and on days 1-3 of treatment,were statistically compared between the two groups. Results Following treatment,there were 25 remarkable cases (75.7%),six effective cases (18.2%),and two ineffective cases (6.1%) in the study group,and 16 remarkable cases (48.5%),eight effective cases (24.2%),and nine ineffective cases (27.3%) in the control group,which reflects a more significantly curative effect in the study group compared with the control group (u=-2.487,P=0.013). The mortality rate of the study group was lower than that of the control group 〔6.1% (2/33) vs. 27.3% (9/33),χ2=5.345,P=0.021〕. There was intervention between the treatment method and time in the levels of serum cholinesterase,SOD,and MDA (P< 0.05). The effect of treatment on the levels of serum cholinesterase,SOD,and MDA levels was significant (P<0.05). Time also exhibited significant effects on serum cholinesterase,SOD,and MDA levels (P<0.05). There were no significant differences in serum cholinesterase,SOD,and MDA levels between the two groups before treatment and on day 1 following treatment (P>0.05). The levels of serum cholinesterase and SOD in the study group on day 2 and 3 following treatment were higher than those in the control group,while the level of MDA was lower than that of the control group (P<0.05). The levels of serum cholinesterase and SOD in the study group on days 1-3 after treatment were higher than those before treatment,while the levels of MDA were lower than those before treatment (P<0.05). The levels of serum cholinesterase and SOD in the control group on days 2-3 after treatment were higher than those before treatment,while the level of MDA was lower than that before treatment (P<0.05). Spearman correlation analyses showed that the levels of serum cholinesterase,SOD,and MDA in the study group before and after treatment were correlated with efficacy and prognosis (P<0.05). Conclusion Vitamin C combined with octreotide in the treatment of cirrhosis and gastrointestinal bleeding can significantly improve efficacy and prognosis by increasing the levels of serum cholinesterase and SOD and reducing the level of MDA. The levels of serum cholinesterase,SOD,and MDA are related to the efficacy and prognosis,and may be used as reference indices for evaluation of the curative effect,which could guide clinical intervention and improve treatment as well as prognosis.
  【Key words】 Liver cirrhosis;Gastrointestinal hemorrhage;Ascorbic acid;Octreotide;Prognosis;Cholinesterase;Oxidative stress
 
Relationship of Coagulation Indices and Platelet Parameters with Preeclampsia in the Third Trimester of Pregnancy  WANG Shuang1,WANG Zhi-mei1*,YANG Jia-jia2,MEI Fang-fang1,SONG Li1,HAI Lan-lan1,Ayinuerguli·Aimaiti1
1. Department of Obstetrics,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China
2. Department of Gynecology and Obstetrics,The Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China
* Corresponding author:WANG Zhi-mei,Associate professor;E-mail:meizhiwang@sohu.com
  【Abstract】 Objective To investigate the relationship of coagulation indices and platelet parameters with preeclampsia in the third trimester of pregnancy. Methods The enrolled participants were 260 cases of women in the third trimester of pregnancy who received inpatient treatment in The First Affiliated Hospital of Xinjiang Medical University between 2013 and 2016,including 180 with preeclampsia[82 were identified with mild preeclampsia (mild preeclampsia subgroup) and 98 with severe preeclampsia (severe preeclampsia subgroup) based on the diagnostic criteria for preeclampsia] and 80 without preeclampsia (control group). We collected and compared the baseline characteristics of them such as age,parity,gestational weeks,minzu,systolic pressure,coagulation indices [prothrombin time (PT),activated partial prothrombin time (APTT),international normalized ratio (INR),fibrinogen (FIB)] and platelet parameters [platelet count (PLT),mean platelet volume (MPV),platelet distribution width (PDW) and plateletcrit (PCT)]. Logistic regression analysis was performed to explore the associated factors of severe preeclampsia. Results  The systolic pressure,coagulation indices (PT,APTT,INR,FIB) and platelet parameters (PLT,MPV,PDW,PCT) differed significantly between the mild and severe preeclampsia patients and the controls (P<0.05),while the mean age,distribution of age (including age <35 and ≥35),parity,mean gestational weeks,distribution of gestational weeks(including <34 ,34-36,≥37 gestational weeks) and distribution of minzu did not (P>0.05). Logistic regression analysis revealed that systolic pressure,APTT,PLT,MPV,PDW,and PCT were factors associated with severe preeclampsia (P<0.05). Conclusion  PT,APTT,INR,FIB,PLT,MPV,PDW and PCT are associated with preeclampsia in the third trimester of pregnancy. APTT,PLT,MPV,PDW,and PCT are associated factors for severe preeclampsia occurred during this period.
  【Key words】 Preeclampsia;Third trimester of pregnancy;Platelet parameter;Coagulation function
 
Research on Inquiry Ability of General Practitioners in the Job-transfer Training in Chongqing LI Qiao-ya 1,DENG Hui-sheng 1*,WU Zhi-li 1,SHI Zhang-di 1,HE Ying 2,LI Luo-chang 2
1.Department of Geriatrics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China
2.General Practice Center,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China
* Corresponding author:DENG Hui-sheng,Associate professor,Chief physician,Master supervisor;E-mail:702197987@qq.com
  【Abstract】 Objective To investigate the current situation and existing problems of general practitioners'inquiry ability in the job-transfer training in Chongqing,and to provide a reference for further improving the inquiry ability of general practitioners. Methods The research subjects were 468 physicians who attended the job-transfer training for general practitioners in General Medical Education Center of the First Affiliated Hospital of Chongqing Medical University from 2014 to 2016. Trainees'inquiry ability were evaluated by a self-made inquiry ability assessment program. The scores of these abilities were standardized (1 point) and then compared. Results The median score of 468 trainees was 21.20 (10.65). The assessment contents of the top three scores were whether trainees asked patients' past history,personal history,and family history [1.00 (0.34)],trainees' appearance,behavior,and attitude [0.80 (0.60)],and whether trainees asked the main disease symptoms [0.75 (0.20)]. The assessment contents of the last three scores were whether trainees gave the self introduction [0.20 (0.40)],whether trainees had a good expression in process of inquiry [0.40 (0.20)],whether trainees asked patient's name,age,occupation,address and other general situation [0.40 (0.60)]. Conclusion The trainees have a better performance on asking patients' past history,personal history,and family history,and main symptoms as well as having a good appearance,behavior and attitude. However,they have a worse performance on giving the self introduction,having a good expression in process of inquiry,and asking patient's name,age,occupation,address and other general situation,which are expected to be improved in future.
  【Key words】 General practitioners;Job-transfer training;Inquiry
 
Job-transfer Training for General Practitioners from Township Health Centers in Xinjiang Uygur Autonomous Region XU Pei-lan1,HE Gui-xiang2,WEI Jing-jing2,MA Guo-fang2,3*
1.School of Public Health,Central South University,Changsha 410008,China
2.School of Public Health,Xinjiang Medical University,Urumqi 830011,China
3.Collaborative Innovation Center of Health Risks Governance,Shanghai 200433,China
*Corresponding author:MA Guo-fang,Professor,Master supervisor;E-mail:420194943@qq.com
  【Abstract】 Objective To understand the situation of job-transfer training for general practitioners (GPs) from township health centers in Xinjiang Uygur Autonomous Region. Methods According to 2016 Statistical Yearbook of Xinjiang Uygur Autonomous Region,the number of rural population in Xinjiang Uygur Autonomous Region,the number of townships and the number of rural population in 14 prefectures from 2010 to 2015 were collected in April 2017.According to allocation files of job-transfer training for GPs from 2011 to 2015,the number of GPs who could participate in the job-transfer training in 14 prefectures and their township health centers was collected. And then the number of GPs per 10 000 rural population in Xinjiang Uygur Autonomous Region and 14 prefectures was calculated under different configuration standards.Using stratified random sampling method,14 counties and cities were selected,and relevant staff from Health and Family Planning Commissions in these counties and cities were interviewed.The interview included the understanding of the number of GPs who could participate in the job-transfer training in prefectures and the understanding of participation in job-transfer training. Results According to the standards of one,two or three qualified GPs per 10 000 rural population,1 246,2 492 and 3 738 GPs should be allocated to Xinjiang Uygur Autonomous Region in 2020. In 14 prefectures of Xinjiang Uygur Autonomous Region,there are 2 135 (1 165 from township health centers and 970 from community health centers) GPs who participated in job-transfer training from 2011 to 2015.And 31 GPs were from township health centers and 53 were from community health centers in 2015.The interview results showed that there was a contradiction between working and learning as well as the qualification requirements of GPs who could participate in job-transfer training and the absence of the actual qualifications.The training also could not meet the needs of basic requirements. Conclusion Job-transfer training for GPs in Xinjiang Uygur Autonomous Region mainly can not meet the actual needs.
  【Key words】 Township health centers;General practitioners;Job-transfer training
 
The Application of Mobile Healthcare to Chronic Disease Management in China LIN Zi-zi,WU Shan-yu*
School of Nursing,Yanbian University,Yanji 133000,China
*Corresponding author:WU Shan-yu,Associate professor,Master supervisor;E-mail:1357010343@qq.com
  【Abstract】 With the popularity of smart mobile phone and the rapid development of information technology,a novel mobile healthcare model based on the Internet emerges as the times require,which has become a global trend. Meanwhile,in view of high mortality rate and disability rate of chronic diseases,it is increasingly urgent to apply mobile healthcare to chronic disease management. Based on the domestic and foreign relevant literaturein recent years,the new advances in the application of mobile healthcare to chronic disease management were introduced. Moreover,in this paper,we discussed the general situation and existing problems of mobile healthcare in chronic disease management in China,and proposedtailor-made suggestions,expecting to promote the development of mobile healthcare in domestic chronic disease management.
  【Key words】 Mobile healthcare;Chronic disease;Disease management;Review
 
Hierarchical Medical Service Model of Stroke Based on Cloud Computing System in Regional Medical Consortium YANG Xiao-guang1,MA Li2,LI Na1,WANG Tao3,BAI Bo3,WANG Chen2*
1.President's Office,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100050,China
2.Department of General Practice,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100050,China
3.Information Centre,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100050,China
*Corresponding author:WANG Chen,Chief physician,Professor,Doctoral supervisor;E-mail:wangchen-tr2002@163.com
  【Abstract】 The establishment and improvement of information sharing platform in regional medical consortium (RMC) will help to strengthen the collaboration among medical institutions at all levels,and form a new pattern of hierarchical medical services,two-way referral and orderly medical diagnosis and treatment. Stroke has not only a high mortality rate but also a high disability rate in chronic non-communicable diseases. Therefore,based on Beijing Tian Tan Hospital Medical Consortium in Fengtai District,we integrated the key technology of diagnosis and treatment standards,quality management,and information management to develop the collaborative medical cloud computing system for the systematic intervention of stroke with plug-in and click-to-run features,which achieves the information sharing,regional monitoring,cooperative consultation,and remote reservation,trying to establish a medical consortium of stroke with synergistic prevention and treatment led by general hospitals as well as community health service centers and emergency centers. To promote vertical integration of medical resources within medical consortium,this paper tries to develop an orderly hierarchical medical system and a hierarchical medical service model of stroke based on information technology in order to improve the professional level of the diagnosis and treatment of stroke in the region,which may achieve a certain social and economic benefits.
  【Key words】 Regional medical consortium;Cloud computing system;Stroke;Hierarchical medical system
 
Application of the Remote Blood Glucose Control System for Type 2 Diabetes Mellitus Management in Community GONG Wei-jia1,YAO Jun1*,LIAN Yuan-yuan1,SUN Ya-li1,ZHANG Li-na1,FAN Meng1,ZHANG Jun-qing1,GUO Xiao-hui1
1.Department of Endocrinology,Peking University First Hospital,Beijing 100034,China
2.Beijing Xicheng District Shichahai Community Health Service Center, Beijing 100123,China
*Corresponding author:YAO Jun,Associate chief physician,Master supervisor;E-mail:yaojun20170401@163.com
  【Abstract】 Objective To explore the application of the remote blood glucose control system for type 2 diabetes mellitus (T2DM) management in community. Methods A total of 363 newly diagnosed but poorly controlled T2DM patients from Shichahai Community Health Service Center were selected in Xicheng District of Beijing from June 2012 to May 2013. They were randomly divided into the control group (n=184) and the experimental group (n=179) by random number table. Patients in the control group received conventional blood glucose management while the community health service center carried out remote blood glucose control on patients in the experimental group. Patients in both groups were followed up for one year. Results of laboratory examinations before the intervention and 3,6 and 12 months after the intervention were compared between two groups,which included fasting blood glucose (FPG),glycosylated hemoglobin (HbA1c),total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),creatinine (Cr),systolic blood pressure (SBP),diastolic blood pressure (DBP) and a seven-day diet control. Results Test results of FPG,TC,HDL-C,LDL-C,Cr and the seven-day diet control differed significantly in two groups (P<0.05). These results differed significantly between two groups at different time points (P<0.05). Intervention methods and different time points had an interaction on the results of FPG,TC,HDL-C,LDL-C,Cr and the seven-day diet control (P<0.05). There were no significant differences in HbA1c,TG and SBP between two groups (P>0.05),but they showed significant differences in the same group at different time points (P<0.05). Intervention methods and different time points had an interaction on the results of HbA1c,TG,and SBP (P<0.05). The DBP results showed no significant differences between two groups (P>0.05) or at different time points (P>0.05). There was no interaction on DBP between intervention methods and different time points (P>0.05). Conclusion Remote blood glucose control system has positive effects on type 2 diabetes mellitus management in community and improves patients'metabolism. 
  【Key words】 Diabetes mellitus,type 2;Remote blood glucose control system;Community health services
 
Effects of Community-based Comprehensive Interventions on the Rehabilitation of Schizophrenia Patients GUO Zheng-jun1,GUO Yu-min2,YAO Feng-ju1,WANG Hai-ling1,WANG Yu-jie1,YANG Shi-chang1* 
1.Control and Prevention Section,The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China
2.Finance Section,Xinxiang Maternal and Child Health Hospital,Xinxiang 453002,China
*Corresponding author:YANG Shi-chang,Professor;E-mail:yangshch2000@163.com
  【Abstract】 Objective To explore the effects of community-based comprehensive interventions on the rehabilitation of schizophrenia patients. Methods Based on the inclusion and exclusion criteria,from Xinxiang National Register Information System for Severe Mental Disorders,we enrolled 150 schizophrenic patients under management from January 2005 to January 2016 and equally randomized them into home-based care and education group,social skills rehabilitation training group and comprehensive intervention group. In addition to the conventional medical treatment,patients in home-based care and education group,social skills rehabilitation training group,comprehensive intervention group and their family members were given schizophrenic knowledge training,rehabilitation training about social skills,schizophrenic knowledge training combined with rehabilitation training about social skills,respectively. The interventions for all groups lasted for 3 months. The mental symptoms,rehabilitation status and social functioning were assessed by Positive and Negative Symptoms Scale (PANSS),Morningside Rehabilitation Status Scale (MRSS) and Social Disability Screening Schedule (SDSS) before intervention and at 6,12 months after intervention,respectively. Results The final participants were 145 cases (49 in home-based care and education group,48 in social skills rehabilitation training group and 48 in comprehensive intervention group) after excluding 2 deaths during intervention,1 case lost to follow-up and 2 withdrawals. The average scores of PANSS,MRSS and SDSS measured before intervention,and at 6,12 months after intervention differed significantly between the groups (P<0.05). Contents and duration of intervention produced interaction effects on the scores of PANSS,MRSS,and SDSS in all groups (P<0.05). At both 6,12 months after intervention,compared with other two groups,comprehensive intervention group demonstrated significantly different average scores of PANSS,MRSS and SDSS (P<0.05);home-based care and education group and social skills rehabilitation training group had obviously different average scores of PANSS,MRSS and SDSS (P<0.05). The recurrence rate of schizophrenia within 1 year after intervention differed significantly among the three groups (P<0.05). Conclusion Community-based comprehensive interventions can effectively alleviate the schizophrenia symptoms,improve the rehabilitation status and social functioning,as well as reduce the recurrence rate within 1 year after intervention in schizophrenic patients. 
  【Key words】 Schizophrenia;Comprehensive intervention;Rehabilitation;Treatment outcome
 
Intervention Effects of Improved Social Skills Training for Community Reentry on Symptoms,Cognition and Social Functioning of Community Schizophrenia Patients JIANG Jun1,LI Zhi-wu1*,KANG Rui-ying2,YAN Hong-feng1,WU Ye-qing2
1.Nanyuan Hospital,Beijing 100076,China
2.Fengtai Community Health Service Center,Fengtai District,Beijing 100141,China
*Corresponding author:LI Zhi-wu,Associate chief physician;E-mail:gjzh195825@163.com 
  【Abstract】 Objective To explore the intervention effects of improved social skills training for community reentry on symptoms,cognition and social functioning of community schizophrenia patients. Methods From Fengtai Community Health Service Center,162 chronic schizophrenia patients enrolled in Beijing Mental Health Management System were selected from May 2014 to April 2015,and they were randomly divided into the control group (n=82) and the intervention group (n=80). Patients in the control group received medication treatment only,while besides medication treatment,patients in the intervention group also accepted social skills training for community reentry. The intervention lasted for 12 months. The Positive and Negative Symptom Scale (PANSS),Insight and Treatment Attitude Questionnaire (ITAQ) and Social Function Defect Screening Scale (SDSS) were adopted to assess symptoms,cognition and social functioning of schizophrenia patients before intervention and after 12-month intervention. Results During the intervention period,nine patients were lost to follow-up and eventually,there were 77 patients in the control group and 76 patients in the intervention group. Before intervention,there were no significant differences in the scores of PANSS,ITAQ and SDSS between two groups (P>0.05). After 12-month intervention,there were no significant differences in the scores of positive symptom and general psychopathological symptom between two groups (P>0.05). However,there were significant differences in the scores of negative symptom,PANSS,ITAQ and SDSS between two groups (P<0.05). Conclusion On the basis of medication treatment,the improved social skills training for community reentry can effectively improve the symptoms,cognition and social functioning of community schizophrenia patients.
  【Key words】 Schizophrenia;Social skills training for community reentry;Cognition;Social functioning
 
Clinical Characteristics and Rules for Using Lugua Polypeptide Injection in Combination with Other Drugs among Cervical Spondylosis Patients HAN Tao1,2,XIE Yan-ming1,LI Yuan-yuan1 *,ZHANG Yin1,ZHUANG Yan3
1.Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing 100700,China
2.Wangjing Hospital of CACMS,Beijing 100102,China
3.Navy General Hospital,Beijing 100048,China
*Corresponding author:LI Yuan-yuan,Associate researcher,Master supervisor;E-mail:chibjyy@163.com
  【Abstract】 Objective To investigate the clinical features and rules for using Lugua polypeptide injection in combination with other drugs among patients with cervical spondylosis. Methods From the hospital information system (HIS) of 23 tertiary grade A hospitals,we collected the in-hospital data of totaled 2 901 cervical spondylosis cases who were treated by Lugua polypeptide injection from February 2004 to November 2014. Descriptive statistical analysis of the clinical characteristics was performed. Frequency analysis and association analysis were carried out to explore the use of Lugua polypeptide injection in combination with other drugs. Results Of the 2 901 cases,1 726 (59.5%) were 45-64 years old;top 3 complications were lumbar intervertebral disc herniation (9.6%,278/2 901),fracture (8.7%,251/2 901),and hypertension (6.0%,174/2 901);the 3 leading syndromes among 253 cases whose TCM syndromes were recorded were qi stagnation and blood stasis syndrome [136 cases (53.8%)],asthenia of liver and kidney [83 cases (32.8%)],phlegm-stasis syndrome [8 cases (3.2%)]. All of them were treated by combination use of Lugua polypeptide injection and other drugs (western/Chinese drugs). The most frequently used 3 western drugs were methylcobalamin [41.4% (1 201/2 901)],cobamamide [38.1% (1 104/2 901)] and mannitol [22.1% (642/2 901)] ,respectively;the top 3 used Chinese medicines were Jingshu granules [22.1% (642/2 901)],Jintiange capsule [18.4% (533/2 901)],Qianggu capsule [10.0% (289/2 901)],respectively;in terms of pharmacological action,the most frequently used 3 categories of western drugs were antibiotics [50.6% (1 468/2 901)],nerve nutrition drugs [45.8% (1 328/2 901)],hypertonic dehydrating agents [44.8% (1 299/2 901)],respectively;the most commonly used 3 categories of Chinese medicine were agents for promoting blood circulation to remove blood stasis [59.2%(1 716/2 901)],agents for tonifying the kidney and strengthening the bone [33.3%(967/2 901)],and those for clearing away heat and toxic materials [13.7% (397/2 901)]. Association rule analysis revealed that,of the combination of Lugua polypeptide injection + 2 types of western/Chinese medicine,Lugua polypeptide injection + Epinephrine injection + dopamine and Lugua polypeptide injection + Shengmai injection + Shenfu injection won the greatest support;the greatest support were Lugua polypeptide injection + antacid and antiulcer drug + antishock drug,and Lugua polypeptide injection + agents for clearing away heat and toxic materials + agents for promoting blood circulation to remove blood stasis. Conclusion In the management of cervical spondylosis,as the high-risk population,people aged 45-64 years should be paid special attention. For clinical treatment of this disease,Lugua polypeptide injection combined with Chinese and western medicine is most commonly used. The commonest Chinese medicines involved in the therapy are agents for promoting blood circulation to remove blood stasis,and tonifying the kidney and strengthening the bone,and the commonest western medicines are antibiotics and nerve nutrition agents. 
  【Key words】 Cervical spondylosis;Lugua polypeptide injection;Hospital information system;Medication
 
Regularities of Prescribing Therapy for AIDS Combined with Ascites Due to Cirrhosis by an Elderly Famous TCM Doctor Named LI Fa-zhi WANG Dan-ni1,2,3,CHEN LI-hua1,WU Rui-hong1,XU Qian-lei1,2,3,ZHANG Xiao-wei1,2,3,ZHANG Li1,SUN Miao-na1,WU Xin-yi1,GUO Hui-jun1,2,3*
1.AIDS Clinical Research Center,The First Affiliated Hospital of Henan University of TCM,Zhengzhou 450000,China
2.Key Research Division of AIDS,State Administration of Traditional Chinese Medicine of the People's Republic of China,Zhengzhou 450000,China
3.Henan Key Laboratory of Viral Diseases Control with TCM,Zhengzhou 450000,China
*Corresponding author:GUO Hui-jun,Professor,Chief physician;E-mail:guo.6268505@163.com
  【Abstract】 Objective To investigate the regularities of prescribing therapy for AIDS combined with ascites due to cirrhosis by LI Fa-zhi,an aged famous TCM doctor. Methods According to the inclusion and exclusion criteria,from Elderly Famous TCM Doctors'Clinical Diagnosis and Treatment Data Collection System,we selected 259 cases of AIDS combined with ascites due to cirrhosis treated by professor LI Fa-zhi from October 2007 to September 2014 and finally enrolled 240 cases (totaled 794 visits) after excluding 19 cases without response. Complex Network Analysis System for Clinical TCM-treated Cases (Liquorice software) was used for descriptive statistical analysis and complex network analysis. Results For AIDS combined with ascites due to cirrhosis treated by LI Fa-zhi ,the three drugs used most frequently were Atractylodes (770 times),Astragalus membranaceus (761 times) and Alisma (707 times);the three combinations used most commonly were Atractylodes-Astragalus membranaceus (747 times), Poria cocos-Alisma (698 times) and Angelica-Alisma (696 times);the core drugs used for invigorating qi and spleen and promoting dieresis,for activating blood circulation,for astringing liver,soothing liver and promoting the circulation of qi,for inducing diuresis to reduce edema,were Atractylodes,Astragalus membranaceus and Poria cocos,Angelica and Ligusticum wallichii,White peony root,Bupleurum,and Folia perillae acutae,Alisma,Radix stephaniae tetrandrae,Fructus chaenomelis lagenariae,Pericarpium arecae,Indian bread exodermis and Epicarpium benincasae,respectively;the core prescriptions were Dangguishaoyao powder with Fangjihuangqi decoction,Modified Jiming powder,respectively. Conclusion LI Fa-zhi treats this disease mainly by soothing liver,invigorating the spleen,regulating qi,inducing diuresis for removing edema ,as well as removing blood stasis,nourishing qi and eradicating qi stagnation.
  【Key words】 Acquired immunodeficiency syndrome;Ascites due to cirrhosis;LI Fa-zhi;Complex network analysis;TCM therapy
 
Recent Developments in Health Information Literacy Assessment Tools YAO Zhi-zhen1,2,ZHOU Lan-shu1*
1.School of Nursing,The Naval Military Medical University,Shanghai 200433,China 
2. Hudong Community Health Service Center,Pudong New Area,Shanghai 200129,China
*Corresponding author:ZHOU Lan-shu,Professor,Doctoral supervisor;E-mail:zhoulanshu@hotmail.com
  【Abstract】 Health information literacy assessment is one of the important research fields of health information literacy,and a key basis for delivering health education and behavior intervention. Based on the review of recent developments in health information literacy assessment tools at home and abroad,we found that the development in this field in foreign countries is better,which could be represented by comparatively well developed health information literacy assessment tools such as functional,interactive and critical health information literacy assessment tools,whereas in China,the development is still in the initial stage. In view of this,based on learning from the relevant advanced experience of foreign countries,we proposed suggestions for improving the development of health information literacy assessment tools suitable for China's culture,in order to provide a reference for health education delivery and health promotion.
  【Key words】 Health information literacy;Information literacy;Health literacy;Assessment tools
 
Recent Developments in the Scoring System for Comorbidities of COPD SHI Qi-fang,SHENG Ying,WANG Shu-yun* 
Intensive Care Unit,Shanghai Pudong Hospitai/Fudan University Pudong Medical Center,Shanghai 201399,China. 
*Corresponding author:WANG Shu-yun,Chief physician,Master supervisor;E-mail:wangshuyun1665@sohu.com
  【Abstract】 Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD),which not only seriously impair the quality of life,but also increase the frequency of acute exacerbation of COPD and mortality. In recent years,comorbidities

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