Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-23 Cooperative journals: 《中国全科医学》
Abstract： Background The clinical reasoning of general practitioners is the key to providing quality medical services to patients，but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed. Objective This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching. Methods From September to December 2022，38 master's degree students of the Medical School of Tongji University were divided into the in-service group（16） and residential training group （22）. The course consists of three modules，namely core，case and result，and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale，while the content of subjective evaluation comes from multi-source feedback. SPSS 22.0 was used for statistical analysis. Results The final course scores for the core and case modules were statistically significant for both groups（P<0.05），but the first course scores were not（P>0.05）. The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared，and there was statistical significance （P<0.001）. Subjective evaluation can be divided into positive evaluation and improvement evaluation. It is found that with the deepening of the course，the number and percentage of positive evaluation of core modules and case modules continue to rise，while the number and percentage of improvement evaluation continue to decline. Conclusions Programmatic assessment can enrich the evaluation system of general clinical reasoning，promote students' construction of general clinical reasoning in order，and also found that "flipped classroom" is a form of procedural evaluation.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-03-26 Cooperative journals: 《中国全科医学》
Abstract： Background The level and quality of diagnosis and treatment of Helicobacter pylori（Hp）infections in Shanghai's community health service Institutions is unclear，and there is a lack of systematic evaluation and monitoring. Objective To understand the current status of diagnosis，treatment and management of Helicobacter pylori（Hp）infection in community health centers in Shanghai，to evaluate the quality of diagnosis and treatment，and to explore the problems and improvement measures. Method A questionnaire was distributed to a total of 249 community health centers in 16 administrative districts of Shanghai and 3 875 general practitioners（GPs）working in the community health centers from May to June 2022 to investigate the standardization of prescriptions for the eradication of Hp infections in the community health centers，the detection of Hp infections，the provision of drugs for the eradication of Hp infections，the management of Hp infections，the difficulties of Hp infections in the treatment of Hp infections，as well as the knowledge of community-based GPs on the diagnosis and treatment of Hp infections. Result The result of the prescription eradication program for Hp infection in primary health care facilities in Shanghai was only 32.0 percent correct. The proportion of health service centers with the ability to conduct Hp infection testing in primary healthcare institutions in Shanghai is high，nearly 80%. Most of the community health service centers were able to equip the basic medicines needed for the eradication of Hp，but the rate of bismuth equipment was low，54.6%. The rate of Hp diagnosis and treatment standard supervision was 80.0%. The demand for the training of standardized diagnosis and treatment of Hp infections was high，accounting for 66.7%. The main difficulties in Hp infection diagnosis and treatment were incomplete drug provision，insufficient doctor's diagnosis and treatment ability and insufficient equipment. Community general practitioners do not have enough basic knowledge about the diagnosis and treatment of Hp infection. Conclusion The capacity to conduct Hp testing needs to be further strengthened in primary care organizations in Shanghai，especially in remote community health service centers，including the purchase of more Hp-related testing equipment and reagents，and the completion of related medications needed for the eradication of Hp. In addition，it is necessary to further strengthen the standardized diagnosis and treatment training of Hp infection for community health centers，improve the diagnosis and treatment ability of general practitioners on Hp infection，and at the same time，strengthen the supervision of Hp diagnosis and treatment standardization，so as to further improve the diagnosis and treatment ability of community general practitioners on Hp infection.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： Primary health care institutions undertake a range of crucial health-related responsibilities. With the continuous advancement in the medical field，community health service institutions have significantly improved their hardware conditions and effectively enhanced their capacity for health information systems，thereby highlighting the growing demand of individuals to receive specialist diagnosis and treatment within the community. This paper discusses the significance， connotation，implementation strategy，and method of constructing specialized disease diagnosis and treatment technology in the community. The article emphasizes that developing specialized disease diagnosis and treatment technology in community health services can enhance the proficiency of general practitioners，improve primary medical technology standards，elevate community health service levels，and meet public demands for specialized disease diagnosis and treatment. The development of comprehensive-specialty integration entails not only advancing specialized diagnostic and treatment technologies based on general practice work but also collaborating with higher-level hospitals to introduce a series of specialized technologies for joint diagnostic and treatment efforts. In terms of specific implementation strategies，it is essential to identify appropriate specialized technologies based on local diagnostic and treatment needs while conducting applied basic research on clinical method deficiencies throughrecruited expertise. Gradually establishing distinctive technical brands will help build momentum towards creating a specialization#2;focused development base.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： The professional capacity and infrastructure of general practitioners in grass-roots medical and health institutions in China are relatively weak，and the energy of specialists in general hospitals is limited and resources are abundant， so we will further integrate the medical resources of community health institutions and general hospitals and strengthen the cooperation between general practitioners and specialists. In order to better protect the quality of medical care and promote the health of patients. This paper systematically sorts out the typical practices and experiences of the construction of outpatient clinics of combination of general practice and specialty，and takes the source，connotation，construction path and construction path of the concept of full-specialty combination of outpatient clinics Development effectiveness，existing problems and strategic recommendations are elaborated. Point out the challenges that may be faced in the construction of outpatient clinics of combination of general practice and specialty management model. In addition，in view of the innovative practices of each region，five aspects of suggestions are put forward in combination with existing problems: Improve the rules and regulations for the construction of outpatient clinics of combination of general practice and specialty，coordinate and unify the outpatient path of outpatient clinics of combination of general practice and specialty，pay attention to the protection of outpatient clinics of combination of general practice and specialty teams，clarify the population of outpatient clinics of combination of general practice and specialtyservices，and improve the health evaluation system for the outcomes of outpatient clinics of combination of general practice and specialty.In order to provide reference for the country to carry out the construction of outpatient clinics of combination of general practice and specialty in depth.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： The development of the clinical diagnosis and treatment technology combined with general practice and specialist is an important measure to improve the comprehensive service level of community health centers（CHCs），promote the more reasonable medical order，and implement hierarchical medical system. In this article，we find that most of CHCs in the city have carried out the clinical diagnosis and treatment technology combined with general practice and specialty，by analyze the documents related to the development of community health in Shanghai and published literature，and combine the survey results of these technologies carried out by Shanghai community health institutions. It has become an important strategy for CHCs to improve their clinical capacity，the development of these technologies，by focusing on common and frequently-occurring diseases in the community，and combining its own medical advantages，to select appropriate disease types. However，during the development of the clinical diagnosis and treatment technology combined with general practice and specialist，there are some difficulties，such as the lack of relevant talents in the community and awareness of some experts on community specialized services，the difficultyof in-service education of general practitioners，besides，specialized drugs in the community and brand publicity on community characteristic technologies are also indispensible. The development of the clinical diagnosis and treatment technology combined with general practice and specialist in the community needs the policy support of the health administrative department. We suggest that CHCs should carry out the training of the combination of general practice and specialist in combination with the professional development of general practitioners，increase the drugs for specialty and special disease diagnosis and treatment，propagate the community characteristic technology in multiple ways，and explore the general practice and specialist combined diagnosis and treatment mode innovatively.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-01-17 Cooperative journals: 《中国全科医学》
Abstract： Background Mild cognitive impairment（MCI） is an age-related chronic noncommunicable disease facing a certain caregiving burden. At present，most studies focus on the caregiving burden and social support of caregivers of patients with moderate-to-severe cognitive impairment，but there are few studies on the social support and related factors of caregivers of MCI patients. Objective To explore the social support and related factors of caregivers of MCI patients，and provide evidence for feasible social support for caregivers of MCI patients. Methods A total of 102 family caregivers of patients initially diagnosed as MCI in Weifang Community Health Service Center，Pudong New Area，Shanghai from April 2020 to August 2021 were recruited. A cognitive impairment management group was established to investigate basic information，social support rate score（SSRS），positive aspects of caregiver（PAC） score and Zarit Caregiver Burden Questionnaire （ZBI） score of the caregivers of patients with MCI. The related factors of social support for the participants were analyzed. Results The average score of social support of caregivers of MCI patients was （31.26±6.87），including the average score of objective support as （7.02±2.10），subjective support as（17.93±4.62） and support utilization as（6.31±1.96）. Comparison of SSRS scores of caregivers with different marital status，monthly household income status，and understanding of MCI showed statistically significant differences（P<0.05）. Multiple linear regression analysis showed that marital status，relationship with patients，living together，and total PAC scores were the related factors of caregivers' objective support（P<0.05），while the relationship with patients，monthly family income，religious belief，and total PAC scores were factors influencing caregivers' subjective support（P<0.05）. Binary Logistic regression analysis indicated that the relationship with patients and monthly household income，awareness of MCI and total score of positive feelings were the influencing factors of social support of MCI caregivers（P<0.05）. Conclusion The total social support of family caregivers of MCI patients is low，and the distant relationship between patients and caregivers，low monthly household income，low awareness of MCI，and low positive feelings of caregivers are independent influencing factors on the social support of MCI caregivers. Caregivers should be supported in all aspects at the family，social and community levels，thus improving their happiness and also facilitating collaborative community management of MCI.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2023-12-27 Cooperative journals: 《中国全科医学》
Abstract： At present，the collaboration of general practice and speciality has been applied to the diagnosis，treatment and management of various chronic diseases in the community based on the technical support of disease diagnosis and treatment and the implementation of hierarchical diagnosis and treatment. Based on the patient-centered，systematic and holistic thinking characteristics of general practice，the general practice team of Yangpu Hospital Affiliated to Tongji University explored and practiced a more comprehensive，in-depth and effective collaboration model of general practice and speciality around the multi-dimensional construction of 'six ones'. The construction of 'six ones' was based on the collaboration of general practice and speciality between general hospitals and community health service centers. Taking osteoarthritis（OA），a common chronic disease in the community，as an example，its contents and characteristics were as follows.（1）Establishment of a multidisciplinary team：the established team could rely on the basis of the three-dimensional integrated health care system of the general hospitals，to give play to the liaison and coordination role of general practice department in general hospitals，refine and coordinate the multidisciplinary division of labor；（2）Improvement of a set of diagnosis and treatment processes：improve a set of hierarchical diagnosis and treatment process for diseases based on scientific evidence，and evaluate the effectiveness of the diagnosis and treatment process，so that it could help to improve patients' symptoms and quality of life；（3）Development of an APP：the developed APP could cover multiple functions such as hierarchical diagnosis and management of OA patients， doctor-patient communication，popularization of science，appointment registration，and could record the complete diagnosis and treatment data in the exclusive information platform；（4）Designing a set of publicity and promotion programs：Publicize the program in multiple scenarios such as disease diagnosis and treatment，health examination and consultation in general hospitals and communities through a variety of forms of text，pictures and videos；（5）Establishment of a case database： establish a specific disease database for OA patients，continuously follow up patients and implement hierarchical management of the collected data，so as to provide more cases with general characteristics；（6）Construction of a set of curricula：the curriculum is built around OA specialties，including "bone pain as an undifferentiated disease in general practice" and "chronic disease management of OA"，the course is conducted in the form of problem-oriented learning，outpatient consultation and teaching round demonstration，which was for multi-level training of undergraduate，graduate and continuing education. Taking the 'six ones' construction of OA management in the community as an example，the practice of the collaboration of general practice and speciality for the management of chronic disease based on the thinking of general practice suggests the potential of comprehensive，in-depth cooperation and mutual promotion between the two sides in multiple dimensions of medicine，teaching and research，as well as the effectiveness of optimizing and integrating the team，technology and information support related to hierarchical disease management for promoting the physical and mental health of patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-04-19 Cooperative journals: 《中国全科医学》
Abstract： Background Coordinated regional health development aims to optimize resource allocation by constructing a well-structured and functional regional collaborative system to provide continuous medical services，and to leverage the unique features and strengths of medical centers and community health centers within a region via fully integrating resources and sharing information. However，current available systems for assessing coordinated regional health development mainly focus on outcomes，which are relatively non-diversified and unsystematic，thus further research is required to fill this gap. Objective We aimed to construct an evaluation system for coordinated regional health development，to provide scientific evidence for evaluating the coordinated development capacities of regions. Methods We collected essential factors related to coordinated regional health development through a literature review and semi-structured interviews，and used them to construct a draft version of the Coordinated Regional Health Development Assessment System（CRHDAS）. Then we selected 19 experts who were familiar with coordinated regional health development（engaging in general medicine，medical education，administrative management，and public health management） from Shanghai using stratified sampling to attend two rounds of online combined with offline Delphi questionnaire surveys from December 2020 to March 2021 to determine the weights of the indicators and test the logical consistency of the weights of indicators at each level using Analytic Hierarchy Process. After that，we established the final version of CRHDAS. Results The effective response rate and authoritative coefficient were 95.0% and 0.87，respectively，for the first round of survey，and were 100.0% and 0.92，respectively，for the second round of survey. The CRHDAS consists of four first-level indicators（with corresponding weights of 0.387，0.296，0.187 and 0.130），12 second-level indicators，and 31 third-level indicators. The consistency ratios for the weights of three levels of indicators are <0.100. Conclusion The CRHDAS is of high-level scientificity and practicality，which can help identify problems and deficiencies of the collaboration mode between community health centers，providing a theoretical and practical basis for guiding coordinated regional health practice in the future.
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