Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-06-12 Cooperative journals: 《中国全科医学》
Abstract： Background Follow-up is a necessary step in the management of chronic disease patients. Cloud follow up as a new form of follow-up may improve the quality of follow-up. However，there is currently a lack of patient-oriented evaluation tools for cloud follow-up service quality. Objective To develop a scale for evaluating the service experience of chronic disease patients in cloud follow-up and to examine its reliability and validity，in order to provide a tool for evaluating the quality of cloud follow-up services. Methods Guided by the Service Quality （SERVQUAL） evaluation model，the scale was developed by using methods including literature review，semi-structured interview，expert consultation. During August to October 2022，a survey was conducted among chronic disease patients （n=480） discharged from a tertiary hospital and lived under the network of a community service center in Hangzhou，China. Item analysis and tests of reliability and validity were test on the developed scale. Results The developed scale for evaluating the service experience of chronic disease patients in cloud follow-up had 37 items distributed in 5 dimensions. Patients' perceptions and expectations to each item were evaluated simultaneously. The overall Cronbach's α coefficient of the developed scale was 0.962，with split-half reliability of 0.732 and test-retest reliability of 0.844.The content validity index of the scale was 0.980. The correlation coefficient between the scale and satisfaction scores was 0.754（P<0.01）. Confirmatory factor analysis showed good fit of the scale. The factor loading coefficients of the scale items ranged from 0.514 to 0.988（P<0.001），the composite reliabilities of the dimensions ranged from 0.947 to 0.987，and the average variance extracted（AVE）ranged from 0.693 to 0.947. The correlation coefficients between dimensions were all smaller than the square root of the corresponding AVE. Conclusion The scale for evaluating the service experience of chronic disease patients in cloud follow-up，developed in this study，demonstrated good reliability and validity. It can be used to evaluate the experience of chronic disease patients in cloud follow-up services.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-06-11 Cooperative journals: 《中国全科医学》
Abstract： Background With the precipice decline of the birth population and the successive adjustment of the fertility policy in China，it is inevitable to re-examine the breadth and depth of maternal and infant health care services. Also，it has posed great challenges to the community health service institutions，which are the important suppliers of maternal and infant health care services. Objective To investigate the current status of maternal and infant health services in Shanghai communities，in order to provide suggestions and evidence for upgrading the level of primary care services for mothers and infants. Methods From August 2022 to April 2023，using purposive sampling method，the study selected 5 community health centers in the central district of Shanghai，in which in-depth personal interviews were conducted with 10 maternal and infant health service providers during participatory observation；organized a focus group interview with 12 primary health workers in the urban-rural fringe areas. In addition，8 obstetrics staff from tertiary hospitals participating the construction of obstetrics and gynecology medical consortium，were invited to conduct 2 focus group interviews to obtain information from different perspectives.The data were analyzed using the content analysis method. Results A total of 4 themes and 11 sub-themes were extracted:（1） some health care projects are poorly implemented （inadequate mental health care，ineffective contraceptive guidance，and difficulties in implementation of traditional Chinese medicine health care）；（2） health talent team construction needs to be strengthened （inadequate human resources，limited professional knowledge and skills，poor motivation to work，and little role of the family physician teams）；（3） the implementation process is challenging （difficulty in cross-district management and low participation of residents）；（4） the services integration need to be improved （deviation in the positioning of higher level medical institutions and insufficient coordination among agencies）. Conclusion At present，maternal and infant health care in Shanghai communities is still facing various challenges. It is necessary to make full use of the opportunity of medical union construction to strengthen talent training and establish an innovative human resource management model. At the same time，when strengthening the top-level design and clarifying the division of tasks between the various tiers of medical institutions，the performance assessment and incentive mechanism should be improved to truly stimulate the morale and service enthusiasm of community maternal and infant health service providers. Multiple measures should be taken to effectively enhance the quality of service and meet the needs of current health care tasks.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-06-11 Cooperative journals: 《中国全科医学》
Abstract： Background Multimorbidity pose challenges to older adults' health services. It is of great importance to explore its impact on health services utilization in the elderly. The Chinese Multimorbidity-Weighted Index（CMWI）has been developed to measure the burden of multimorbidity in Chinese middle-aged and elderly，but there is a lack of cohort studies on the association between CMWI and health service utilization. Objective To explore the association between burden of multimorbidity and utilization of health among older adults，which provides scientific evidence for improving the intervention and management of older adults' patients with multimorbidity. Methods From December 2021 to January 2024，taking Sihui City of Zhaoqing City，Guangdong Province as an example，the electronic health records of residents from 2017 to 2021 were collected from the city's national health information platform to establish a natural population cohort for health examination of the elderly. We used the time of the first health examination in this period as the baseline，the CMWI was used to measure individual's baseline burden of multimorbidity .We use the negative binomial regression to analyze the association between individual's CMWI respectively and the total number of outpatient visits，chronic disease-related outpatient visits，total number of hospitalizations and chronic disease-related hospitalizations during the follow-up period. Results Among the total 39 989 participants，there were 14991（55.18%）cases of multimorbidity，and the CMWI was 1.3（0，2.3）. During an average 1 268 days follow-up period，26141 people（65.37%）had used outpatient services，the number of total outpatient visits and chronic disease-related outpatient visits was 2（0，6）and1（0，4）.7 332（18.34%）had used hospitalization services，the number of total hospitalization and chronic disease-related hospitalization was 0（0，0）and 0（0，0）. Age，genders，education levels and CMWI varied significantly by the utilization of health（P<0.05）. The residential type varied significantly by the utilization of outpatient services（P<0.05）but no by utilization of inpatient services（P>0.05）. After adjusting the covariates of age，gender，residence and education levels，negative binomial regression analysis showed that CMWI was a risk factor on the increase of health service utilization in the elderly（IRR>1）. For each unit increase in CMWI，the total number of outpatient visits increased by 1.210（95%CI=1.196~1.224），the number of chronic disease-related outpatient visits increased by 1.276（95%CI=1.259~1.292），the total number of hospitalizations increased by 1.277（95%CI=1.244~1.312），and the number of chronic disease-related hospitalizations increased by 1.286（95%CI=1.252~1.321）. Conclusion CMWI is a risk factor for the increase of health service utilization in the elderly，and the number of health service utilization in the elderly increases with the increase of CMWI. More attention should be paid to the burden of multi-chronic diseases in the elderly，so as to provide scientific basis for improving the intervention and management of multi-chronic diseases in the elderly in China.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Acute ischemic stroke（AIS）is characterized by high rates of disability，mortality，and recurrence，posing a significant burden on patients and society. In the era of big data，predictive models are increasingly used in patient diagnosis，treatment decisions，prognosis management，and healthcare resource allocation，highlighting their growing importance. Machine learning methods have become a crucial tool for predicting the prognosis of AIS patients and have been widely applied. This review explores recent advancements in the study of AIS prognosis prediction，focusing on machine learning methods. It discusses current issues and challenges faced by machine learning models，aiming to provide new insights and references for methods of early assessment and prediction of prognosis outcomes in AIS patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Previous studies have found that inter-arm blood pressure difference（IAD）and mild cognitive impairment（MCI）are both associated with cardiovascular risk factors，but it is unclear whether there is an association between IAD and MCI. Objective To explore the relationship between IAD and MCI in rural elderly persons and to provide a scientific basis for clarifying the mechanisms of cognitive decline in elderly persons. Methods From July to August 2019，the rural elderly residents aged 60 years and older were selected using the multi-stage cluster sampling method from 5 townships in 2 counties（districts）of Guizhou Province，and questionnaire surveys，general physical examinations，cognitive function assessments，and bilateral arm blood pressure measurements were carried out among them. Cognitive function was evaluated using the Mini-Mental State Examination（MMSE） scale，and activities of daily living were assessed using the Activities of Daily Living（ADL） scale. Spearman rank correlation analysis and binary logistic regression model were used to investigate the association between IAD and MCI in the elderly persons. Results A total of 1 795 questionnaires were distributed，and data from 1 088 participants were finally included in the study by excluding subjects with incomplete information on the questionnaires，those who did not undergo blood pressure measurements，and those who did not undergo blood tests. Among the 1 088 rural elderly residents，138 patients（12.68%）with MCI，99 patients（9.10%）with systolic inter-arm blood pressure difference（sIAD） ≥ 10 mmHg，and 80 patients（7.35%）with diastolic inter-arm blood pressure difference（dIAD） ≥ 10 mmHg were detected. Individuals with IAD ≥ 10 mmHg had a higher prevalence of MCI and lower MMSE scores，orientation scores，language scores，and delayed recall scores compared to those with IAD <10 mmHg （P<0.05）. The results of correlation analysis showed that the sIAD was significantly negatively associated with the total MMSE score （rs=-0.094），orientation score （rs=-0.082），verbal ability score （rs=-0.065） and delayed recall score （rs=-0.104）；and the dIAD was significantly negatively associated with the total MMSE score （rs=-0.080），orientation score （rs=-0.094），and attentional calculation score （rs=-0.063）（all P<0.05）. Multivariate logistic regression analysis showed that the risk of MCI increased by 8.80% for each 1 mmHg increase in sIAD （OR=1.088，95%CI=1.046-1.131；P<0.001）；sIAD ≥ 10 mmHg （OR=2.169，95%CI=1.262-3.728；P<0.05） and dIAD ≥ 10 mmHg （OR=1.926，95%CI=1.047-3.542；P<0.05） were the influencing factors for the occurrence of MCI in the elderly. Conclusion The prevalence of MCI in rural elderly was 12.68%，and their elevated IAD was associated with an increased risk of MCI. And the risk of MCI was higher in elderly with IAD ≥ 10 mmHg than in those with IAD <10 mmHg.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Although the number of case reports on pulmonary infarction（PI）secondary to pulmonary embolism（PE）is increasing in recent years，its misdiagnosis remains common，mainly as pneumonia. In patients with intermediate and high-risk pulmonary embolism，delays in diagnosis and timely treatment would lead to poor prognosis. Objective By analyzing the pneumonia-misdiagnosed cases of patients with PI，we summarized their clinical characteristics and related risk factors，and constructed a multivariate joint model to improve the accurate diagnosis rate at early stage. Methods This retrospective study included the hospitalized patients with pulmonary embolism at the First Affiliated Hospital of USTC from January 2017 to December 2023. In the group of pneumonia-misdiagnosed patients with intermediate to high-risk PI，we analyzed the clinical characteristics and compared the differences between the misdiagnosed groups and control group. Furthermore，using a multivariate logistic regression analysis，we explored the independent predictive factors of the delayed diagnosis，analyze the predictive value of various indicators for the misdiagnosis by ROC curves，and compared the AUC values using Delong test. Results Among 101 cases of PI patients，70 of them were misdiagnosed as pneumonia. Comparing with the control group，the characteristics of misdiagnosed patients were old age，higher incidences of fever and chest pain with unlikely presence of dyspnea. From 2017 to 2023，the misdiagnosis rate gradually decreased in percentages of 100.0%，83.3%，74.1%，71.4%，63.2%，66.7%，and 50.0%，respectively. Based on the results of multivariate logistic regression analysis，the characteristics of over sixty-years-old age（OR=18.271，95%CI=4.373-76.339，P<0.001），fever（OR=16.073，95%CI=3.510-73.786，P<0.001），chest pain（OR=6.660，95%CI=1.571-28.233，P=0.010）and non-dyspnea（OR=9.027，95%CI=2.049-30.249，P=0.003）were independent predictive factors for the misdiagnosis. Therefore，a multivariate joint model was constructed as the following equation：Y=-6.624+0.095×A（factor of age）+2.510×F（factor of fever）+2.683×N（factor of non-dyspnea chest pain）. The model indicated the PI misdiagnosis parameters as AUC under the curve（OR=0.880，95%CI=0.802-0.959，P<0.001），best cutoff value（0.854），sensitivity（0.871）and specificity（0.806）. Therefore，the predictive values are superior to single-factor indicators of age（Z=2.771，P=0.006），fever（Z=4.653，P<0.001）and non dyspnea chest pain（Z=4.014，P<0.001）. Conclusion Although the misdiagnosis rate of pulmonary infarction has decreased in recent years. Clinicians should keep alert to the differential diagnosis of pulmonary infarction and pneumonia in elderly PE patients with symptoms of fever and non-dyspnea chest pain.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background In patient involvement，patients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectiveness，efficiency，and quality of healthcare services. However，the implementation of proven patient#2;centered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary disease（COPD）in our country remains to be explored.Objective This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.Methods Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological framework，the relevant studies on patient involvement among patient with COPD were searched by computer on PubMed，Embase，Cochrane Library，CNKI，Wanfang Database，China Biology Medicine disc. A thematic analysis was methodically applied to distill and synthesize findings. Results A total of 37 articles were included in this review. The categorization of patient involvement was divided into three types：direct involvement in medical care，organizational-level，and clinical research. Based on the intensity of involvement，categories were further classified into three levels：consultation，engagement，and collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviors，including：integration in direct medical care（patients expressing their preferences and wishes regarding treatment plans）；consultation at the organizational management level（assessing patient treatment experiences and organizing discussions around patients' concerns）；as well as involvement in clinical research，including consultation（listening to patient needs）and engagement（expressing preferences and wishes for interventions，involved in the development of assessment tools，and in discussions about research design and implementation）. Assessing patient treatment experiences（10 articles，27.03%）and expressing patient preferences and wishes regarding interventions（10 articles，27.03%）were the two most frequently implemented behaviors of patient involvement in COPD. Conclusion There are numerous measures for patient involvement in the improvement of medical quality，but there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of life，indicating that the practice of patient involvement in China requires further exploration.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Hypertension is a common chronic disease that seriously endangers the health of the population. The primary-care doctors are the main force in the management of hypertension. However，the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control. Objective The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension，and analyze the causes of therapeutic inertia，providing a reference basis for improving hypertension control rates in China. Methods A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023. The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions: knowledge mastery of hypertension diagnosis and treatment，“soft reasons”and “overestimation of treatment efficacy” as well as “medical insurance policies.” Binary logistic regression analysis was employed to explore the influencing factors of therapeutic inertia.Results A total of 407 questionnaires were distributed in this study，and 386 valid questionnaires were collected，yielding an effective response rate of 97.96%. (1) The average score for primary healthcare providers' knowledge of hypertension diagnosis and treatment was 6 (0.5)，with a scoring rate of 61.19% (5.50/9.00). The total score for therapeutic inertia in hypertension management was 48 (7.0)，with a scoring rate of 56.55% (45.24/80.00). (2) The scores for the “soft reasons” dimension，“overestimation of treatment efficacy” dimension，and “medical insurance policies” dimension were 26 (4.8)，10 (2.0)，and 6 (2.5) respectively，with scoring rates of 51.97% (25.89/50.00)，65.42% (9.81/15.00)，and 44.64% (6.96/15.00) respectively. When comparing the average scores of the three dimensions of therapeutic inertia，the “medical insurance policies” dimension had the lowest score compared to the other two groups (P<0.05). Multivariate analysis showed that male gender，rural areas，lower mastery of hypertension diagnosis and treatment knowledge，and a weekly patient volume of less than 10 hypertensive individuals were associated with a higher tendency towards therapeutic inertia among primary healthcare providers (P<0.05). Conclusion therapeutic inertia is prevalent among primary healthcare providers in the diagnosis and treatment process of hypertension. Low levels of hypertension treatment cognition，overestimation of treatment efficacy，and “soft reasons” are the primary factors contributing to therapeutic inertia among primary healthcare providers. It is recommended to strengthen education on therapeutic inertia in hypertension，conduct diversified training on diagnostic and management knowledge，and promote clinical informatization and artificial intelligence decision-making systems to effectively improve the therapeutic inertia of primary healthcare providers in hypertension management.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Diabetes mellitus is difficult to cure and has a long process . The level of self-care is crucial for determining the regression and health outcomes of patients with diabetes. A comprehensive and theory-based tool is urgently needed to assess the level of self-care of diabetes. In this way，the self-care of patients with diabetes can be kept up to date and accurate nursing care can be carried out. Objective To examine the psychometric properties of the Chinese version of Self-care of Diabetes Inventory（SCODI），and provide a scientifically validated assessment tool for the self-care of Chinese patients with diabetes. Methods The Brislin Translation Model was used for translation and cultural adaptation of the English version of the SCODI into Chinese. A total of 261 adult patients with diabetes were enrolled using a consecutive sampling method at the First Affiliated Hospital and the Affiliated Sir Run Run Hospital of Nanjing Medical University from December 2022 to June 2023. Data were collected using a self-developed general information questionnaire and the Chinese version of SCODI. Exploratory factor analysis was used to assess the structural validity. Cronbach's α，split-half reliability and composite reliability were used to describe the reliability. Glycosylated hemoglobin was used as a criterion to assess the criterion-related validity. Spearman's rank correlation analysis was used to examinate the correlation between the Chinese version of SCODI score and glycosylated hemoglobin. Results The Chinses version of SCODI contained 4 dimensions and 40 items：self-care maintenance score（75.94±13.15），self-care monitoring score（70.65±18.71），self-care management score（69.16±18.24），and self-care confidence score（85.41±13.63）. In the self-care maintenance dimension，4 factors were identified：complication screening behaviors，exercise behaviors，hygienic care behaviors and diet-medication behaviors. The self-care monitoring dimension had 2 factors：physical monitoring and symptom identification. The self-care management dimension included 2 factors：autonomous behaviors and counseling behaviors. Two factors were extracted from the self-care confidence dimension：monitoring and managing confidence，health maintenance confidence. The Cronbach's α，split-half reliability and composite reliability values for the total scale were 0.915，0.836 and 0.912，respectively. The Cronbach's α for the four dimensions were 0.709-0.908. A significantly negative correlation was observed between each subscale and glycosylated hemoglobin（rs=-0.160，-0.300，-0.177，-0.192；P<0.001），serving as a criterion. Conclusion Based on the middle-range theory of self care of chronic illness，the Chinese version of SCODI exhibits strong psychometric properties，making it a valid and reliable instrument for evaluating self-care of Chinese patients with diabetes.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-24 Cooperative journals: 《中国全科医学》
Beijing Hypertension Association
China Association of Gerontology and Geriatrics
Beijing Community Health Service Association
Beijing Community Health Promotion Association
Abstract： Hypertension，Diabetes，and Dyslipidemia are collectively referred to as the three highs ，which often coexist in the same individual. It significantly increasing the risk of hospitalization，death，and related burdens for patients. So it is necessary to jointly control the risk and standardize the treatment. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention，treatment，and management of the three highs ，but there are no applicable norms，consensus，and guidelines for the co-management of the three highs in primary healthcare institutions at domestic and foreign. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from many fields such as cardiovascular，endocrine，pharmacy，and public health services to participate in the consensus. It widely soliciting clinical practice needs of primary healthcare workers，integrating and evaluating the evidence related to the prevention and treatment of the three highs in primary healthcare institutions. After multiple rounds of discussions，revisions，and voting，the consensus for primary healthcare in the prevention and treatment of the three highs was formed，which includes 21 recommended opinions. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the three highs ，and provide scientific strategic support，implement management with primary healthcare characteristics，and lay a solid foundation for comorbidity co-management.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-24 Cooperative journals: 《中国全科医学》
Abstract： Background After being completely promoted for less than seven years，China’s contracted family doctor service work still faces a number of development problems. The primary obstacle impeding the work of contracted family doctor service is an inadequate guarantee mechanism. There is an urgent need for scientific and reasonable policies on contracted family doctor service to guarantee the effective development of the work. Objective To quantitatively analyze the textual content of China’s contracted family doctor service policies，to explore the focus and shortcomings of the existing policies，and to provide the basis and reference for the development and optimization of the subsequent contracted family doctor service policies. Methods Policy texts were collected by visiting the official websites of the China government and the National Health Commission of the People’s Republic of China on 2023-01-10，and 15 policy texts on contracted family doctor service from 2015-01-01 to 2022-12-31 were selected to construct a three-dimensional analytical framework of policy tools-stakeholders-policy strength，to categorize，code，and analyze the policy documents. Results Supply-based，demand-based，and environment-based tools accounted for 30.5%（69/226），19.0%（43/226），and 50.5%（114/226） of the policy tool dimension. Family doctors，contractors，non-contractors，primary medical and health care institutions，hospitals（secondary and above），and the government accounted for 29.2%（123/422），14.7%（62/422），9.2%（39/422），21.3%（90/422），13.3%（56/422），and 12.3%（52/422） of the stakeholder dimension. The average strength of China’s contracted family doctor service policies was 2.2 points. In the cross-dimension of policy tools-stakeholders，the distribution of stakeholders in supply-based and environment based tools was relatively poor. There were some sub-tools that were absent from the policy tools. In the cross-dimension of policy tools-policy strength，environment-oriented policy instruments were used more often as policy strength increased. In the cross dimension of stakeholders-policy strength，there were large differences of the policy strength matching scores among various stakeholders. Family doctors had the highest score（311 points） with non-contractors the lowest score（90 points）. Conclusion From the perspective of policy tools，policy tools should be allocated rationally，with the weight of use continuously adjusted，the internal structure optimized，and the rationality of the distribution of policy tools among stakeholders improved. From the stakeholder’s perspective，all stakeholders should be taken into account，their respective positions need to be clarified，and the demand of the non-contractors should be emphasized. From the perspective of policy strength，the policy supervision and management capacity ought to be strengthened to continuously improve the implementation of the policy of contracted family doctor service.
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 2024-05-21 Cooperative journals: 《中国全科医学》
Abstract： Background Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases（ASCVD），but the values and preferences of community patients for pharmacotherapy remain unclear. Objective To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD，which would help clarify the individualized treatment burden and provide patient centered clinical practice. Methods This study employed a sequential exploratory mixed-methods design. Firstly，we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District，Chengdu City from November 2021 to January 2022. for a focus group discussion，aiming to collect qualitative insights into their experience，values，and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis，and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase，a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy. Results Four themes emerged from the qualitative data，including knowledge and use of medications，barriers of medication use，facilitators of medication use，and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study（response rate of 93.5%）. The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous，participants generally preferred taking fewer medications with less frequency，and were less likely to use injectable medications. Conclusion The study suggests that it may be appropriate to increase the use of compound preparations，and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition，we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-14 Cooperative journals: 《中国全科医学》
Abstract： The innovative integration of treatment and prevention is pivotal for enhancing the healthcare system and advancing Healthy China. Guided by a focus on preventive health policies，it fosters collaboration between treatment and preventive services，ensuring seamless linkage across health promotion，prevention，treatment，rehabilitation，and end-of#2;life care. Conceptually，this shift involves transitioning from unidirectional intervention to comprehensive health management，from provider-driven to participatory decision-making，and from transient doctor-patient relationships to sustained accountability relationships. Structurally，it emphasizes coordination between medical and public health systems，collaboration among healthcare institutions，and multi-stakeholder governance. Institutionally，it optimizes evaluation，financing，remuneration，and talent development systems while leveraging intelligent means for integration and promoting interoperability across personnel，resources，and information.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-10 Cooperative journals: 《中国全科医学》
Abstract： Background The key task in China's medical and health field during the "14th Five-Year Plan" period is to realize treatment-prevention integration and innovate the mechanism of treatment-prevention integration. Objective This paper analyzes the implementation mechanism of treatment-prevention integration under the background of integrated service system construction，and provides reference for exploring the path of medical and prevention integration adapting to the strategy of “Healthy China”. Methods Taking 2018 as the time node，relevant literature was searched on CNKI and Wanfang data knowledge service platform with keywords of "treatment-prevention integration"，"medical and prevention coordination"，"combination of prevention and treatment" and literatures on case policies，measures and implementation effects of integrated service systems such as medical alliance. Finally，18 literatures and 15 cases were selected. Based on the rainbow model，system integration，organizational integration，professional integration，service integration，functional integration and normative integration were determined as condition variables from macro，meso and micro levels and supporting factors，and the effect of treatment-prevention integration was determined as result variable. QCA was adopted to explore the implementation mechanism of medical and preventive integration under the background of integrated service system construction. Results There were four configuration paths that could effectively improve the effect of treatment-prevention integration，and the four paths were in line with the multi-layer integrated path and the medium-micro integrated path respectively. The following results were obtained：（1）It was more effective to carry out treatment-prevention integration relying on the integrated service system，and there are multiple paths that can effectively improve the effect of treatment-prevention integration under the integrated service system；（2）Service integration plays a fundamental role in improving the effect of medical and preventive integration；（3）The setting of relevant policy indicators for improving the system integration，professional integration and functional integration of treatment-prevention integration is not perfect. Conclusion （1）Relying on the construction of integrated service system to promote the improvement of treatment-prevention integration effect；（2）Give full play to the basic guarantee role of service integration；（3）Make reference to the successful experience of multi-level integration cases，set policy indicators at macro，meso and micro levels in a balanced manner，and improve the integration of system integration，professional integration and supporting elements.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-10 Cooperative journals: 《中国全科医学》
Abstract： As an important direction of China's medical and health system reform，medical and prevention integration is of great significance to meet the all-round health needs of the people，and how to establish a scientific and effective medical and prevention integration model is a top priority. Using literature analysis and other methods to collect data，the implementation status and dilemma of China's medical and prevention integration policy were reviewed，and the influencing factors of medical and prevention integration policy implementation were analyzed based on the six dimensions of the Horn-mitt model. On this basis，it is proposed to refine policy objectives，clarify policy implementation standards，increase resource supply，enrich policy implementation methods，explore common interests of medical and defense institutions，improve "coordination mechanisms"，and actively guide policy implementers to carry out medical and prevention integration services. It aims to provide reference significance for the high-quality improvement of medical and prevention integration services in the future.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-08
Abstract： Background Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by multiple symmetrical erosive arthritis. IgG glycosylation has been shown to play a role in various immune processes and has been associated with the onset and progression of RA. Objective To systematically review the relationship between IgG glycosylation and RA, and offer insights for the development of RA preventive strategies. Methods We conducted a systematic review for researches on the association between IgG glycosylation and RA in PubMed, Web of Science, CNKI, Wanfang Database, and Weipu Database as of May 1, 2024. The quality of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework. Results A total of 469 relevant studies were identified, and 45 studies were included in this systematic review. The exposure factors in these studies were IgG glycosylation levels, and the outcomes included preclinical RA, RA transition, early RA, established RA, RA activity levels, RA remission, and RA during pregnancy. The results of GRADE indicated that most of the evidence provided was of low to moderate quality (88.9%). Conclusion This systematic review revealed that IgG glycosylation and its derived structures were associated with RA and demonstrated predictive capabilities in identifying RA and evaluating the therapeutic outcomes in RA treatment. However, for more precise conclusions, future research should prioritize high-quality, large-scale randomized controlled trials.
Peer Review Status:
Awaiting Review
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics Subjects: Statistics >> Biomedical Statistics submitted time 2024-05-06
Abstract： 【Abstract】 Extremely unbalanced data here refers to datasets where the values of independent or dependent variables exhibit severe imbalances in proportions, such as extremely unbalanced case-control ratios, very low disease incidence rates, heavily censored survival data, and low-frequency or rare genetic variants. In such scenarios, test statistics in classical statistical methods, such as logistic regression and Cox proportional hazards models, may deviate from normality or chi-square assumptions, leading to difficulties in controlling type I errors. With the increasing availability and exploration of resources from large-scale population cohorts in whole-genome association studies, there is a growing demand for efficient and accurate statistical approaches to handle extremely unbalanced data in independent and non-independent samples. To address this need, this paper provides a systematic methodological overview. Firstly, it derives test statistics from classical statistical methods. Secondly, it elucidates the impact of extremely unbalanced data on the distribution of test statistics. Thirdly, it introduces two widely used methods for correcting statistics in genome-wide association studies: Firth correction and saddlepoint approximation methods. Finally, it briefly introduces commonly used software for extremely unbalanced genomic data. This paper provides theoretical references and application recommendations for the statistical analysis of extremely unbalanced data.
Peer Review Status:Awaiting Review
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： Background The prevalence of pelvic floor dysfunction in postmenopausal women is progressively increasing，leading to a significant impact on both their physical and mental well-being due to stress urinary incontinence. Objective This study investigates the impact of menopausal hormone therapy（MHT）in conjunction with Kegel exercises on pelvic floor structure and clinical symptoms in individuals experiencing mild to moderate stress urinary incontinence（SUI）. Methods A total of 75 patients with menopausal syndrome accompanied by mild to moderate SUI who visited the Menopause Clinic at Beijing Shijitan Hospital in 2022 were selected. They were allocated into the MHT group and the control group in a 2∶1 ratio using a random number table method，and the MHT group was further randomly divided into subgroups receiving Tibolone and estrogen and progestogen therapy（EPT）in a 1∶1 ratio. Both the control group and the MHT group underwent pelvic floor muscle training（PFMT），commonly referred to as Kegel exercises，for 15-30 minutes per session，2-3 times daily，and 2-3 times weekly，over a continuous period of 12 months. The control group received KunTai capsules orally in combination with PFMT，with 4 capsules taken per dose，3 times a day，for 12 months. The MHT group received menopausal hormone therapy in conjunction with PFMT. The EPT subgroups include continuous combined estrogen-progestin therapy（1 mg estradiol valerate + 10 mg dydrogesterone，once daily），continuous sequential estrogen-progestin therapy（femoston 12 courses），and the Tibolone subgroup takes tibolone orally，all of which were administered continuously for 12 months. The study examined serum estradiol（E2）and follicle-stimulating hormone（FSH）levels within and between groups and subgroups before and after treatment. In addition，measurements were obtained for urethral rotation angle（URA），bladder detrusor thickness（BDT），posterior vesicourethral angle（PVUA），levator hiatus area（LHA），urinary incontinence quantification，urinary incontinence score，clinical efficacy，as well as changes in the modified Kupperman Menopausal Index（KMI）score，and the modified oxford staging（MOS）. Results Upon completion of the study，7 participants from the MHT group were lost to follow-up（5 in the Tibolone subgroup and 2 in the EPT subgroup），with 3 participants from the control group also lost to follow-up. In the end，a total of 65 participants were included. After 1 year of treatment，there were no statistically significant differences in FSH，E2，and MOS between the MHT group and the control group（P>0.05）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，and URA between the MHT group and the control group（P>0.05）.However，the LHA of the MHT group was significantly lower than that of the control group（P=0.028）. After 1 year of treatment，there were no statistically significant differences in PUVA，BDT，URA，and LHA between the EPT and Tibolone subgroups（P>0.05）. Statistically significant differences were found in the comparison of clinical efficacy between the control group and the MHT group（P=0.010）. Conversely，no statistically significant differences were observed in the comparison of clinical efficacy between the EPT and Tibolone subgroups（P=0.724）. After 1 year of treatment，the MHT group showed lower urinary incontinence quantity，urinary incontinence score，and KMI score compared to the control group（P<0.05）. Before and after the treatment，there were no statistically significant differences in urinary incontinence quantity，urinary incontinence score，and KMI score between the EPT and Tibolone subgroups（P>0.05）. Conclusion The combination of MHT with PFMT yields a positive effect on the pelvic floor structure and markedly alleviates symptoms of urinary incontinence. Nevertheless，there is no significant differences between EPT and Tibolone in the improvement of pelvic floor structure and alleviation of clinical symptoms in patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-04-15 Cooperative journals: 《中国全科医学》
Abstract： The Screening Tool of Older Person's Potentially Inappropriate Prescriptions（STOPP）and the Screening Tool to Alert to Right Treatment（START）were initially developed by a panel of experts from Cork University Hospital，Ireland in 2008，and underwent a second update in 2015. Since their inception，these criteria have played a pivotal role in identifying potentially inappropriate medication use in the elderly，enhancing oversight of medication misuse in older individuals，and reducing adverse drug events among the elderly. In 2023，the third edition of the STOPP/START criteria was released，providing updated and more practical evidence-based guidance. Building upon the second edition，this iteration includes the addition，revision，and removal of certain criteria，resulting in a total of 190 new standards for potentially inappropriate medication use. This latest version incorporates the most recent research findings and clinical evidence related to appropriate medication use in older adults. We provide a detailed analysis of the STOPP/START criteria （version 3），offering valuable insights for the updating and refinement of potentially inappropriate medication criteria in our country. Furthermore，it presents recommendations for future research in this field.
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