Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
ZHOU Zhensen
HUANG Yan
CHENG Siwei
ZHANG Xiaoyu
ZHANG Xiaoyu
SUN Ting
YANG Xianjun
XIE Hui
MA Zuchang
Abstract： Background In the field of cardiovascular risk assessment，aortic stiffness is considered a key predictive indicator，and carotid-femoral pulse wave velocity（cfPWV）is recognized as the gold standard for non-invasive assessment of atherosclerotic risk in the aorta. Due to challenges such as technical difficulty，cfPWV testing has not been widely implemented in China. Objective This study aimed to develop and validate a screening model for early atherosclerotic risk in the aorta based on cardiovascular risk factors，with the intention of replacing the complex measurement process of cfPWV and reducing reliance on traditional measurement methods. Methods A total of 878 participants recruited from the Health Checkup Center of the First Affiliated Hospital of Anhui Medical University between May and November 2023 were selected as research subjects，randomly divided into a model-building group（n=703）and a validation group（n=175）in an 8:2 ratio. Patient general information，laboratory test results，and cfPWV were collected. Based on the cfPWV examination results and relevant guidelines，participants in the model-building group were divided into those without atherosclerotic risk in the aorta（n=503）and those with atherosclerotic risk in the aorta（n=240）. Multifactorial logistic regression analysis was used to screen variables and establish a nomogram assessment model. The receiver operating characteristic curve（ROC curve）for predicting the risk of atherosclerosis in the aorta was plotted for the model，and the model's discriminative ability and calibration were assessed using the area under the ROC curve（AUC）and the Hosmer-Lemeshow test，respectively. The Delong test was used to compare the AUCs of different models，and decision curve analysis（DCA）was used to assess the clinical utility of the model. Internal validation of the model was performed using the bootstrap method with 1，000 resampling iterations. Results Participants with atherosclerotic risk in the model-building group were older，had higher BMI，systolic blood pressure（SBP），diastolic blood pressure（DBP），mean arterial pressure（MAP），urea，fasting blood glucose（FBG），low-density lipoprotein cholesterol（LDL-C），triglycerides（TG），total cholesterol（TC），alanine aminotransferase（ALT），aspartate aminotransferase（AST），hemoglobin（Hb），and a higher proportion of alcohol consumption，dyslipidemia，and diabetes than those without atherosclerotic risk in the aorta. The glomerular filtration rate（GFR）and platelet count（PLT）were lower in those with atherosclerotic risk（P<0.05）. Multifactorial logistic regression analysis showed that age（OR=1.112，95%CI=1.082-1.143），MAP（OR=1.146，95%CI=1.107-1.188），Hb（OR=1.026，95%CI=1.004-1.049），and FBG（OR=1.353，95%CI=1.076-1.701）were independent risk factors for atherosclerosis in the aorta（P<0.05）. A predictive model Ⅰ was constructed using statistically significant indicators from the multifactorial logistic regression analysis（age，MAP，Hb，FBG），and models Ⅱ，Ⅲ，and Ⅳ were constructed by additionally including smoking，gender，and dyslipidemia，respectively. The AUCs for models I to Ⅳ were 0.941（95%CI=0.923-0.964，P<0.05），0.941（95%CI=0.922-0.962，P<0.05），0.941（95%CI=0.922-0.963，P<0.05），and 0.939（95%CI=0.919-0.962，P<0.05），respectively. The Delong test showed no statistically significant difference in AUCs among models Ⅰ，Ⅱ，Ⅲ，and Ⅳ（P>0.05）. A nomogram model was constructed using age，heart rate，FBG，and Hb as predictive factors，with an AUC of 0.941（95%CI=0.920-0.962）for the training set，sensitivity of 0.832，and specificity of 0.917. The AUC for the validation set was 0.961（95%CI=0.914-1.000），with sensitivity of 0.872 and specificity of 0.964.DCA results indicated that the use of the early atherosclerosis screening model could benefit participants in clinical practice.Conclusion Based on four simple indexes of age，mean arterial pressure，hemoglobin and fasting blood glucose，a screening model for early aortic sclerosis risk was established，which provides a convenient and efficient method for early vascular function screening.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
YANG Shifang
JI Lupeng
LI Xiaoming
CHEN Xueying
ZHAO Manzhi
HUANG Guohua
CUI Jinghua
CHEN Lian
LI Jing
Abstract： Background The development of excellent general practitioners is essential to preserving people's health. Unfortunately，the general practitioner training model in place today is insufficient，which leaves them unqualified to provide primary medical services. Consequently，enhancing clinical competency should be the main goal of general practitioners' training. Objective To investigate how general practitioners' clinical practice abilities are affected by MDT-based CBL education. Methods From July 2020 to July 2023，26 trainee general practitioners received training at the department of pulmonary and critical care medicine as part of their residency programme. As research subjects，they all signed informed consent. They were divided three groups and trained with different model：traditional model，CBL model and MDT-based CBL model，respectively. Leicester Assessment Package（LAP） was used to assess their clinical practice skills by the end. Self-designed questionnaire was used for satisfaction survey anonymously. The results were analyzed statistically. Results The MDT-based CBL teaching group outperformed the traditional teaching group and the CBL teaching group in the theoretical examination. The MDT-based CBL teaching group had a significantly higher total LAP score （P<0.05） in comparison to either the conventional teaching group or CBL teaching group. Further investigation revealed that the MDT-based CBL teaching group performed better（P<0.05） in the part of patient admissions，collecting medical histories，patient management，problem solving，physician behavior， patient relationship，and preventive therapy. The students from the MDT-based CBL model had the best overall satisfaction， with a significant difference comparing the students from the CBL and traditional teaching groups（P<0.05）. Additionally， the MDT-based CBL teaching group showed a significant improvement in their capacity to guide healthy lifestyle，deal with commodities，guide patient recovery，and use medications after discharge（P<0.05）. Conclusion A novel training approach for general practitioner，the MDT-based CBL teaching mode may enhance the clinical practice abilities and competency of general practitioners.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
Abstract： Background With the acceleration of the aging process of the population and the change of the disease spectrum of residents，the prevalence of chronic diseases such as diabetes is increasing year by year. It is urgent to establish a wide coverage and efficient medical prevention integration mode. Most of the existing studies have focused on the demand for health management services and the influencing factors of service adoption，and few have identified and analyzed the demand for chronic disease healthcare and prevention integration services under digital technology. Objective To explore the demand of residents for medical and preventive integration services for diabetes in the context of digital health，and the impact of different service contents on the acceptance and satisfaction of service objects，so as to provide a theoretical basis for the public to improve the whole process and all-round medical and preventive integration services. Methods Combined with relevant research and practical work，20 survey items on demand for diabetes medical and prevention integration services were established. From January to June 2023，convenient sampling method was used to survey diabetes patients and risk groups in Fujian Province，Guangdong Province and Yunnan Province，and 410 respondents' data were obtained. According to five demographic characteristics of gender， age，education level，residence type and medical insurance type，attribute classification analysis was carried out according to Kano model analysis method，to investigate the relationship between service demand of different attributes and residents' satisfaction，and then put forward the supply strategy of diabetes medical and prevention integration services. Results Residents with different demographic characteristics show common and individual differences in the demand for medical and preventive integration services for diabetes. Among them，the demand for services among people of different ages and educational levels is quite different. The demand for medical prevention integration services of diabetes prevention and treatment groups focuses on screening，prevention and treatment，but the relevant convenient services provided by the Internet and social media have nothing to do with user satisfaction. Conclusion The level of personalization of diabetes primary health care and prevention services should be improved to fully satisfy the needs of the service population for essential attributes such as "initial screening for diabetes and complications"，improve the services for desired attributes such as "establishment of a full-cycle personal electronic health record"，and enhance the services for charismatic attributes such as "risk prediction" and "remote health monitoring". It will also improve services with desired attributes such as the establishment of a full-cycle personal electronic health record，and enhance services with attractive attributes such as "risk prediction" and "remote health monitoring".
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
Abstract： Living Systematic Reviews（LSRs） represent an evolving methodology for systematic review that is continuously updated to incorporate new evidence in a timely manner，ensuring that healthcare professionals and policymakers have access to the most last information to make optimal decisions. Compared to traditional systematic reviews，LSRs ensure the timeliness and accuracy of information by conducting regular searches，screenings，and analyses of new evidence，thereby better meeting the needs of rapidly changing clinical practices. This article aims to introduce the applicability，and production methods and processes of LSRs by comparing them with traditional systematic reviews and rapid reviews，discusses the challenges and opportunities faced during the implementation of LSRs，and illustrates the production process and key aspects of living updating with examples，in order to provide scholars with references and insights for conducting LSRs.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
LIU Caiping
ZHANG Yanhua
TANG Jianpin
WANG Chengpeng
XUE Fengfeng
WANG Huijuan
LI Chuanwei
ZHANG Guangya
LI Huafang
Abstract： Background Long-acting antipsychotics are one of the important choices in the maintenance treatment of patients with schizophrenia，which can effectively prevent relapse. Risperidone microspheres for injection（II） has been improved in dosage form to maintain steady-state concentration，however there is currently a lack of study for efficacy on maintenance phase treatment. Objective To evaluate the efficacy and safety of risperidone microspheres for injection（II） in the maintenance treatment for schizophrenia. Methods This was a single-arm，self-controlled，multicenter study. From May 2021 to May 2022，patients with schizophrenia，aged 18-65 years，were enrolled from 3 centers：Shanghai Mental Health Center， Hangzhou Seventh People's Hospital，and Suzhou Guangji Hospital. All patients switched from oral risperidone to risperidone microspheres for injection（II） for maintenance treatment. During the treatment period，25mg，37.5mg or 50mg were injected every two weeks，followed up for 12 weeks. At baseline，and at the end of 2，4，8，and 12 weeks，the social functioning was assessed using the Personal and Social Functioning Scale（PSP）；the clinical symptoms and overall changes were assessed using the Positive and Negative Symptoms Scale（PANSS） and the Clinical Global Impression Scale（CGI）；the health status was assessed using the European Five-Dimensional Survival Quality Inventory（EQ-5D）；The Simpson-Angus Scale（SAS）， Barnes Akathisia Rating Scale（BARS），and Abnormal Involuntary Movement Rating Scale（AIMS） were used to assess the extrapyramidal symptoms （EPS），and the laboratory indices were also collected. Results A total of 71 patients were included in the study. The total PSP scores of patients at the end of the 2，4，8 and 12 weeks of treatment were（48.20±24.65）（49.07±25.81） （50.46±26.96），and （51.85±28.16），respectively，which were higher than the baseline［（43.89±22.32）］（P<0.05）. The PANSS total score，positive symptom scale，negative symptom scale，and general psychopathology scale scores were reduced at the end of 12 weeks of treatment compared with baseline （P<0.05）. CGI-S scores were lower than baseline（P<0.05）， CGI-I scores were significantly reduced at the end of 12 weeks compared with the end of 4 weeks after treatment（P<0.01），and EQ-5D scores were higher than baseline（P<0.05）. Common adverse reactions were increased prolactin，EPS，and dizziness， and no serious adverse reactions（SAE） or drop-out patients due to AE were observed. Conclusion Risperidone microspheres for injection（II） can effectively improve the clinical symptoms of schizophrenia in the maintenance period，and it is well tolerated.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02 Cooperative journals: 《中国全科医学》
Abstract： Chronic obstructive pulmonary disease （COPD）is one of the common respiratory diseases，and the acute exacerbation of COPD is an acute event that severely reduces the quality of life in patients with COPD. We searched PubMed，CNKI，Wanfang Data Knowledge Service platform，Vip.com and Chinese Biomedical Literature，sifted out 69 representative literatures according to the inclusion and exclusion criteria，and found that there were 23 Patient-reported Outcome（PRO）assessment tools used in patients with acute exacerbation of COPD. Except for the EXACT PRO，all of them directly use PRO assessment tools of stable patients. These assessment tools are divided into general，disease-specific and symptom-specific assessment tools，mainly involving symptoms，physiological field，social field，psychological emotion，daily activities and other fields. The number of items is from one to 100，and the response scale is mostly in the form of Likert，and its development and assessment are based on classical test theory . It is suggested that future studies on quality of life of patients with acute exacerbation of COPD should focus on the following points：strengthening the research on specific assessment tools；attaching importance to the combined application of classical test theory，item response theory and generalizability theory；paying attentionto the study of the minimal clinically important difference of assessment tools；selecting assessment tools appropriately.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-07-02
Song, Xiaochen
Zhang, Hui
Zhong, Sen
Tan, Xianjie
Ma, Shuiqing
Jin, Ying
Pan, Lingya
Wu, Ming
Cao, Dongyan
Yang, Jiaxin
Xiang, Yang
Abstract： Objective: The current treatment for early-stage neuroendocrine carcinoma of the cervix (NECC) mainly relies on operation and chemotherapy. We want to evaluate values of postoperative radiation in early-stage NECC.
Methods: Retrospective cohort study. Early-stage NECC patients from 2006 to 2022 in our hospital were included. Depending on whether received postoperative radiation, the patients were divided into Postoperative non-radiation group (Group A) and Postoperative radiation group (Group B). We use Kaplan-Meier method to analyze the progression-free survival (PFS), overall survival (OS), recurrence and OS rate.
Results: Sixty-six cases were included, 32 (48.5%) in Group A and 34 (51.5%) in Group B. After 35 (range 12-116) months follow-up, 26 (39.4%) had recurrence. Compared with Group A, Group B had lower pelvic recurrence rate (12.5% vs 2.9%, p = 0.142), higher distant recurrence rate (28.1% vs 44.1%, p = 0.177), and similar mortality rate (29.4% vs 31.3%, p = 0.871). Cervical stromal invasion ≥1/2 was more common in Group B (28.0% vs 63.0%, p = 0.012). Postoperative radiation in patients with cervical stromal invasion ≥1/2 showed an extended trend in PFS (33.9 months vs 47.9 months) and OS (40.7 months vs 70.0 months) but without statistical difference (p = 0.963, p = 0.636). Lymph-vascular space invasion (LVSI) is a high-risk factor for tumor recurrence (HR 9.13, p = 0.005), but radiation after surgery did not improve the PFS (51.5 months vs 48.8 months, p = 0.942) and OS (53.9 months vs 60.6 months, p = 0.715) in patients with LVSI.
Peer Review Status:
Awaiting Review
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-28 Cooperative journals: 《中国全科医学》
Abstract： Background Intra-abdominal infection is a common etiology of sepsis，and older patients with intra#2;abdominal sepsis have a high mortality rate. Therefore，it is significant to evaluate the prognosis accurately. Currently，the measurement of skeletal muscle mass derived from computed tomography（CT）has become a research hotspot. Whereas theprognostic value of skeletal muscle mass in older patients with abdominal sepsis is rarely reported. Objective To investigate the prognostic value of the skeletal muscle index（SMI）at the midpoint of the third lumbar vertebra（L3）along with sequential organ failure assessment（SOFA）score or acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）in older patients diagnosed with intra-abdominal sepsis. Methods This study was conducted at the emergency medicine center of Beijing Chao#2;Yang Hospital from January 1，2022 to July 31. A total of 335 older patients with intra-abdominal sepsis were recruited. The participants were divided into survival group （250 cases） and non-survival group（85 cases）based on their survival status during hospitalization. Clinical characteristics and L3 SMI derived from abdominal CT were compared between survival and non-survival groups. Multivariable Logistic regression analysis was used to identify the risk factors of in-hospital mortality in older patients with intra-abdominal sepsis. The receiver operating characteristic （ROC） curves of L3 SMI，SOFA score，APACHE Ⅱ score，and combined variables for predicting in-hospital mortality were drawn，and the area under the curve（AUC）were calculated and subsequently compared. Results 335 older patients with intra-abdominal sepsis were included，of whom 85（25.4%）died. There were statistically significant differences in age，BMI，albumin，creatinine，procalcitonin，L3 SMI，nutritional risk screening 2002 （NRS2002），sepsis shock proportion，SOFA score，APACHE Ⅱ score between the two groups （P<0.05）. Multivariable Logistic regression analysis revealed that decreased L3 SMI（OR=0.924，95%CI=0.886-0.964，P<0.001），increased NRS2002 score（OR=1.312，95%CI=1.086-1.585，P=0.005），increased SOFA score（OR=1.170，95%CI=1.053-1.300，P=0.004），and increased APACHE Ⅱ score（OR=1.052，95%CI=1.003-1.103，P=0.038）were independent risk factors for in-hospital mortality in older patients with intra-abdominal sepsis. The AUCs of L3 SMI，SOFA score，and APACHE Ⅱ score for predicting the risk of in-hospital mortality were 0.711，0.740，and 0.742，respectively. L3 SMI combined with SOFA score，or APACHE Ⅱ score could improve their predictive ability，with AUCs of 0.795 and 0.792，respectively. Conclusion Decreased L3 SMI was an independent risk factor for in-hospital mortality in older patients with intra-abdominal sepsis，The skeletal muscle mass based on abdominal CT combined with critical illness scoring systems could effectively evaluate the prognosis of these patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-28 Cooperative journals: 《中国全科医学》
Abstract： Background With the development of society and the aging of the population，the demand for community medical services is increasing. As an important part of community medical service，the informationization level and information service ability of family doctors are of great significance to improve the quality and efficiency of community medical service. Objective To investigate the effect of the WeChat applet "Intelligent GIS Family Doctor Information Platform" based on geographic information system（GIS）in the application of family doctor contracting service. Methods In March-April 2023， among 27 family doctor teams in Zhujing Town，Jinshan District，Shanghai，185 residents served by two neighbourhood family doctor teams and two rural family doctor teams were selected as the control group using stratified random sampling method，and 186 residents served by the same two neighbourhood family doctor teams and two rural family doctor teams were selected as the intervention group；the control group adopted the existing family doctor contracting management mode，and the intervention group adopted the existing family doctor contracting management mode. The control group adopts the existing family doctor contracting management model，while the intervention group develops a contracting service management model based on the "Intelligent GIS Family Doctor Information Platform" WeChat app on the basis of the existing management model. A retrospective data collection method was used to compare the family doctor contracting service before and after the use of the "Smart GIS Family Doctor Information Platform" WeChat app in the intervention group，as well as the knowledge，belief and behaviour of the residents in the control group and the intervention group，in order to analyse the "Smart GIS Family Doctor Information Platform" WeChat app to analyse the application effect of "Intelligent GIS Family Doctor Information Platform". Results The municipal contracting service assessment score of the intervention group was higher after using the "Smart GIS Family Doctor Information Platform" WeChat app ［（87.76±4.60）］ than before ［（63.65±4.53）］（P<0.05）；the score of the control group was higher than that of the intervention group after using the "Smart GIS Family Doctor Information Platform" WeChat app ［（63.65±4.53）］ （P<0.05）；the score of the intervention group was higher than that of the control group after using the "Smart GIS Family Doctor Information Platform" WeChat app. In the intervention group without using the "Smart GIS Family Doctor Information Platform" WeChat applet，the contracting rate，community consultation rate，family doctor consultation rate，and contracted medical checkup rate for people over 65 years old were 41.70%，26.67%，3.30%，and 71.43%，respectively. The contracting rate， community consultation rate，family doctor consultation rate，and contracted medical examination rate of people over 65 years old in the intervention group were 44.48%，28.89%，6.15%，and 74.02% respectively，and all the indicators of the intervention group were higher than those of the intervention group before the use of the WeChat applet of the "Intelligent GIS Family Physician Information Platform"（P<0.05）. In the control group，the scores of knowledge，attitude and behaviour of family doctor contracting service were（8.14±1.46），（22.47±2.78）and（4.57±1.35），while in the intervention group，the scores of knowledge，attitude and behaviour of family doctor contracting service were（8.77±1.28），（23.54±1.98）and（4.97±1.17）， respectively. The intervention group's scores on knowledge，attitude and behaviour of family doctor contracting service were higher than those of the control group（P<0.05）. Conclusion The application of GIS-based WeChat applet for family doctor contracting service can improve the quality of the work of family doctor contracting service and enhance the residents'adherence to family doctor contracting service.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-24 Cooperative journals: 《中国全科医学》
Abstract： The accessibility and quality of ambulatory care（including outpatient and emergency services in primary care facilities，hospitals and other healthcare facilities） determine the efficiency of overall health care system and population health. Ambulatory care is also the core component of continuing care in an aging society. The concept of ambulatory care sensitive conditions（ACSCs） was firstly introduced by American researchers in 1990s. Since then，hospitalization for ambulatory care sensitive conditions（ACSHs） was widely used to evaluate the accessibility and quality of ambulatory care. In recent years， research on ACSH has gradually attracted the attention of scholars from all over the world，and preliminary research evidence from China indicated that the issue should not be ignored. This paper firstly introduces the origin of the concept of ACSH，then identifies the mixing concepts such as ACSH，avoidable hospitalization and inappropriate hospital admission，systematically summarizes the cutting-edge international identification criteria of ACSH，and finally discusses the policy value of ACSH as an indicator in the context of domestic and international research advances，clarifies the problems that should be noted in the identification of ACSCs in China，proposes strategies to reduce ACSH.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-18 Cooperative journals: 《中国全科医学》
Abstract： Background Chronic kidney disease（CKD）is a worldwide public health problem，stage 4 CKD is a critical stage during the course of CKD，marking the significant decline of kidney function and the obvious appearance of symptoms. Although fermented cordyceps sinensis powder has been used in the treatment of chronic kidney disease for a long time，its prognostic effect on CKD，especially the curative effect of stage 4 CKD，lacks evidence-based medical evidence. Objective To explore the long-term prognosis of stage 4 CKD patients treated with fermented cordyceps sinensis powder and the potential related factors affecting the prognosis. Methods A total of 631 patients diagnosed with stage 4 CKD in the nephrology Department of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from 2013 to 2022 were collected. Based on standardized integrated Chinese and Western medicine treatment，patients were divided into cordyceps treatment group（339 cases）and integrated Chinese and Western medicine treatment group（252 cases）according to whether fermented cordyceps sinensis powder was used. Data such as patients’ basic information，whether they were accompanied by diabetes，the occurrence and time of endpoint events，the time of diagnosis of stage 4 CKD，and relevant laboratory indicators at diagnosis were collected. After eliminating baseline differences between groups with propensity score matching，COX regression analysis was conducted to analyze potential prognostic factors. Survival curve was drawn by Kaplan-Meier method，and the difference of survival between groups was compared by Log-rank test. Results A total of 378 patients were included after matching at a ratio of 1:1. Multivariate Cox proportional hazard regression analysis showed that the using of fermented cordyceps sinensis powder（HR=0.79，95%CI=0.64-0.98，P=0.030），the increased level of estimated glomerular filtration（HR=0.97，95%CI=0.94-1.00，P=0.025）and serum albumin（HR=0.97，95%CI=0.96-0.99，P=0.002）prolonged the survival time of stage 4 CKD patients；male（HR=1.37，95%CI=1.09-1.71，P=0.006），the increased level of brain natriuretic peptide（HR=1.00，95%CI=1.00-1.00，P=0.003），blood phosphorus（HR=2.44，95%CI=1.63-3.67，P<0.001）and 24 h urinary protein（HR=1.00，95%CI=1.00-1.00，P<0.001）shortened the survival time of patients with stage 4 CKD. The results of survival curve analysis showed that cumulative survival rate of cordyceps treatment group was higher than that of integrated Chinese and Western medicine treatment group（HR=0.70，95%CI=0.57-0.86，P<0.001）. The cumulative survival rate in the low protein level subgroup was higher in the cordyceps treatment group than in the integrated Chinese and western medicine treatment group（HR=0.67，95%CI=0.52-0.85，P<0.001）. In the high urinary protein level subgroup，there was no significant difference in cumulative survival between the two treatment groups（P=0.518）. Conclusion Long-term use of fermented cordyceps sinensis powder can prolong the progression of renal function in patients with stage 4 CKD，and can play a better clinical effect under the premise of active control of urinary protein. Relatively low levels of brain natriuretic peptide and serum phosphorus，and relatively high levels of serum albumin are also potential factors for good prognosis in patients with stage 4 CKD.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Primary medical institutions，with the characteristics of comprehensive，continuous，coordinated，convenient and economical，play an important role in the diagnosis and treatment of common and frequently#2; occurring children's diseases，planned immunization and child health management，and lay a solid foundation for children's health services. It is essential to improve the quality of child health services for children under the management of family doctor contract. There are regional differences in the ability of children's health services at primary institutions in China. Therefore， accurate evaluation of the quality of children's health services at primary institutions is helpful to find problems in time and promote the development of children's health services at a higher level. Objective To assess the quality of community children's health services for contracted children，analyze the quality problems and optimization strategies，and provide international vision and decision-making reference for further improving the quality. Methods Taking a district of Chengdu as a typical case，three community health service centers with stronger child health service ability in the district were selected as the sample institutions， and the parents of children contracted by the sample institutions were surveyed with the online questionnaire on the quality of community child health service by using the Chinese version of primary care assessment tool （PCAT）. Results Totally，3 631 parents of contracted children were investigated. The total PCAT score of community child health service quality in the sample centers was（58.72 ± 13.43）. The dimensions with relatively high PCAT scores of community child health service quality includes "continuity"，"community first consultation （service availability and service use）" and "comprehensive service （service provision）"，while the dimensions "children and family-Centered"，"comprehensive （available services）" and "coordination （referral）" had low scores. Conclusion It is suggested to strengthen the supply of diagnosis and treatment services for common pediatric diseases in the community，unblock the referral mechanism of Pediatrics，strengthen the awareness of parents of contracted children to be included in the contracted service team to participate in diagnosis and treatment decisions，and pay attention to the health services for children with non local registered residence.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Population aging has heightened，raising concerns about elderly health. Oral frailty，a novel frailty phenotype in the elderly，directly impacts the quality of life. A thorough grasp of oral frailty's prevalence in the elderly is crucial for formulating effective preventive and interventional strategies. Objective To systematically evaluate the prevalence of oral frailty in the elderly. Methods The CNKI，Wanfang Data，VIP，CBM，PubMed，Web of Science，Embase，CINAHL and Cochrane Library databases were searched for literature related to the study purpose with a time limit of the construction of the database to 19 April 2024. Literature was independently screened，information extracted and quality assessed by 2 researchers， and Meta-analysis was performed using Stata 14.0 software. Results A total of 19 cross-sectional studies were included，with a total sample size of 11 776 cases and a risk of bias quality score of 6-9，all of which were of moderate or high quality. Meta#2;analysis showed that the prevalence of oral frailty in elderly people was 29.5%（95%CI=24.1%-35.2%），and the prevalence of pre-oral frailty was 47.9%（95%CI=40.5%-55.4%）. Subgroup analyses showed that the progressive increase in the prevalence of oral frailty in the elderly with advancing age. Higher prevalence rates of oral frailty were observed in individuals screened using the Oral Frailty Index-8，Chinese elderly，elderly females，residents of medical and nursing care facilities，those withouta spouse，living alone，smokers，and elderly individuals with primary school education or lower（P<0.05）. Conclusion The prevalence of oral frailty is high in the elderly，warranting particular attention to the oral health status of elderly individuals in China who are advanced in age，female，residing in medical and nursing care facilities，living alone without a spouse， smokers，and have lower educational levels.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Obstructive sleep apnea（OSA）is prevalent in the elderly population due to the weakened neuromuscular function of the upper airway and unstable respiratory regulation in the elderly. OSA is a risk factor for a variety of common chronic diseases，and affects cognitive function and multi-system organ function in the elderly. Therefore，it is essential to provide effective therapeutic interventions for OSA in the elderly. The Sleep Medicine Branch of the Chinese Geriatrics Society，as the initiator，organized domestic experts in related fields to repeatedly discuss the operation process，requirements，specific ways and methods of noninvasive positive pressure ventilation（NPPV）treatment for elderly OSA patients with reference to domestic and international clinical studies，and finally made this expert consensus，which is aimed at standardizing the treatment of NPPV in elderly OSA patients in China to provide a reference.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Research has linked the physical constitution of overweight/obese individuals to obesity， with a potential bidirectional association. Although FATmax intensity exercise can boost their fitness，the exact magnitude of this benefit needs further study. Objective Systematic evaluation is needed to assess the impact of FATmax intensity exercise on physical fitness indicators among overweight or obese populations. Methods Retrieve RCTs from PubMed，Web of Science，Ebsco，CNKI，VIP，Wanfang（January 2001 to January 2024） on FATmax exercise effects on body composition， cardiovascular endurance，lipid metabolism in overweight/obese patients. Evaluate quality with Cochrane tool，Meta-analyze with RevMan5.4.Results A total of 16 randomized controlled trials were included，including 568 overweight or obese patients. The Meta-analysis results showed that compared with the control group，the FATmax intensity exercise intervention group significantly improved body composition（BMI：WMD=-1.82，P<0.01；BFR：WMD=-2.86，P<0.01；WHR：WMD=-0.04，P<0.01）， cardiovascular endurance（VO2max：WMD=3.34，P<0.01），and lipid metabolism except for TC（TG：WMD=-0.24， P<0.01；HDL-C：WMD=0.14，P<0.01；LDL-C：WMD=-0.27，P<0.01）. Conclusion FATmax exercise benefits body composition，cardiovascular endurance，and lipid metabolism（except TC）in overweight/obese patients. Optimal results vary： ≥ 12 weeks，3-5 times/week，60-minute running for body composition；≥ 12 weeks，5 times/week，<60 minutes combined for VO2max； ≥ 12 weeks，3 times/week，60-minute running for TG； <12 weeks，4 times/week，60-minute combined for HDL-C；<12 weeks，4 times/week，>60-minute combined for LDL-C.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Diabetes has a high incidence rate and many complications，which was an urgent public health problem，but the prevention and management is still not ideal. Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease. Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months. The patients were grouped according to the course of disease（Group A：course of disease<1 year；Group B：course of disease 1-5 years；Group C：course of disease 5-10 years；Group D： course of disease>10 years）；In outpatient，the three-division team composed of traditional Chinese medicine practitioners， endocrinologists and caregivers carries out comprehensive treatment such as physique identification，complication screening， medicine，food，exercises and emotion intervention；When patients are at home，the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP. We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management. Additionally，we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6 （SDSCA-6）. Results Through the management of the Three Division management，Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention（P<0.05）. The BMI and waist circumference of groups A，B，C，and D were all reduced compared to before the intervention（P<0.05）. Common dietary issues in patient self-management included an unreasonable dietary structure（38.12%），common exercise issues included insufficient exercise volume or intensity（36.46%），and common monitoring issues included insufficient monitoring（37.02%）. The self-management levels of groups A，B，C，and D in the four dimensions of "healthy eating" "self#2;monitoring" "adherence to medical advice" and "education and communication" all improved compared to before the intervention （P<0.001）. Conclusion The Three Division management can improve the self-management ability of diabetes patients and play a good comprehensive role in diabetes. Clinical practice should particularly emphasize the management of patients with a diabetes course of less than one year.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Medically unexplained symptoms （MUS） is a common problem in primary medical care. The etiology of MUS is unclear，which brings continuous pain to patients and affects the doctor-patient relationship. As a result，the management of MUS is a challenge for general practitioners. Combined with relevant literature and guidelines，this paper expounds the diagnosis and treatment ideas of MUS，so as to help general practitioners identify and manage MUS in clinical practice effectively，and finally achieve the purpose of improving the treatment effect of patients and building a harmonious doctor-patient relationship.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-07 Cooperative journals: 《中国全科医学》
Abstract： Background Muscle mass loss increases the risk of hyperglycaemia and sarcopenia in patients with type 2 diabetes mellitus（T2DM），and Chinese adults with T2DM are predominantly non-obese，who are more likely to be associated with muscle mass loss than the obese. Objective To establish an individualized Nomogram prediction model for the risk factorsof muscle mass loss in non-obese patients with T2DM. Methods A retrospective study was conducted to select 905 non-obese patients with T2DM admitted to the Affiliated Drum Tower Hospital，Nanjing University from January 2018 to September 2023. The patients were divided into a training set（n=633）and a validation set（n=272）using simple random sampling at a ratio of 7∶3，and the general data and clinical indexes of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed to determine risk factors for muscle mass loss in the training set and a Nomogram prediction model was constructed. The predictive value and clinical utility of the Nomogram prediction model were evaluated using receiver operating characteristic（ROC）curve，Hosmer-Lemeshow calibration curve，and decision curve analysis（DCA）， respectively. Results The prevalence of muscle mass loss in non-obese patients with T2DM was 42.3%（383/905）. Comparison of the clinical indicators of the patients in the training and validation sets showed no statistically significant differences（P>0.05）. Multivariate Logistic regression analysis showed that age（OR=1.039，95%CI=1.010-1.070，P=0.009），male（OR=3.425，95%CI=2.133-5.499，P<0.001），BMI<23.5 kg/m2 （OR=19.678，95%CI=11.319-34.210，P<0.001），elevated HbA1c （OR=1.196，95%CI=1.081-1.323，P<0.001），increased visceral fat area（OR=1.021，95%CI=1.010-1.032，P<0.001） were independent risk factors for muscle mass loss in non-obese patients with T2DM. The area under curve（AUC）of the ROC for the Nomogram prediction model to predict the risk of muscle mass loss occurring in patients in the training and validation sets was 0.825（95%CI=0.793-0.856，P<0.001）and 0.806（95%CI=0.753-0.859，P<0.001），respectively. The Hosmer-Lemeshow test showed that the model had a good fit（training set：χ2 =11.822，P=0.159；validation set：χ2 =8.189，P=0.415）. Bootstrap method of plotting the calibration of the model showed that the calibration curves fitted well to the standard curves. The DCA curves showed that it was more beneficial to use the Nomogram prediction model to predict the incidence risk of muscle mass loss in patients with T2DM when the threshold probability of the patient was 0.06 to 0.94. Conclusion Age，male，BMI<23.5 kg/m2 ，elevated HbA1c，and increased visceral fat area are independent risk factors for muscle mass loss in non-obese patients with T2DM. The Nomogram prediction model established in this study can individually predict the risk of muscle mass loss in non#2;obese patients with T2DM，which facilitates the early identification of high-risk groups and the development of individualised interventions.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background With the acceleration of China's aging population，the prevalence of chronic diseases and comorbidity patterns pose significant challenges to global health. There is a close relationship between the prevalence of chronic diseases and individuals' self-rated health （SRH） status. However，there is limited research on the prevalence of chronic diseases and comorbidity patterns among middle-aged and elderly populations in rural areas of Xinjiang，China，and their impact on SRH status. Objective To understand the prevalence of chronic diseases and comorbidity patterns among middle#2;aged and elderly populations in rural areas of Xinjiang and to explore the impact of chronic diseases and comorbidity patterns on SRH status，providing effective reference for improving the health level of this population. Methods The data for this study were derived from the survey database of the National Social Science Foundation project （17BRK030） from 2016 to 2019. A questionnaire survey was conducted on the demographic characteristics，chronic disease status，and self-rated health status of male and female heads of households. Ordered logistics regression analysis was used to screen the influencing factors of SRH status. SOM network training analysis and partial least squares method were employed to evaluate the interrelationships among 14 chronic diseases and the degree of their impact on SRH status. Results A total of 3 400 middle-aged and elderly individuals were surveyed. Residents' SRH status varied significantly by geographical distribution，gender，age，education level，occupation， marital status，illness or disability，and chronic disease status（P<0.05）. Geographical region as southern Xinjiang，education level of primary school and below，and presence of chronic diseases were identified as risk factors for SRH status. Being male， aged 45-59 years，occupation as pastoralists，staff of government or public institutions，or technical workers，being divorced， and having illness or disability were identified as protective factors for SRH status. The prevalence of chronic diseases among middle-aged and elderly populations in rural areas of Xinjiang was 71.96%. The top three diseases were hypertension （36.67%）， arthritis or rheumatism（18.09%），and heart disease（11.91%）. The comorbidity rate of chronic diseases was 22.18%，with hypertension（23.19%），arthritis or rheumatism（19.62%），and heart disease（17.84%） being the top three comorbid diseases. The predominant comorbidity pattern was the co-occurrence of two chronic diseases（78.18%）. The most common comorbidity pattern among individuals with two chronic diseases was hypertension combined with heart disease，and among those with three chronic diseases was hypertension combined with heart disease and arthritis or rheumatism. The impact of chronic disease status on SRH status revealed that individuals with chronic diseases had significantly lower SRH status than those without chronic diseases，and individuals with two or more chronic diseases had lower SRH status than those with one chronic disease. Conclusion The prevalence of chronic diseases and comorbidity among middle-aged and elderly populations in rural areas of Xinjiang is high. Chronic respiratory diseases，arthritis or rheumatism，heart disease，anemia，and other chronic diseases have a significant impact on SRH status. Therefore，it is necessary to further strengthen the construction of chronic disease service systems，improve the health records of middle-aged and elderly individuals，establish specialized clinics for chronic disease comorbidity to detect and control the comorbidity of chronic diseases among middle-aged and elderly populations. Additionally， efforts should be made to enhance health education for middle-aged and elderly groups，increase awareness of chronic diseases， and promote active and healthy lifestyles to improve the health level and quality of life of middle-aged and elderly populations.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-06-06 Cooperative journals: 《中国全科医学》
Abstract： Background Nonalcoholic fatty liver disease（NAFLD）is a common digestive system disease，which is often diagnosed by imaging methods in clinical work. At present，there is a lack of research on the effectiveness evaluation of imaging diagnostic methods with histology as the gold standard. Objective To study the consistency of imaging and histological diagnosis of NAFLD，and to analyze the influencing factors of gallstone disease（GD）complicated with NAFLD. Method From January 2021 to July 2022，53 patients with GD who underwent simple cholecystectomy and liver biopsy were selected from the Department of Hepatobiliary surgery，Nanjing Hospital affiliated to Nanjing University of traditional Chinese Medicine. The demographic characteristics，BMI，systolic blood pressure（SBP）and diastolic blood pressure（DBP）of the subjects were collected，and the laboratory indexes，imaging and histological results were collected. The consistency of imaging and histological diagnosis of NAFLD was evaluated by Kappa consistency test. According to the histological diagnostic criteria，the subjects were divided into NAFLD group（n=15）and non-NAFLD group（n=38）. Multivariate Logistic regression analysis was used to explore the influencing factors of NAFLD in patients with GD. Results The imaging detection rate of NAFLD in GD patients was 20.7%（11/53），which was lower than that of histology（28.3%）（15/53）（Kappa=0.404，P=0.001）. The sensitivity of imaging diagnosis was 60.0%（9/15），the specificity was 94.7%（36/38），and the rate of missed diagnosis was 40.0%（6/15）. There were 8 cases of nonalcoholic fatty liver（NAFL），7 cases of nonalcoholic steatohepatitis（NASH） and no NASH associated cirrhosis in 15 patients with histological manifestation of NAFLD. The proportion of fibrosis in the NASH group was higher than that in the NAFL group. There were significant differences in the levels of BMI，SBP，fasting blood glucose（FPG）and aspartate aminotransferase（AST）between NAFLD group and non-NAFLD group（P<0.05）. Multivariate Logistic regression analysis showed that BMI（OR=1.5，95%CI=1.084~2.075，P=0.014）and FPG（OR=2.163， 95%CI=1.246~3.756，P=0.006）were the influencing factors of GD patients with NAFLD. Conclusion Compared with histological diagnosis，the missed diagnosis rate of imaging diagnosis of NAFLD is higher，and the incidence of NAFLD may be underestimated by imaging diagnosis as a means of epidemiological investigation. High BMI and high FPG are the main risk factors of GD complicated with NAFLD.
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