Search

Background Hierarchical diagnosis and treatment system is crucial for deepening the medical and health system reform and establishing the basic medical and health system with Chinese characteristics. Primary care institutions play an essential role in hierarchical diagnosis and treatment system by assuming the role of "gatekeepers" of residents health. The post competency of general practitioners, who are the core of primary care institutions, significantly influences the service capacity of these institutions. Objective To construct an indicator system for the evaluation of post competency of general practitioners in primary care institutions. Methods From September to December 2022, 13 medical professionals were consulted through two-round Delphi expert consultation method; the hierarchical analysis and entropy method was used to calculate the weights of the indicators. Results The indicator system was optimized and sifted through two rounds of Delphi expert consultation, the evaluation system of primary general practitioners was finally constructed, consisting of 5 primary indicators and 27 secondary indicators. The weights of the indicators at all levels were clarified through the hierarchical analysis combined with the entropy method, in which the basic public health service capacity indicator had the highest weight and was the core indicator. The indicator system was tested for reliability and validity by small samples, and all of them were at an acceptable level. Conclusion An indicator system for evaluation the post competency of general practitioners in primary care institutions was constructed, contributing to the selection and appointment of general practitioners, which will provide an objective reference for the evaluation of post competence of general practitioners in primary care institutions.

Abstract Objectives Doctors who wish to become general practitioners (GPs) in China are required to attend and complete general practice resident training. In the early stages of the standardized GP training system, GP training supervisors play important roles. This study aims to explore how GP residents perceive their GP supervisors, factors that affect GP residents’ satisfaction level, as well as to offer suggestions based on the implications of this study. Design We conducted a mixed quantitative and qualitative study. Firstly, with respect to the quantitative research, we conducted a survey to investigate training satisfaction through questionnaires, then extracted and analyzed the factors that influence training satisfaction. In the qualitative study, we conducted in-depth, semistructured interviews using qualitative research criteria (COREQ)––a 32-item checklist for interviews. Participants Participants in the quantitative survey included 1172 GPs whose training time wasbetween 2008 and 2017. Afterwards, 100 participants were selected from this sample , filtered by stratified random sampling and by having provided extreme answers on the quantitative survey (less than 5% of the total sample). They were chosen for the qualitative research to conduct a more detailed investigation., This stratified random sampling was based on residents’ grades, regions, and training levels (city level or county level). Extreme answers were identified as answers of “extremely good” or “extremely bad” to questions from the initial comprehensive survey of 1172 participants. Consequently, 30 participants with extreme answers were found, while the remaining 70 participants in the interviews were selected by stratified random sampling. Ultimately, this sample of participants met our information collection and sample estimation requirements. Results The results show that satisfaction with GP theoretical training supervisors, GP hospital-based training supervisors, and GP community-based training supervisors differed. Considering long-term averages, the hierarchy of satisfaction is as follows: GP theoretical training supervisors > GP community-based training supervisors > GP hospital-based training supervisors. GP hospital-based training supervisors need to improve their conception of GPs, teaching methods and conscientiousness. GP community-based training supervisors need to improve their teaching methods, knowledge of clinical theory and practice ability. Conclusions On the one hand, teams of GP supervisors in China have gradually been established over time. On the other hand,the satisfaction tendencies of residents with respect to their GP supervisors are quite different, and teams of GP supervisors must be promoted and improved.

Objectives: Diabetes has been related to higher risk and poor prognosis of patients with tuberculosis, while the influence of prediabetes on the treatment outcome of patients with tuberculosis remains not determined. A meta‐analysis was performed to evaluate the influence of prediabetes on treatment outcome of patients with tuberculosis. Methods: Relevant cohort studies were acquired through a search of Medline, Embase, and Web of Science databases. To minimise the influence of between‐study heterogeneity, a randomised‐effects model was used to pool the results. Results: Eight prospective cohort studies including 3001 patients with tuberculosis were available for the meta‐analysis. Among them, 752 (25.1%) were with prediabetes at baseline, and the patients were followed for a mean duration of 17.7 months. It was shown that compared to patients with normoglycemia, those with prediabetes were associated with a higher incidence of unfavourable treatment outcome (risk ratio [RR]: 1.41, 95% confidence interval [CI]: 1.02 to 1.96, p = 0.04; I2 = 56%). Subgroup analysis did not support that difference in study country (Asian or non‐Asian), diagnosis (pulmonary tuberculosis only or also with extrapulmonary tuberculosis), mean age, follow‐up duration, or study quality score had significant influence on the results (p for subgroup difference all >0.05). However, prediabetes at baseline was not associated with an increased risk of all‐cause mortality during follow‐up (RR: 1.59, 95% CI: 0.75 to 3.38, p = 0.23; I2 = 54%). Conclusions: Patients with tuberculosis and prediabetes may have a higher risk of unfavourable treatment outcome compared to patients with normoglycemia. [ABSTRACT FROM AUTHOR]

Objective: The participation of general practice (GP) residents in COVID-19 prevention and control tasks touched workload participation in public health and disease prevention and control and was also a rare, valuable training experience for the residents and research material for medical education. This experience contributed to the understanding of three key points: First, was the content of the COVID-19 prevention task suited to them, or did it overload them in the present? Second, their competence in the COVID-19 prevention task reflected whether the early medical school training was sufficient or not. Third, what can be drawn from this study to promote public health training in the future? This study aimed to explore these issues by conducting a real epidemic situated training (REST) program.Methods: A situated cognition study was designed that included situational context design, legitimate peripheral participation, and the construction of a community of practice. The Task Cognitive Load Scale (NASA-TLX Scale) and self-developed questionnaires were adopted to conduct a questionnaire survey of resident doctors in a GP training program from West China Hospital of Sichuan University, and 183 questionnaires were collected. SPSS 23.0 statistical software was used for the statistical analysis of data.Results: The NASA scale showed that the intensity of field epidemic prevention and control (training) was tolerable. In particular, there was statistical difference in the cognitive load intensity of training before and after the epidemic occurred at different time points (P < 0.05). This shows that they were early trained and well-prepared before sudden outbreak of the COVID-19. Before the outbreak of the epidemic, the public health knowledge and training received came from undergraduate education (83.16%), early residents program training (69.47%), online self-study (49.16%), and continuing education (20.53%).Conclusion: Former medical school education and training at the regulatory training stage have a good effect and enable residents to master the skills required for epidemic prevention and control and to physically and mentally prepare for the task. After this stage, epidemic prevention and control training in real situations will make important contributions to the self-assessment and performance improvement of public health training.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by irreversible progressive airflow limitation, often manifested by persistent cough, sputum production and other respiratory symptoms that pose a serious threat to human health and affect the quality of life of patients. The disease is associated with chronic inflammation, which is associated with the onset and progression of COPD, but anti-inflammatory therapy is not first-line treatment. Inflammation has multiple manifestations and phenotypes, and this heterogeneity reveals different patterns of inflammation, making treatment difficult. This paper aims to explore the direction of more effective anti-inflammatory treatment by analyzing the nature of inflammation and the molecular mechanism of disease occurrence and development in COPD patients, and to provide new ideas for the treatment of COPD patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xu, Zeng, Li, Su and Fan.)

Background: Comorbidity is a common phenomenon in the older population; it causes a heavy burden on societies and individuals. However, the relevant evidence, especially in the southwestern region of China, is insufficient., Objectives: We aimed to examine current comorbidity characteristics as well as correlations among diseases in individuals aged >60 years., Design: Retrospective study., Methods: We included records of 2,995 inpatients treated at the Gerontological Department of Sichuan Geriatric Hospital from January 2018 to February 2022. The patients were divided into groups according to sex and age. Diseases were categorised based on the International Classification of Diseases and their Chinese names. We calculated the age-adjusted Charlson Comorbidity Index (ACCI), categorised diseases using the China Health and Retirement Longitudinal Study questionnaire, and visualised comorbidity using web graphs and the Apriori algorithm., Results: The ACCI was generally high, and it increased with age. There were significant differences in the frequency of all diseases across age groups, especially in individuals aged ≥90 years. The most common comorbid diseases were liver diseases, stomach or other digestive diseases, and hypertension. Strong correlations between the most common digestive diseases and hypertension were observed., Conclusion: Our findings provide insights into the current situation regarding comorbidity and the correlations among diseases in the older population. We expect our findings to inform future research directions as well as policies regarding general clinical practice and public health, especially for medical consortiums., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ma, An, Zhang, Deng, Deng and Su.)

This study was aimed to construct transgenic mouse model with target for Runxl gene. Runxl cDNA of mice was amplified by PCR from pcDNA3. 1 Flag Runx1 FL vector and inserted into ptetO7-Asc-IRES-EGFP vector to form a recombinant vector, and then the recombinant vector was injected into fertilized egg by microinjection technology to get a transgenic mouse. The results of PCR and Southern blot indicated that the Runx1 transgenic mouse was constructed successfully, and this could provide an important tool for studying the function of Runxl gene in vivo.

Objective: To evaluate the role of cysteinyl leukotriene(CysLT) in the pathogenesis of hypoxic pulmonary hypertension and the preventive effects of montelukast, a CysLT receptor antagonist, on hypoxic pulmonary hypertension., Methods: Thirty male Wistar rats were randomly divided into three groups: control group, hypoxic group and montelukast preventive group. The animal model of pulmonary hypertension was established by exposing the rats to normabaric hypoxic conditions for 3 weeks. The thickness of pulmonary arterioles was measured by a computerized image analyzer. The level of LTC4 in plasma was measured by EIA., Results: In the hypoxic group, the index of right ventricular hypertrophy[RV/(LV + S)] and the index of wall thickness of pulmonary arteriole (WT% and WA%) increased significantly when compared against those in the control group [RV/(LV + S): 30.85% +/- 1.44% vs 20.75% +/- 1.97%; WT%: 23.54% +/- 4.43% vs 13.17% +/- 3.67%; WA%: 72.76% +/- 9.28% vs 50.41% +/- 6.37%, P < 0.01, respectively]. Meanwhile, the plasma level of LTC4 in hypoxic rats was higher than that in control rats [(2395.40 +/- 193.86) pg/ml vs (1006.50 +/- 193.17) pg/ml, P < 0.01]. In the preventive group, the RV/(LV + S) (24.09% +/- 1.09%), WT% (15.44% +/- 4.72%) and WA% (51.98% +/- 12.18%) decreased remarkably as compared with those of the hypoxic group(P < 0.01). The plasma level of LTC4 in the preventive group (2706.25 +/- 350.49 pg/ml) was not significantly different from that in the hypoxic group(P > 0.05)., Conclusion: Chronic hypoxia stimulates synthesis and release of LTC4. CysLT may play an important role in the pathogenesis of hypoxic pulmonary hypertension and montelukast can prevent hypoxi pulmonary hypertension.