Knowledge-attitude-practice model is widely used in the self-management of type-2 diabetes.Through proper education,patients can gain diabetic knowledge as well as positive attitude on glucose control.By regulating diet,exercise,self glucose monitoring and medication compliance,diabetic patients are able to control blood glucose more effectively,and have less complications and higher quality of life.Researches on the application and effectiveness of various diabetic knowledge,attitude and self-management behavior scales are reviewed in this article.

Objective To investigate the factors related to choice of community health service centers (CHSCs) in standardized training general practitioners (GPs) in Shanghai.Methods Totally 152 GPs,(including those of Traditional Chinese Medicine) who completed the residency training in 2013 and signed employment contract with community in Shanghai were surveyed with a self-designed questionnaire.Results Among all the participants,113 (74.3％) attached the greatest importance to the salary level when choosing CHSC,58 (38.2％) expected annual salary more than 120 000 Yuan during the first 3 years.GPs tended to work in the city center(40.1％) or CHSCs near to their home(38.2％),mainly because of the job commuting (59.9％).Considering career development,the CHSCs with high level comprehensive service (51.3％) and with large population (5.0％) were more attractive.GPs paid more attention to the national demonstration community (57.2％) and CHSCs with member ofShanghai outstanding young physician training program(51.7％).In this survey,household register was the main influencing factor for choosing CHSCs,Shanghai natives paid more attention to the location of the community than those not Shanghai natives (61.8％ vs.34.2％),more inclined to CHSCs that close to their house (55.3％ vs.21.1％),non-Shanghai natives preferred authorized strength (51.3％ vs.28.9％).GPs of Western medicine expected higher salary than GPs of TCM (x2 =13.648,P ＜ 0.05),Males expected higher salary than females (x2 =7.799,P ＜ 0.05),Conclusions GPs pay the most attention on salaries and tend to work in the city central area,prefer CHSC with high level comprehensive service and large served population.The main factor influencing GPs to chose CHSCs is the household register,the category of Gps and gender.

BACKGROUND:There remains controversy that whether patel ar resurfacing in total knee arthroplasty and whether patel ar chondromalacia has influence on clinical outcomes.
OBJECTIVE:To evaluate anterior knee pain, clinical function and effects of patel ar chondromalacia on clinical outcomes after total knee arthroplasty without patel ar resurfacing for degenerative osteoarthritis.
METHODS:Clinical data of 162 patients (162 knees) with degenerative osteoarthritis undergoing total knee arthroplasty without patel ar resurfacing from June 2008 to February 2010 were retrospectively analyzed. Outerbridge classification was used for patel ar chondromalacia, Visual Analogue Scale for anterior knee pain, and the Knee Society clinical scoring system for clinical function.
RESULTS AND CONCLUSION:The incision of al patients reached stage-I healing. The patel ar chondromalacia:grade I in 18 patients, grade II in 36 patients, grade III in 62 patients, and grade IV in 35 patients. At the final fol ow-up, there were six (4.0%) patients with anterior knee pain, including four cases of mild pain and two cases of moderate pain, no severe pain. The mean Knee Society clinical scoring system scores and patel ar score were obviously elevated. Outerbridge classification did not affect the incidence of anterior knee pain after replacement (χ2=0.42, P=0.94), the Knee Society clinical scoring system score (knee score:F=1.83, P=0.14;functional score:F=0.56, P=0.64) and partel ar score (F=0.78, P=0.51). These data suggested that total knee arthroplasty without patel ar resurfacing for degenerative osteoarthritis can obtain satisfactory clinical outcomes, and the patel ar chondromalacia may not affect the clinical outcomes.

Objective To investigate the methods and results of lengthened proximal femoral nail antirotation (PFNA) in the treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures. Methods Of the 21 patients with femoral shaft combined with ipsilateral femoral neck fractures treated by lengthened PFNA from 2006 to 2009,16 patients with complete follow-up were retrospectively studied.There were 15 males and 1 female,at mean age of 35 years (range,21-51 years).Injury causes were all high-energy trauma including traffic injuries in 11 patients and fall injuries in five.According to Garden classification,there were seven patients with type Ⅰ femoral neck fractures,six with type Ⅱ and three with type Ⅲ.Femoral shift fractures contained six superior part fractures and nine medial part fractures and one inferior part fracture.According to Winquist classification,there were two patients with type Ⅰ femoral shaft fractures,four with type Ⅱ,six with type Ⅲ and four with type Ⅳ.Two patients had open fractures belonging to type Ⅰ Gustilo-Anderson.Harris hip score was used to evaluate functional outcomes at the last follow-up postoperatively. Result The mean follow-up time was 2.4years (range,1-4 years ).The mean period for healing of femoral neck and shaft fractures was 4.2months ( range,3-6 months) and 5.1 months ( range,3-8 months) respectively.Four patients showed delayed diagnoses of femoral neck fractures ; two patients had delayed union of femoral shaft fractures ; one suffered from avascular necrosis of the femoral head ; one patient presented 3 cm of extension of the affected limb and was accompanied by active pain of the knee joint for over four months.According to Harris score,function of hip joints was excellent in seven patients,good in six and fair in three,with excellence rate of 82％. Conclusions It is relatively few that the femoral shaft fracture is combined with ipsilateral femoral neck fracture.The rate of missed diagnosis of femoral neck fractures is high and the patients with high energy trauma hould be highly paid attention to.Lengthened PFNA conforms to characteristics of biomechanical fixation and presents short operation time and solid fixation. Lengthened PFNA achieves affirmatory effects for treatment of femoral shaft fractures combined with ipsilateral femoral neck fractures.

BACKGROUND:Screw fixation of the fractured vertebral body can share the stress of implant, increase fixing strength, and help to maintain the stability of late fracture. However, whether it can assist reduction using fracture vertebral screw, but no relevant clinical reports were found at present. OBJECTIVE:To explore the effectiveness of self-designed screw-assisted reduction of fractured vertebrae. METHODS:161 cases of thoracolumbar fracture who had been hospitalized between June 2001 and June 2009 were enrol ed in this study, including 101 males and 60 females, at the age of 22-67 years, averagely 36 years. By Denis classification, 64 cases affected burst fractures and 97 flexion-compression fractures. Fracture levels involved T11 (9 cases), T12 (63 cases), L1 (74 cases) and L2 (15 cases). The self-designed method of reduction assisted with screw insertion was used. The efficacy of this reduction method was evaluated by operation time, intraoperative bleeding, fracture union time, height ratio of anterior borders of injured and normal vertebrae, sagittal Cobb’s angle, and reduction of fragments.
RESULTS AND CONCLUSION:The operation time ranged from 60 to 150 minutes, averaging 80 minutes. The intraoperative bleeding ranged from 67 to 750 mL, averaging 98 mL. The fol ow-up time ranged from 16 to 42 months in 161 patients. Fracture union time ranged from 10 to 18 weeks, averaging 12.6 weeks. The ratio of anterior heights and sagittal Cobb’s angle of fractured vertebrae were significantly improved from (54.39±9.60)%and (22.55±7.90)° respectively preoperati on to (82.80±6.63)%and (8.91°±5.85)° 12 months postoperation (P<0.05). The size of spinal canal was increased by (46.5±2.6)%postoperatively. CT scan revealed satisfactory fragment reduction and no deep infection appeared. These findings suggest that our self-designed screw-assisted reduction of the fractured vertebrae can improve the reduction quality in the treatment of thoracolumbar fractures.

ObjectiveThe purpose of this study was to analyze the outcomes of surgical treatment of displaced intra-articular calcaneal fractures (ICFs) in children and its characteristics.MethodsBetween January 2004 and October 2008,we review the results of 9 displaced,intra-articular fractures in 8 skeletally immature patients,who were treated with open reduction and internal fixation in our hospital.There were 7 males and 1 female,with the mean age of 13.1 years(range:10 to 15 years).Preoperative radiographs and computed tomographic scans were used to classify fractures.Clinical and radiographic evaluation were performed in postoperative follow-up visits.The functional outcomes were assessed with use of the modified American Orthopaedic Foot and Ankle Society(AOFAS) ankle and hindfoot score.The published literatures of child ICFs treated with ORIF were reviewed.ResultsIn the series,there were 4 tongue-type and 5 joint depression-type fractures according to Essex-Lopresti classification,and according to Sanders classification,we found 5 type-Ⅱ fractures,3 type-Ⅲ and 1 type-Ⅳ fractures.The mean follow-up time was 47.4 months (range:21 to 72 months).All fractures healed within 2 to 4 months.The average preoperative and postoperative Bohler angles were 5.7 and 33.1 degrees respectively,and the mean Gissane angles were 106.5 and 128.0 degrees respectively.The mean modified-AOFAS score was 65.2 points(range:53 to 68 points).Skin necrosis was found in one foot.After the review of literatures,78.6％ (48/61) of displaced ICFs were male in children.Based on the Sanders classification,36 of 67 (53.7％) were type-Ⅱ fractures,25 of 67 (37.3％) were type-Ⅲ and 6 of 67 (9.0％) were type-Ⅳ; And 15 of 37 (40.5％) were tongue-type,22 of 37 (59.5％) were joint depression-type fractures according to Essex-Lopresti classification.ConclusionMost children with displaced ICFs treated with ORIF had a good clinical outcome with few complications.The children and adolescents that were exposed to high-energy trauma suffer calcaneal fractures that were similar to adult fracture patterns.

Objective To evaluate the reliability and validity of the Chinese version of the Diabetes,Hypertension and Hyperlipidemia(DHL) Knowledge Instrument in community diabetic patients.Methods A face-to-face interview was conducted among 513 patients with diabetes in the community from January to March 2016 by using the Chinese version of DHL Knowledge Instrument.Forty of them were randomly sampled and reinvestigated 4 weeks later.The analyses on Cronbach's α coefficient,test-retest reliability,content validity,discriminant validity and construct validity were performed to evaluate reliability and validity of the DHL Knowledge Instrument.Results The qualified questionnaires were collected from 488 participants,including 232 males and 256 females with a mean age of (66 ± 6)years.The overall scores of the Chinese version of DHL Knowledge Instrument was 67.7 ± 18.0 and the scores of diabetes,hypertension,hyperlipidemia,medications and general issues sub-scales were 82.0 ± 22.5,65.9 ± 25.2,38.2 ± 34.3,75.5 ± 20.8 and 72.1 ± 22.9,respectively.The standardized Cronbach's α coefficient of the total scale was 0.849 and the test-retest reliability of the total scale was 0.706 (P ＜ 0.01).In term of content validity,the correlation coefficient was from 0.580 to 0.827 among total scale and sub-scales (P ＜ 0.01).In term of discriminant validity,the difference between the high and the low score group on total scale and sub-scales were significant (t value =-13.486 to-35.528,all P ＜ 0.01).In term of construct validity,based on exploratory factor analysis,the scale was revised.According to confirmatory factor analysis of revised scale,four factor model containing 20 items was well fitted (X2 =159.689,df =134,P =0.064);the GFI (goodness of fit index) =0.966,AGFI (adjusted goodness of fit index) =0.952,RMSEA (root mean square error of approximation) =0.020.Conclusion The Chinese version of DHL Knowledge Instrument possesses good reliability and validity and is suitable to evaluate the knowledge of community diabetic patients,and the modified version may work better than the original one.

Objective To investigate the feasibility and clinical effect of cannulated screws plus separate vertical wirings technique for acute fracture of the inferior pole of the patella.Methods From May 2012 to September 2013,14 patients with fresh closed unilateral fracture of the inferior pole of the patella were treated with the cannulated screws plus separate vertical wirings.Eight patients were injured in traffic collisions and 6 in fall accidents.Fracture AO classification was type 34A1 in 8 patients and type 34A2 in 6 patients.Time from injury to operation was 1-7 days (mean,2.5 days).Number of tie wires was determined according to the degree of fracture comminution.Fracture healing,fixed position and patellar length were evaluated by radiographic examination postoperatively.Knee mobility and Bostman evaluation system were investigated to analyze the clinical effect.Results All the patients obtained average 15-month follow-up (range,12 to 29 months).At postoperative 2 months,the fracture healed with good alignment of the broken bone and proper place of the internal fixation device noted on the X-ray films.At postoperative 6 and 12 months,X-ray films revealed fracture bony healing,good location of the wire internal fixation,and no apparent shortening of the patella.At the 12 months,range of knee motion was (126.0 ± 4.5) ° for flexion and (2.0 ± 1.7) ° for extension.Bostman functional score for patella fracture was (28.1 ± 1.9) points.And 12 patients were rated as excellent and 2 good,with excellence rate of 100％.Conclusion Cannulated screw fixation plus separate vertical wiring is effective to stabilize patella inferior pole fracture and has good results,indicating a recommended surgical method.

ObjecfiveTo explore clinical value of 64-slice spiral CT coronary angiography in diagnosing coronary atherosclerotic heart disease. as compared to that with selective coronary angiography.MethodsOne hundred and thirteen patients who underwent both 64-slice spiral CT coronary angiography as well as selective coronary angiography at an interval of no more than one month at Zhongshan Hospital.Shanghm in 2006 were selected for the study and their imaging reports were analyzed and compared.ResultsImages of 910 segments of coronary arteries were collected and assessed.Sensitivity,specificity and likelihood ratio for negative test result of 64-slice spiral CT coronary angiography in diagnosis of coronary atherosclerotic heart disease were 73.8 percent.97.0 percent and 24.4,respectively,with an overall agreement of 93.2 percent,positive predictive value of 82.7 percent and negative predictive value of 95.0 percenL ConclusionsSixty-four-slice spiral CT coronary angiography has hish specificity,negative predictive value and positive likelihood ratio,with high accuracy,in diagnosing coronary atherosclemtic heart disease.

This cardiac output detector uses AT89C52 as the core MCU, carries the pulse signal sampling from pulse sensor into the SCM after A/D conversion, and then figures out the cardiac output value and displays it on the LED. Software analysis works out the cardiac output value through five-point difference threshold for feature location of the pulse graph method theory. Experiment results show that the normal measured cardiac output is 5.411 L/min, the standard deviation of 0.873, while the catheter method as the gold standard of the mean 5.51 L/min, the standard deviation of 1.09. This system can meet the testing requirements of normal cardiac output. It is a non-invasive, convenient and new cardiac output measurement instrument with continuous testing, easy operation and low cost.
Cardiac Output ; Monitoring, Physiologic ; instrumentation ; methods ; Pulse