A review of the system background for the multi-institution physician practice in China,and an analysis for the specific constraints for physicians of public hospitals to embrace such a practice On this basis, the paper probed into the measures to encourage the physicians for doing so. The measures recommended include advanced design, improvement of the quality of care and safety mechanism,incentives mechanism, mandatory enforcement of medical liability insurance to minimize risk exposure of such a practice, aiming at advancement of this practice.

Objective:To explore the intervention effect of 321 health education guided by transtheoretical model on hemodialysis patients.Methods:A total of 107 cases of hemodialysis patients from January to December in 2019 in the Central Hospital of Panzhihua, Sichuan Province, were divided into a control group of 53 cases and a study group of 54 cases by table of random number. Patients in the control group received routine health education, and patients in the study group were intervened by 321 health education guided by transtheoretical model. The level of health literacy, symptoms, quality of life of patients in the two groups were evaluated by chronic disease patients health literacy scale, the Chinese version of Dialysis Frequency Severity and Symptom Burden Index (DFSSBI), and the Chinese version of Kidney Disease Questionnaire (KDQ) before and after the intervention.Results:After the intervention, the total score of the health literacy scale of patients with chronic diseases in the control group and the score of the three dimensions of information acquisition ability, communication and interaction ability, and willingness to be healthy were (89.16±11.04), (32.62±3.51), (31.48±3.61), (16.85±2.57), lower than those of the study group (99.86±11.46),(35.92±3.42),(35.73±3.92),(19.96±2.77), respectively, and the differences were statistically significant ( t values were -21.898--4.925, P<0.01). After the intervention, the total score, physical symptom score and psychological symptom score of the two dimensions of DFSSBI in the control group were (56.39 ± 8.21), (47.27 ± 6.85), (9.12 ± 1.31),higher than those of the control group (49.00 ± 6.31), (41.81 ± 5.35), (7.17 ± 0.95),respectively, and the differences were statistically significant ( t values were 5.226, 4.599, 8.827, P<0.01). After the intervention, the incidence of difficulty in falling asleep, fatigue, dry skin, itching, dry mouth in the study group were 38.89%(21/54), 38.89%(21/54), 27.78%(15/54), 27.78%(15/54), 25.93%(14/54), lower than those in the control group 66.04%(35/53), 62.26%(33/53), 49.06%(26/53), 49.06%(26/53), 45.28%(29/53), respectively, and the differences were statistically significant(χ 2 values were 5.124-9.224, P<0.05 or <0.01). The symptom scores of difficulty in falling asleep, fatigue, dry skin, itching, dry mouth in the control group were (7.44 ± 0.81), (7.34 ± 0.72), (7.42 ± 0.73), (8.62 ± 0.72), (7.82 ± 0.77), higher than those in the study group(6.11 ± 0.65), (6.02 ± 0.59), (6.15 ± 0.61), (7.12 ± 0.65), (5.84 ± 0.51) respectively, and the differences were statistically significant ( t values were 9.376-15.710, P<0.01). After the intervention, the total score of KDQ and the scores of physical symptoms, fatigue and depression in the control group were (106.46 ± 13.39), (23.87 ± 2.40), (22.71 ± 2.67), (22.52 ± 2.93), lower than those in the study group (116.89 ± 14.59), (27.12 ± 2.53), (25.16 ± 2.82), (27.12 ± 3.75), respectively, and the differences were statistically significant ( t values were -7.062--3.851, P<0.01). Conclusions:Intervention of 321 health education guided by transtheoretical model on hemodialysis patients can improve their health literacy and symptoms, reduce their symptom burden score and improve their quality of life.

Information Systems ; Medical Informatics ; Medical Records Systems, Computerized ; Pathology

Animals ; DNA Methylation ; Female ; Genes, Tumor Suppressor ; Genes, ras ; Humans ; Lung Neoplasms ; genetics ; metabolism ; Nasopharyngeal Neoplasms ; genetics ; metabolism ; Signal Transduction ; Tumor Suppressor Proteins ; genetics ; metabolism ; Uterine Cervical Neoplasms ; genetics ; metabolism

Adenocarcinoma ; chemically induced ; metabolism ; Animals ; Apoptosis ; drug effects ; Carcinogens ; toxicity ; Histocompatibility Antigens Class I ; metabolism ; Humans ; Interferon-gamma ; metabolism ; Interleukin-2 ; metabolism ; Lung Neoplasms ; chemically induced ; metabolism ; Lymphocytes ; cytology ; metabolism ; Pulmonary Surfactant-Associated Protein C ; metabolism ; Sterigmatocystin ; toxicity

ObjectiveTo avoid the complications such as scar,alopecie,scalp numbness,hematoma etc,resulted from the conventional coronal incision rhytidectomy,and to explore and solve the issues about endoscopic frontal and temporal rhytidectomy.MethodsThrough 3-5 short incisions in hairline,we dissected under frontal periosteum or gales aponeurotica and in superficial layer of deep temporal fascia.The frontal and temporal cavitites were feedthrough at temporal crest.The corrugator supercilii muscle,superciliary depressor muscle,frontal muscle and orbicularis oculi were treated.Sufficient dissection was done under the periosteum of os orbitale.ResultsThis method had been applied in 186 patients with forehead lift.After operation,transient paralysis of facial nerve frontal branch were found in 3 patients.The depression of glabellum and lateral canthus were found in 5 patients.The depressions were corrected by autologous fat injection. Other 178 patients' results were satisfactory.ConclusionsEndoscopic frontal and temporal rhytidectomy has some advantages,such as minute invasion,less hemorrhage,few complications,and stable operation result,etc.Compared to the conventional coronal incision rhytidectomy,this method will be used more widely.

Objective To observe the clinical efficacy of the combined therapy of super-laser radiation and plum acupuncture on alopecia areata.Methods Altogether 178 alopecia areata patients were randomly divided into 3 groups:65 patients in the treatment group being given super-laser radiation and plum acupuncture,55 in the control group A solely with super-laser radiation and 58 in the control group B solely with plum acupuncture.The therapeutic effects of the treatment group and the control groups were compared by rank sum test.Results At the end of the 1st treating period,the cured cases,markedly effective cases,ordinary effective cases and invalid cases in control group A were 1,4,10 and 40;those numbers of control group B were 1,3,11 and 43;those numbers of the treatment group were 3,12,14 and 36.At the end of the 2nd treating period,those numbers of control group A were 8,8,16 and 23;those numbers of control group B were 7,8,18 and 25;those numbers of the treatment group were 11,20,19 and 15.At the end of the 3rd treating period,those numbers of A control group were 21,11,12 and 11;those numbers of B control group were 20,14,11 and 13;those numbers of the treatment group were 33,17,10 and 5.Comparing the performance of each groups at the end of the 3 periods,we found that effects were always better in the treatment group than the other two control groups.The difference between the treatment group and the other two control groups was statistically significant (P＜0.05).Conclusions It is effective and safe to use super laser radiation combined plum acupuncture on alopecia areata.The clinical efficacy of this joint method is better than either of the two separate ways.

Objective To explore the higher dangerous factors,the early clinical performances and its contents of neonatal pulmonary hemorrhage(NPH).Methods The clinical performances,chest radiograms and autoptical pathological materials of 66 cases of newborns who died of NPH at our neonatal department during 1993 to 2003 were reviewed and analyzed.Results The higher dangerous factors of NPH were premature delivery/low birth weight,serious diseases lead to hypoxia and severe infections.The early clinical performances of NPH were the suddenly aggravation of dyspnea and the increasing of moist sounds.The early X-ray performances were lower penetrance of lung fields extensively and well-distributly with path clouds,the intercostals space usually increased.According to the autoptical(patho)-logy,this X-ray perfomance indicated the edema of the pulmonary with small amount of hemorrhage.Conclusion The patients with the higher dangerous factors and the early clinical performances of NPH,must be diagnosed and interfered it as early as possible to reduce the mortality of NPH.

Objective To study the relationship between the positive expression of human leukocyte antigen B27 (HLA-B27) in different age groups and genders in Uygur and Han nationality in Xinjiang,and explore the clinical value of HLA-B27 in different ethnic groups.Methods From January 2013 to November 2016,1 416 cases of Uygur and Han patients with positive expression of HLA-B27 were detected by flow cytometry.There were 369 cases of Uygur and 1 047 cases of Han.Results Independent samples t-test showed that the positive expression of HLA-B27 in Uygur and Han population was statistically significant (165.22±8.262 vs 163.99±8.113,t=2.479,P=0.013).In male,there was a significant difference in the positive expression of HLA-B27 between Uygur and Han population (165.40 ± 8.237 vs 163.99 ± 8.164,t =2.187,P =0.029).In the age of 41～60 years old and ＞60 years old,the positive expression of HLA-B27 in Uygur was higher than that in Han nationality (166.18 ± 7.650 vs 164.53 ± 8.018,t =2.215,P =0.027;171.63 ± 8.134 vs 167.40 ± 9.469,t =2.126,P=0.035).There was no significant difference in the positive expression of HLA-B27 between Uygur and Han nationality in women,as well as in the age of 20 years and 21～40 years (t=-0.029～1.257,all P＞0.05).Conclusion The investigation showed that the positive expression of HLA-B27 in Uygur was higher than that in Han nationality.The content of HLA-B27 positive expression has racial difference.

Objective To explore the clinical indication and operative methods for different upper eyelid aging through perieyebrow incision.Methods We collected totally one hundred fifty-two cases in this study,including six males and 146 females,and aged from 26 to 80 years (average 47).There were 29 cases with only ptosis of upper eyelid,and the rest 123 cases were ptosis of upper eyelid with ptosis of eyebrow,sunken upper eyelid,bloated upper eyelid,or over-wide between eyebrow and eye region (compensatory eyebrow elevation).Through the incision of upper or lower margin of eyebrow,we treated these five types of upper eyelid aging by excision of redundant skin,orbicularis oculi muscle,frontal muscle,ROOF,or orbital fat,or ROOF elevation for upper eyelid rejuvenation.Results Patients were followed up for 3 to 120 months,with average 14.4 months.All ptosis of upper eyelid and over-wide between eyebrow and eye region patients were improved obviously.In 36 ptosis of upper eyelid with ptosis of eyebrow,seven of them treated with upper eyebrow margin incision got the best results;and the rest 29 patients treated with lower eyebrow margin incision,fifteen patients were lifted slightly,and the rest fourteen patients got no improvement.All scars of inferior eyebrow margin incision were invisible.Faded and applanate one millimeter wide scars were seen on two patients with superior eyebrow margin incision.In all patients with ptosis of upper eyelid,80％ patients with sunken upper eyelid were improved obviously,and 85 ％ with bloated upper eyelid were improved significantly.Conclusions Upper eyelid aging is divided into five categories.Upper eyelid aging could be corrected by perieyebrow approach.Our methods are simple,safe,fewer complications,and with short convalescence,which is the minimally invasive procedure recommended for Chinese patients with upper eyelid aging.