Objective:To investigate the current status of chronic respiratory disease (chronic obstructive pulmary disease, bronchial asthma and obstructive sleep apnea) management capacity in community health centers in Beijing Miyun district.Methods:From November 21 to 22,2018,nineteen community health centers and 65 general practitioners in Miyun district of Beijing were selected to participate in a questionnaire survey. The self-designed questionnaire was divided into two parts: the questionnaire for medical institutions(institution questionnaire)and questionnaire for general practitioners(doctor questionnaire). The institution questionnaires were distributed by the Miyun District Health Commission,and filled in by the person in charge of the institution; the knowledge questionnaires were sent to all general practitioners of 4 community health service centers. The two independent sample t test was used to compare the measurement data in accordance with normal distribution between the two groups, and analysis of variance was used for multi group comparison. Results:Nineteen institution questionnaires were sent to all centers in the district and all 19 valid questionnaires were recovered. Among them, 18 centers thought that chronic respiratory diseases should be included in the management of chronic non-communicable diseases, and health records should be established to achieve regular follow-up monitoring, but only one center had put asthma in the record. Nine centers purchased pulmonary function instrument; 8 centers were equipped with inhaled glucocorticoid, and 1 center was equipped with β 2-receptor agonists. The effective recovery rate of knowledge questionnaire was 100.0% (65/65). There was no significant difference in the knowledge scores of three kinds of chronic respiratory diseases (chronic obstructive pulmary disease, bronchial asthma, obstructive sleep apnea) among general practitioners [(63±19), (64±23), (62±21), F=0.087, P>0.05]. The scores of general practitioners with different ages and professional titles were (57±15), (66±13), (42±16) and (54±19), (67±12), (68±11) respectively. There were significant differences in the knowledge scores of general practitioners with different ages and professional titles ( F= 8.582 and 6.079, all P<0.05). The average scores of general practitioners with age>50 years or junior professional title were lower than others. Conclusions:The leaders of each center in Miyun district have a clear understanding of the necessity of diagnosis and treatment of chronic respiratory diseases, but there are still some problems, such as insufficient attention to chronic respiratory system, insufficient investment in disease management infrastructure, and lack of professional knowledge of chronic respiratory diseases among general practitioners. It is hoped that in the future, chronic respiratory diseases can be introduced into public health service projects, investment in related disease infrastructure will be strengthened, and comprehensive respiratory knowledge and ability training courses suitable for grass-roots general practitioners can be popularized as soon as possible.

Objective:To investigate the status quo of nursing capacity for chronic respiratory disease in community health service centers.Methods:A questionnaire survey on nursing capacity for chronic respiratory disease was conducted in November 2018 among nurses working in internal medicine, general practice and chronic disease management departments of 4 community health service centers in Beijing Miyun District. The questionnaire included the knowledge and work content of chronic respiratory diseases. At the same time semi-structured interviews was conducted on the role of nurses in the management of chronic respiratory diseases among nurses selected by purposive sampling method.Results:In the study 63 valid questionnaires were collected and 14 nurses were interviewed. The results showed that the total score of nurses′ knowledge about chronic respiratory diseases was (62.0±14.4), and the scores of knowledge of chronic obstructive pulmonary disease (COPD), bronchial asthma and obstructive sleep apnea were (55.5±19.3), (61.0±21.6), (69.5±25.1), respectively. The total knowledge score of nurses with middle-rank professional title or above was higher than that of those with primary title [(67.0±12.9) vs. (54.0±13.6), t=-3.07, P<0.01]. The work contents mainly involved were nursing procedures(22/63,34.9%), health education(18/63,28.6%) and nursing evaluation(8/63,12.7%).Three themes were extracted from the deep interviews: the main work contents for nurses should be nursing procedures, nurses should participate in the chronic respiratory disease management as a member of the integrated medical team; nurses expected practice-oriented trainings of chronic respiratory disease management. Conclusions:The knowledge of chronic respiratory diseases among nurses in community health center needs to be improved, and the nursing skills special for respiratory diseases are needed. It is suggested to develop training courses and nursing guidelines suitable for community health centers and for nurses to participate in chronic respiratory disease management as team members, so that nurses in primary care institutions can play a better role in the management of chronic respiratory diseases.

Objective? To explore the effects of the establishment and application of "Five in one"stepwise psychological rehabilitation model for cancer patients. Methods? In February 2016, the Department of Chest Oncology in West China Hospital Sichuan University established "Five in One" stepwise psychological rehabilitation model: a team consisting of oncology doctors, nurses, medical social workers, sunshine nurses/psychologist and psychiatrist who provided holistic psychological management including psychological assessment, psychological education, and psychological intervention. By convenience sampling, a total of 1 402 cancer patients admitted before the establishment of the model in the hospital from August 2015 to January 2016 were selected and put into the control group. Routine nursing intervention was given to the group. Totally 1 823 cancer patients admitted from February to July in 2016 after the establishment of the model in the hospital were selected and assigned into the observation group. The "Five in One" model was adopted for the group. The two groups were compared in terms of the conditions of adverse emotions and suicide risks. Results? The incidence of adverse emotions was 29.24%, and the incidence of suicide risk was 3.92% in the control group. The incidence of adverse emotions was 10.92% and 1.76% for the suicide risk in the observation group. There were statistical differences in the incidence of adverse emotions and suicide risks between the two groups (P＜0.01). Conclusions? The establishment of "Five in One" model for cancer patients can reduce cancer patients' adverse emotions and risks of suicide, and provides new ideas and methods for the management of cancer patients' psychological distress.

OBJECTIVETo understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.

METHODSFrom December 20, 2010 to March 10, 2011, the system sampling method was used to get the cases. A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi, Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture, Yunnan province were interviewed, and the demographic characteristics, quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared. A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.

RESULTSOf the 462 cases, 239 cases were from standard MMT clinic, and 223 cases were from the extension MMT clinic. Among them, 117 cases were new research objects into the group during the investigation. Among the clients of extension MMT clinic, 96.7% (147/152) of them were males, 37.5% (57/152) were Dai nationality, and 61.2% (93/152) were married, 38.8% (59/152) with primary school education, 95.4% (145/152) lived with their family or relatives, 96.7% (147/152) could arrive at the clinic from their habitation within 15 minutes. The positive detection rates 72% (13/18), 71% (24/34), 58% (30/52), 29% (15/52), 14% (6/44), 14% (4/29), 15% (5/34), 17% (6/35), 6% (2/33), 16% (5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ(2) = 61.04, P < 0.05). The period of retention of the clients in extension MMT clinics was 175-days averagely, with an average retention 122 days of when withdrawing. The retention rates of the clients were 52% (37/71)and 61% (28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively. There was no difference in the retention rate between those of two types of clinics (χ(2) = 0.82, P = 0.37) .

CONCLUSIONMost of the clients in extension MMT clinics lived with their family or relatives, and spent less time on the way to the clinics. After 9 months methadone maintenance therapy, the quality of life of clients in extension clinics was improved while addiction among them decreased. The extension clinic was an effective strategy for retention in remote areas.

China ; Cohort Studies ; Demography ; Heroin Dependence ; Humans ; Male ; Methadone ; Opiate Substitution Treatment ; Quality of Life ; Substance-Related Disorders ; Treatment Outcome

Objective To understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.Methods From December 20,2010 to March 10,2011, the system sampling method was used to get the cases .A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi , Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture , Yunnan province were interviewed , and the demographic characteristics , quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared.A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.Results Of the 462 cases,239 cases were from standard MMT clinic ,and 223 cases were from the extension MMT clinic . Among them,117 cases were new research objects into the group during the investigation .Among the clients of extension MMT clinic ,96.7%( 147/152 ) of them were males , 37.5%( 57/152 ) were Dai nationality , and 61.2%(93/152) were married,38.8%(59/152) with primary school education,95.4%(145/152) lived with their family or relatives ,96.7%( 147/152 ) could arrive at the clinic from their habitation within 15 minutes.The positive detection rates 72%(13/18),71%(24/34),58%(30/52),29%(15/52),14%(6/44),14%(4/29),15%(5/34),17%(6/35),6%(2/33),16%(5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ2 =61.04, P<0.05).The period of retention of the clients in extension MMT clinics was 175-days averagely , with an average retention 122 days of when withdrawing.The retention rates of the clients were 52%( 37/71 ) and 61%(28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively.There was no difference in the retention rate between those of two types of clinics (χ2 =0.82,P=0.37).Conclusion Most of the clients in extension MMT clinics lived with their family or relatives , and spent less time on the way to the clinics.After 9 months methadone maintenance therapy , the quality of life of clients in extension clinics was improved while addiction among them decreased.The extension clinic was an effective strategy for retention in remote areas.

Objective To understand the characteristics and retention situation of clients in extension clinic of methadone maintenance therapy.Methods From December 20,2010 to March 10,2011, the system sampling method was used to get the cases .A total of 462 heroin addicts from 22 methadone maintenance therapy clinics and extension clinics located in Mangshi , Ruili, Longchuan, Yingjiang, Lianghe of Dehong prefecture , Yunnan province were interviewed , and the demographic characteristics , quality of life, urine testing results for morphine of the patients between the extension MMT clinic and standard MMT clinic were also collected and compared.A cohort study was conducted to analyze retention situation of the new clients with Kaplan Meier method during 9 months treatment.Results Of the 462 cases,239 cases were from standard MMT clinic ,and 223 cases were from the extension MMT clinic . Among them,117 cases were new research objects into the group during the investigation .Among the clients of extension MMT clinic ,96.7%( 147/152 ) of them were males , 37.5%( 57/152 ) were Dai nationality , and 61.2%(93/152) were married,38.8%(59/152) with primary school education,95.4%(145/152) lived with their family or relatives ,96.7%( 147/152 ) could arrive at the clinic from their habitation within 15 minutes.The positive detection rates 72%(13/18),71%(24/34),58%(30/52),29%(15/52),14%(6/44),14%(4/29),15%(5/34),17%(6/35),6%(2/33),16%(5/31) of urine-morphine testing among new clients of extension MMT clinics decreased as the period of treatment lengthened (χ2 =61.04, P<0.05).The period of retention of the clients in extension MMT clinics was 175-days averagely , with an average retention 122 days of when withdrawing.The retention rates of the clients were 52%( 37/71 ) and 61%(28/46) at 9th month of the extension MMT clinics and standard MMT clinics respectively.There was no difference in the retention rate between those of two types of clinics (χ2 =0.82,P=0.37).Conclusion Most of the clients in extension MMT clinics lived with their family or relatives , and spent less time on the way to the clinics.After 9 months methadone maintenance therapy , the quality of life of clients in extension clinics was improved while addiction among them decreased.The extension clinic was an effective strategy for retention in remote areas.

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.