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Short-term training of direct observation procedural skills (DOPS) for community general practitioner trainers

Jie GU ; Zhigang PAN ; Shanzhu ZHU ; Qian CHEN

Chinese Journal of General Practitioners.2013;12(9):713-716. doi:10.3760/cma.j.issn.1671-7368.2013.09.008

Objective To evaluate the efficacy of short-term training of direct observation procedural skills (DOPS) for community general practitioner (GP) trainers.Methods Thirty six GP trainers participated in one-day workshop of DOPS.The participants were interviewed with questionnaire before and after the training program and the training video was scored.Results 47.2％ (17/36) of GP trainers knew and briefly understood DOPS before the training.41.7％ (15/36)of them had a rough idea of how to use it and only 2.8％ (1/36) had used it before.All of these trainers wanted to learn how to perform DOPS.The vast majority of GP trainers completely or basically understood the standards for evaluation of 11 items of DOPS after the training.The accuracy rates of 4 items were close to or more than 50.0％ in 9-point scale and 7 items exceeded 50.0％ in 3-rank system.There was significant difference in accuracy rates of 6 items between the two scoring system(all P ＜ 0.01).Conclusions Community GP trainers recognize the advantages of DOPS in assessment of clinical skills and have strong intention of application.The efficacy of short-term workshop is satisfactory,but the evaluators need more training and practice.

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Analysis of pre-hospital treatment characteristics of patients with cerebrovascular disorders

Zhigang CHEN ; Suqin LU ; Yiping SUN ; Min WU

Chinese Journal of General Practitioners.2013;12(10):829-830. doi:10.3760/cma.j.issn.1671-7368.2013.10.020

The medical records of stroke patients at Zhenjiang Emergency Medical Center from January 1 to December 31,2011 were analyzed.A total of 797 stroke patients were managed,accounting for 10.42 percent of the emergency number over the same period.The average ages of males and females were (67 ± 14)and (72± 14)years old respectively (P ＜ 0.01).The incidence rate increased with age (P ＜0.05).The highest incidence occurred from 9:00 to 10:00 (n =61,7.7％),while the lowest incidence at 4:00 to 5:00 (n =9,1.1％).A total of 552 (69.3％) cases were sent to class 3A hospitals; the number of patients who independently option hospital were 626 cases (78.5％).Emergency response time (from call to arrival) was an average of 13.49 minutes.A total of 318 cases (39.9％) took no more than 10 minutes and first aid an average of 38.11 minutes.

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Epidemiological and clinical characteristics of 199 cases of HIV/AIDS patients

Hongjie OU ; Juanjuan WANG ; Jiajun LIU

Chinese Journal of General Practitioners.2013;12(10):831-832. doi:10.3760/cma.j.issn.1671-7368.2013.10.021

During the period of January 2006 to December 2012 at our department,retrospective analyses of epidemiological and clinical data were performed for 199 newly diagnosed HIV/AIDS inpatients and outpatients.The male-to-female ratio was 3.78∶ 1.Their age range was 20-40 years.Migrant workers accounted for a large proportion of infection.Sexual contact was a major route of transmission and it accounted for 88.4％.Most of them had non-marital sexual contact.And all infected marital sexual contacts were women.Asymptomatic patients accounted for 55.8％.Pulmonary infection was the most common clinical manifestation.There were more males than females locally.Most of them were young and middleaged.Sexual contact was a major route of transmission.Out-of-town migrant population was important for transmission.

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Analysis on structural characteristics of poison system in acute poisoning of Guangxi

Dongfang JIANG ; Zhenming ZHANG ; Qinghua LIU

Chinese Journal of General Practitioners.2013;12(10):833-835. doi:10.3760/cma.j.issn.1671-7368.2013.10.022

A total of 6004 cases of acute poisoning with 532 kinds of related poisons from 63hospitals were analyzed.According to the classification of pharmaceutical,pesticide,chemical,animal,plant and other poisons,the numbers of poison categories were 217,148,61,34,36 and 36 kinds accounting for 40.8％,27.8％,11.5％,6.4％,6.8％,6.7％ of total number of poisons respectively.According to the case count,they were divided into three groups of low,medium and high morbidity and their poison numbers were 462,59 and 11 kinds accounting for 86.8％,11.1％,2.1％ of total number of poisons respectively.According to the types of poisons,they were divided into five groups of poisoning 1,2,3,4,5 years and their poison numbers were 320,91,34,33 and 54 kinds accounting for 60.2％,17.1％,6.4％,6.2％,10.1％ of total number of poisons respectively.According to the time of poisoning,they were divided into three groups of 1-year,discontinuous and perennial poisoning and their poison numbers were 320,158 and 54 kinds accounting for 60.2％,29.7％,10.1％ of total number of poisons respectively.

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Two preventive interventions of postpartum hemorrhage

Xueye GONG ; Wenjuan ZHANG ; Lili QI

Chinese Journal of General Practitioners.2013;12(10):835-836. doi:10.3760/cma.j.issn.1671-7368.2013.10.023

A total of 358 high-risk pregnant women were divided randomly into observation (A) and control (B) groups.Group A:15ml 10％ calcium gluconate was injected intravenously during the second stage of labor at full dilatation.And 10 U oxytocin was injected intramuscularly upon an immediate delivery of fetal anterior shoulder.Then 400 μg misoprostol was inserted into anus at 5 cm; Group B:10 U oxytocin was injected intramuscularly upon an immediate delivery of fetal anterior shoulder.Then 400 μg misoprostol was inserted into anus at 5 cm.Statistically significant differences existed in the amount of bleeding loss after delivery for 2 h and 24 h (P ＜ 0.01),the time limit of the third labor (P ＜ 0.01) and the occurrence rate of postpartum hemorrhage (P ＜ 0.01).No significant difference existed between two groups in the Apgar score of the first minute (P ＞ 0.05).An intravenous infusion of calcium gluconate plus oxytocin and misoprostol after birth could reduce the rate of postpartum hemorrhage.Worthy of clinical application,this method has no effect upon Apgar score.

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Short-term training workshop of mini-clinical evaluation exercise for community general practitioner trainers

Qian CHEN ; Zhigang PAN ; Shanzhu ZHU ; Jie GU

Chinese Journal of General Practitioners.2013;12(11):870-873. doi:10.3760/cma.j.issn.1671-7368.2013.11.006

Objective To assess the effect of short-term training workshop of mini clinical evaluation exercise (mini-CEX) for community general practitioner (GP) trainers.Methods Thirty six community GP trainers received half-day training workshop of mini-CEX on September 2012.The GP trainers were interviewed with questionnaire before and after the training program and their video scores were analyzed.Results 47％ (17/36) of GP trainers knew of and briefly understood mini-CEX before the training.42％ (15/36) of them had a rough idea of how to use it but nobody had used it before.All of these trainers hoped to know how to carry out mini-CEX.The vast majority of GP trainers completely or basically understood the standards of evaluation for 7 items of mini-CEX after the training.The accurate rate of 1 iten was close to 50％ in 9-point scale and 5 items exceeded 50％ in 3-rank system.There was significant difference in accurate rates of 4 items between two scoring system (all P ＜ 0.01).Conclusions Community GP trainers recognize the advantage of mini-CEX and have intention to apply it for evaluation of clinical skills in training.The results of short-term intensive workshop are satisfactory,but more training for rating system and practice are necessary.

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Controlled clinical studies on drug-induced liver injury in the elderly Chinese patients: a literature review

Ying ZHANG ; Gansheng ZHANG ; Zhijun BAO ; Songbai ZHENG ; Xiaofeng YU

Chinese Journal of General Practitioners.2013;12(11):890-893. doi:10.3760/cma.j.issn.1671-7368.2013.11.012

Objective To review the clinical features of drug-induced liver injury (DILI) in elderly Chinese patients.Methods A literature search was conducted with the key wordsdrug-induced liver injury ordrug-induced liver disease andelderly; four Chinese medical databases were used:including Chinese Biomedical Literature Database (CBM),Chinese Science and Technology Periodical Database (VIP),Wanfang Database and China National Knowledge Infrastructure (CNKI),from when the bases established to December 2011.Data from retrieved literatures of retrospective controlled studies of DILI were analyzed by SPSS 14.0 software.Results Five studies met the inclusion criteria,including 275 elderly patients (aged group) and 602 non-elderly patients (non-aged group) with DILL There was no significant difference in gender between the two groups (P ＞ 0.05).Clinical manifestations of jaundice,fatigue,anorexia,and skin itching were more commonly seen in the aged group (P ＜ 0.01).Cholestatic hepatic injury occurred more frequently in the aged group than in the non-aged group [24.9％ (61/245) vs.18.8％ (102/245),P ＜ 0.05],while hepatocellular type occurred more frequently in the non-aged group [64.3％ (350/544) vs.55.1％ (135/245),P ＜ 0.05].More DILI were induced by Chinese herb medicine and cardiovascular drugs in the aged group than in the non-aged group [47.0％ (79/168) vs.35.9％ (93/254) and 8.3％ (14/168) vs 1.2％ (3/259) respectively,P ＜ 0.05].As for the prognosis,there was no significant difference in clinical cure and improvement rate between the two groups [84.4％ (141/167) vs.81.5％ (291/357),P ＞0.05].Conclusion The elderly are more sensitive to the drugs and have a high risk of DILI.Prevention and timely diagnosis and treatment of DILI are particularly important for elderly patients.

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Effect evaluation analysis of three years intensive intervention for patients with type 2 diabetes at Xinjiekou Community Center in Beijing

Yuling LI ; Qi YUAN ; Aiwu TANG ; Shuo CHEN ; Wei SUN ; Rong KANG

Chinese Journal of General Practitioners.2013;12(11):899-901. doi:10.3760/cma.j.issn.1671-7368.2013.11.015

Following the wishes of volunteer patients,316 cases of type 2 diabetics of our community center in 2008 carried out a three-year intervention from 2008 to 2011 on the basis of rational drug therapy plus the interventions of health education,regular review and lifestyle strengthening.And regular monitoring and recording were performed on the parameters of body mass index (BMI),blood pressure,blood lipids,fasting glucose,2 h postprandial blood glucose,glycosylated hemoglobin (HbA1c) and liver & kidney function.After intervention,some indicators changed:BMI (25.2 ±3.5) vs.(25.0 ±3.3) kg/m2,systolic blood pressure (129.1 ± 11.8) vs.(126.2 ±7.9) mm Hg(1 mm Hg=0.133 kPa),fasting glucose (7.80 ±2.81) vs.(7.25 ± 1.96) mmol/L,2 h postprandial blood glucose (11.04 ±4.60) vs.(9.83 ±3.60) mmol/L,HbA1c (7.39 ± 1.61) vs.(7.17 ± 1.65)％,total cholesterol (5.08 ±1.21) vs.(4.74 ± 1.35) mmol/L,low density lipoprotein cholesterol(LDL) (3.09 ± 0.87) vs.(2.85 ±0.83) mmol/L,high density lipoprotein cholesterol (HDL) (1.27 ± 0.33) vs.(1.41 ± 0.32) mmol/L,serum creatinine 65 vs.72 μmol/L,uric acid 300 vs.317 μmol/L.And the differences were statistically significant (P ＜ 0.05).After intervention,blood pressure compliance rate increased from 72.5％ to 88.0％,LDL-C compliance rate improved from 27.2％ to 38.6％,HDL-C compliance rate of 54.9％ increased to 66.9％.And the differences were statistically significant (P ＜ 0.05).The pre-intervention combined compliance rate of 11.4％ (n =36) rose to 17.7％ (n =56).And there was significant difference (P =0.024).

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Expression and significance of interleukin-25 level in airway inflammation of asthmatics

Hongjia LI ; Fen LIU ; Degan LU ; Yinghua SONG ; Chao WANG ; Caiqing ZHANG

Chinese Journal of General Practitioners.2013;12(11):913-915. doi:10.3760/cma.j.issn.1671-7368.2013.11.021

A total of 59 untreated asthmatics and 47 healthy control subjects were recruited from Qianfoshan Hospital of Shandong Province from May 2011 to April 2012.Compared with healthy control subjects,the levels of IL-25 in induced sputum and eosinophils,IgE,interleukin-4 (IL-4) and interleukin25 (IL-25) in serum samples of asthmatics were significantly higher while the level of interferon-gamma (IFN-γ) were much lower.However,after inhaled glucocorticoid treatment,the levels of eosinophils,IL-4 and IL-25 decreased and IFN-γ significantly increased,while the level of IgE showed no significant changes.It was also found the expression of IL-25 was markedly positively correlated with the levels of eosinophils and IL-4 in serum and markedly negatively correlated with the levels of IFN-γ and had no relatio.

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Application of regional anesthesia under ultrasonic guidance for establishing puncture path of superficial tumor biopsy

Qinghong JING ; Weide DAI ; Changkun SUN

Chinese Journal of General Practitioners.2013;12(9):743-744. doi:10.3760/cma.j.issn.1671-7368.2013.09.016

To explore the value of local anesthesia under ultrasonic guidance for establishing puncture path of superficial tumor.A total of 144 patients with superficial tumor received local pre-puncture anesthesia under ultrasonic guidance so that all lesions were targeted.Transient aggregation of narcotics was applied for raised (n =12) or superficial (n =15) skin lesions.The clarity of scanning acoustic window was enhanced,the puncture distance of tumor broadened and the mass of axial changed to obtain a longer lymph node cortex.The damage of blood vessels occurred easily due to tumor closeness to large blood vessel or shortened puncture path in 17 cases.Anesthetic drug was injected between tumor and blood vessels to enlarge the thickness for visualizing the puncture needle tract clearly.And puncture was accomplished under the guidance of color Doppler.Therefore a puncture path can be created effectively with local anesthesia by ultrasonic guidance.

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