Objective:To analyze the association between continuity of consultation and the management of glycosylated hemoglobin (HbA1c) in diabetes patients contracted by family doctors.Methods:This study was a cross-sectional study. From May 2022 to October 2022, three community health service centers in the urban area of Beijing were selected by convenient sampling. A total of 360 diabetes patients were selected by simple random sampling from the selected centers. Extraction of data from electronic health records were conducted to collect patient characteristics, information on the continuity evaluation indicators for patient visits (usual provider of care, UPC) in 2021 and information of monitoring and control indicators for HbA1c in 2021. The monitoring and control of HbA1c in patients with different continuity of consultations were compared. Chi-square test and logistic regression analysis were used to determine the association between continuity of consultation and HbA1c management (i.e., HbA1c monitoring and control).Results:Of the 360 patients, 167 (46.4%) were male; the age was 68.0 (60.0, 74.0) years and the number of years since diagnosis was 11.0 (7.0, 17.0) years. One hundred and fifty-nine patients (44.1%) had UPC scores below 30%, 101 patients (28.1%) had UPC scores between 30% and 50%, and 100 patients (27.8%) had UPC scores above 50%. The compliance rate for HbA1c monitoring was 66.4% (239/360), and the compliance rate for HbA1c control was 45.8% (165/360). When the UPC score was less than 30%, between 30%-50%, and greater than 50%, the HbA1c monitoring compliance rates were 53.5% (85/159), 73.3% (74/101), and 80.0% (80/100), respectively, and the HbA1c control compliance rates were 37.7% (60/159), 51.5% (52/101), and 53.0% (53/100), respectively, and the differences were statistically significant ( χ2=22.36, 7.57, P<0.05). As the UPC score increased, the likelihood of achieving HbA1c monitoring ( OR=1.020, 95% CI:1.009-1.030 , P<0.001) and control ( OR=1.012, 95% CI:1.003-1.021 ,P=0.008) targets increased. Conclusion:There is an association between the continuity of consultation and the management of HbA1c.

Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.

Objective To propose a novel method for verifying the isocenter in radiotherapy based on markers and conduct a preliminary test. Methods A feasibility experiment was conducted on wooden box phantom for radiotherapy resetting. Fifteen groups of displacement data were randomly generated,corresponding to the position deviations of the isocenter in the radiotherapy plan relative to the original isocenter. According to each set of displacement data,with the aid of movable lasers and a CT scanning couch,CT scanning was performed with two sets of markers (3 per set) affixed to the phantom which were corresponding to the original and treatment isocenters,respectively. In the Eclipse treatment planning system,the coordinate data of the original and treatment isocenters were manually verified,and the difference of coordinate data was calculated to obtain the actual displacement value. The treatment isocenter position was finally confirmed by comparing with the actual displacement. In addition,the study attempts to use threshold segmentation algorithm to automatically detect metal markers and obtain coordinate values of the original isocenter on patient-positioned CT images. In the wooden box experiment,the absolute value of the difference between the actual displacement value and the planned displacement value (?d) was used to represent the position accuracy of treatment isocenter,and the deviation value obtained with threshold segmentation algorithm for isocenter detection was ?s. Results The ?d in the X (left-right),Y (superior-inferior) and Z (anterior-superior) directions was (0.83±0.37) mm,0 (0,0.5) mm and (0.45±0.29) mm,respectively. The ?s in the X,Y and Z directions was (0.46±0.22) mm,0 (0,0.5) mm and (0.33±0.29) mm,respectively. The mean values of ?s in 3 directions were all lower than 2 mm,within the range of permissible clinical positioning error. Conclusion The method of automatically verifying treatment isocenter position based on markers is feasible,and the study provides a useful reference for radiotherapy resetting using CT simulator.

Objective:To investigate the effect of bed board of carbon fiber for treatment combined with fixed bottom board on verification results of Portal Dosimetry(PD)dose of intensity-modulated radiation therapy(IMRT)plan of fixed field for cervical cancer.Methods:A total of 15 patients with cervical cancer who admitted to Nanjing First Hospital from January 2019 to January 2020 were retrospectively selected,and the IMRT plans of fixed field for all patients were designed.The radiation field with 180° gantry angle was selected for each case to make the corresponding PD dose verification plan,and each verification plan included two subfields:AA180_0 and AA180_1.Three types of materials were placed between the accelerator head and the electronic portal imaging device(EPID),which included material without carbon fiber,bed board with carbon fiber for treatment,and the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber,when the Clinac iX accelerator was used to conduct verification plan for each case.The γ passing rates of the subfields(AA180_0 and AA180_1)and the total field(AA180)among three kinds of conditions,which included material without carbon fiber,bed board with carbon fiber for treatment,and the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber,were compared and analyzed.Results:For the subfield AA180_0,the γ passing rates under three different material conditions were respectively(96.09±1.38)%,(90.48±2.24)%and(81.85±2.46)%.For the subfield AA180_1,the γ passing rates under the above conditions were respectively(96.05±1.06)%,(91.86±2.22)%and(86.26±2.74)%.For the total field AA180,the γ passing rates were respectively(90.78±1.40)%,(84.82±2.56)%and(78.49±3.18)%.The γ passing rates of the subfield AA180_0,subfield AA180_1,and the total field AA180 showed statistically significant differences among the three different material conditions(F=177.80,80.00,91.42,P<0.01).Compared with materials without carbon fiber,the γ passing rate of the total field AA180 of the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber significantly decreased by 12.29%.Conclusion:In the PD dose verification of IMRT for cervical cancer,the bed board with carbon fiber for treatment combined with the fixed bottom board will produce adverse effect for the verification results.The effect of the single use of bed board for treatment is relatively small.The combined use of the bed board with carbon fiber for treatment and the fixed bottom board will lead to a significant deterioration in the verification result of PD dose.

Objective:To investigate the effect of bed board of carbon fiber for treatment combined with fixed bottom board on verification results of Portal Dosimetry(PD)dose of intensity-modulated radiation therapy(IMRT)plan of fixed field for cervical cancer.Methods:A total of 15 patients with cervical cancer who admitted to Nanjing First Hospital from January 2019 to January 2020 were retrospectively selected,and the IMRT plans of fixed field for all patients were designed.The radiation field with 180° gantry angle was selected for each case to make the corresponding PD dose verification plan,and each verification plan included two subfields:AA180_0 and AA180_1.Three types of materials were placed between the accelerator head and the electronic portal imaging device(EPID),which included material without carbon fiber,bed board with carbon fiber for treatment,and the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber,when the Clinac iX accelerator was used to conduct verification plan for each case.The γ passing rates of the subfields(AA180_0 and AA180_1)and the total field(AA180)among three kinds of conditions,which included material without carbon fiber,bed board with carbon fiber for treatment,and the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber,were compared and analyzed.Results:For the subfield AA180_0,the γ passing rates under three different material conditions were respectively(96.09±1.38)%,(90.48±2.24)%and(81.85±2.46)%.For the subfield AA180_1,the γ passing rates under the above conditions were respectively(96.05±1.06)%,(91.86±2.22)%and(86.26±2.74)%.For the total field AA180,the γ passing rates were respectively(90.78±1.40)%,(84.82±2.56)%and(78.49±3.18)%.The γ passing rates of the subfield AA180_0,subfield AA180_1,and the total field AA180 showed statistically significant differences among the three different material conditions(F=177.80,80.00,91.42,P<0.01).Compared with materials without carbon fiber,the γ passing rate of the total field AA180 of the combination of the bed board with carbon fiber for treatment and the fixed bottom board with carbon fiber significantly decreased by 12.29%.Conclusion:In the PD dose verification of IMRT for cervical cancer,the bed board with carbon fiber for treatment combined with the fixed bottom board will produce adverse effect for the verification results.The effect of the single use of bed board for treatment is relatively small.The combined use of the bed board with carbon fiber for treatment and the fixed bottom board will lead to a significant deterioration in the verification result of PD dose.

Objective To propose a novel method for verifying the isocenter in radiotherapy based on markers and conduct a preliminary test. Methods A feasibility experiment was conducted on wooden box phantom for radiotherapy resetting. Fifteen groups of displacement data were randomly generated,corresponding to the position deviations of the isocenter in the radiotherapy plan relative to the original isocenter. According to each set of displacement data,with the aid of movable lasers and a CT scanning couch,CT scanning was performed with two sets of markers (3 per set) affixed to the phantom which were corresponding to the original and treatment isocenters,respectively. In the Eclipse treatment planning system,the coordinate data of the original and treatment isocenters were manually verified,and the difference of coordinate data was calculated to obtain the actual displacement value. The treatment isocenter position was finally confirmed by comparing with the actual displacement. In addition,the study attempts to use threshold segmentation algorithm to automatically detect metal markers and obtain coordinate values of the original isocenter on patient-positioned CT images. In the wooden box experiment,the absolute value of the difference between the actual displacement value and the planned displacement value (?d) was used to represent the position accuracy of treatment isocenter,and the deviation value obtained with threshold segmentation algorithm for isocenter detection was ?s. Results The ?d in the X (left-right),Y (superior-inferior) and Z (anterior-superior) directions was (0.83±0.37) mm,0 (0,0.5) mm and (0.45±0.29) mm,respectively. The ?s in the X,Y and Z directions was (0.46±0.22) mm,0 (0,0.5) mm and (0.33±0.29) mm,respectively. The mean values of ?s in 3 directions were all lower than 2 mm,within the range of permissible clinical positioning error. Conclusion The method of automatically verifying treatment isocenter position based on markers is feasible,and the study provides a useful reference for radiotherapy resetting using CT simulator.

Objective:To analyze the association between continuity of consultation and the management of glycosylated hemoglobin (HbA1c) in diabetes patients contracted by family doctors.Methods:This study was a cross-sectional study. From May 2022 to October 2022, three community health service centers in the urban area of Beijing were selected by convenient sampling. A total of 360 diabetes patients were selected by simple random sampling from the selected centers. Extraction of data from electronic health records were conducted to collect patient characteristics, information on the continuity evaluation indicators for patient visits (usual provider of care, UPC) in 2021 and information of monitoring and control indicators for HbA1c in 2021. The monitoring and control of HbA1c in patients with different continuity of consultations were compared. Chi-square test and logistic regression analysis were used to determine the association between continuity of consultation and HbA1c management (i.e., HbA1c monitoring and control).Results:Of the 360 patients, 167 (46.4%) were male; the age was 68.0 (60.0, 74.0) years and the number of years since diagnosis was 11.0 (7.0, 17.0) years. One hundred and fifty-nine patients (44.1%) had UPC scores below 30%, 101 patients (28.1%) had UPC scores between 30% and 50%, and 100 patients (27.8%) had UPC scores above 50%. The compliance rate for HbA1c monitoring was 66.4% (239/360), and the compliance rate for HbA1c control was 45.8% (165/360). When the UPC score was less than 30%, between 30%-50%, and greater than 50%, the HbA1c monitoring compliance rates were 53.5% (85/159), 73.3% (74/101), and 80.0% (80/100), respectively, and the HbA1c control compliance rates were 37.7% (60/159), 51.5% (52/101), and 53.0% (53/100), respectively, and the differences were statistically significant ( χ2=22.36, 7.57, P<0.05). As the UPC score increased, the likelihood of achieving HbA1c monitoring ( OR=1.020, 95% CI:1.009-1.030 , P<0.001) and control ( OR=1.012, 95% CI:1.003-1.021 ,P=0.008) targets increased. Conclusion:There is an association between the continuity of consultation and the management of HbA1c.

Objective:To evaluate the reliability and validity of the Chinese version of Consultation and Relational Empathy (CARE) Measure in the Mandarin speaking population.Methods:From March to June 2018, patient interviews and expert consultations were conducted to explore problems of CARE in Mandarin context and preliminary revisions were made to the measure, then the final adapted tool was developed. A questionnaire survey on the validity of the measure was conducted from July to August 2018, among 373 patients from three community health service centers in Beijing Chaoyang District, selected by convenience sampling. The questionnaire included general information of participants and the revised CARE measure. The results of the survey were analyzed for the reliability and validity of Chinese version of CARE measure.Results:In the culture adaptation stage, 30 word-changes and 13 phrase-changes were made to improve the cultural adaptation of CARE. A total of 373 valid questionnaires were were collected with a valid recovery rate of 100.0%. The participants had a mean age of (60.8±13.12) years, with females of 68.6% (256/373), junior high school or high school education of 58.7% (219/373), and retirees of 71.3% (266/373). The results showed that there was a significant difference in scores of each item between the high group (top 27%) and the low group (bottom 27%) ( P<0.001). There was a positive correlation between each item and the total score, with a correlation coefficient between 0.817 and 0.868 ( P<0.001). The reliability analysis results show that the Cronbach′s α of the revised CARE was 0.960. In the content validity analysis, among the 10 items, the proportion of patients who considered the item "not applicable" was between 1.1% and 4.8%, and the proportion who considered the item "important" was between 92.8% and 96.2%. In exploratory factor analysis, KMO=0.944 and Bartlett′s sphericity test P<0.001. One common factor with an eigenvalue>1 was extracted, and the cumulative variance explained by which was 73.85%, with the load value of each item of 0.815-0.909. Conclusion:The revised Chinese version of CARE measure shows good reliability and validity and it can be applied in primary care settings for Mandarin speaking population.

Objective:To study the position of computed tomography(CT)slice of marker points of radiotherapy,which was determined by control scan(CS)method,on the application effect of patients with head and neck tumors who received radiotherapy.Methods:Based on Control Scan(CS)method,a calculator program of mark-point slice position was made,which was an enterprise WeChat program that could be used in calculating position and CT position scan of patients with head and neck tumor(slice thickness was 3mm).A total of 60 patients with head and neck tumor were selected,and the patients who underwent CT positioning scan by using CS method were divided into observation group,and patients who underwent CT position scan by using conventional method were divided into control group,with 30 cases in each group.The number of cases with three metal marker points displayed at the same slice,and the number of slices containing the CT images of marker point between the located CT scan were compared.Results:The number of patients in the observation group and the control group who showed three markers at the same level at the same time were respectively 26 cases and 13 cases,and observation group increased by 13 cases(43.4%)than control group,and the difference was significant(x2=12.382,P<0.05).The number of CT images with only 1 slice of observation group and control group were respectively 4 cases and 0 cases,which increased by 4 cases(13.3%)than the control group,and the difference was significant(x2=2.411,P<0.05).Conclusions:The CT localization scan of radiotherapy,which uses CS to assist patients with head and neck tumor,can precisely calculate and obtain the primary position of target of CT localization scan.It can take the images of 3 mental marker points of patient who receives radiotherapy to occur at the same CT slice as soon as possible,which has better application effect.It can effectively improve the convenience and work effectiveness of radiotherapy.

Objective:To evaluate the long-term constancy of image uniformity and noise of cone-beam computed tomography (CBCT) for the on-board imager (OBI) system of a Varian linac.Methods:Monthly quality assurance (QA) tests were carried out for the OBI system of a Clinac iX linac, and CBCT images of Catphan 504 phantom were obtained with six scanning protocols. The 6 protocols were high-quality head (HQH), low-dose head (LDH), pelvis spot light (PSL), standard-dose head (SDH), low-dose thorax (LDT) and pelvis, respectively. The 144 series of CBCT images acquired from Nanjing First Hospital, Nanjing Medical University between January 2020 and December 2021 were analyzed, and the data of image uniformity and noise were obtained by delineating regions of interest (ROI) in the images of CTP486 module. Image uniformity was expressed by the absolute value of the maximum difference between the average CT value of the ROI in the 3, 6, 9 and 12 o'clock directions and the central ROI. Image noise was expressed by the standard deviation of CT value of large circular ROI. The smaller the values of image uniformity and noise, the better the image quality. Statistical description was applied to obtain data of the maximum, minimum, mean and standard deviation for the above mentioned two parameters. Y was defined as the difference between the average CT value of ROI in each direction and the average CT value of central ROI, which was used to represent the monthly changes of image quality.Results:The image uniformity and noise of CBCT images of the OBI system were generally stable during 2 years. For the 6 protocols of HQH, LDH, PSL, SDH, LDT and pevlis, the image uniformity was (21.5±1.0), (21.4±2.2), (21.3±0.9), (18.3±1.3), (3.4±1.9) and (7.2±1.9) HU, respectively. The image noise was (19.2±0.2), (41.0±0.3), (14.2±0.3), (38.2±0.2), (16.0±0.9) and (13.5±0.9) HU, respectively. The average image uniformity of LDT was the smallest, and the average image noise of pelvis was the smallest. Under the 6 scanning protocols, the average CT values of central ROI involved in image uniformity were (32.3±2.7), (24.0±3.3), (19.3±2.4), (11.1±2.5), (67.2±2.1), (-24.6±1.7) HU, respectively. The average CT values were stable. The standard deviation of Y was < 3 HU, suggesting that the stability of image quality was favorable every month.Conclusions:The image uniformity and noise of CBCT images for the OBI system are generally stable in 2 years. Among the 6 scanning protocols, LDT yields the best image uniformity, and pelvis has the lowest image noise.