BACKGROUND:Establishing a nomogram prediction model for postoperative pulmonary infection in hip fractures and taking early intervention measures is crucial for improving patients'quality of life and reducing medical costs. OBJECTIVE:To construct a nomogram risk prediction model of postoperative pulmonary infection in elderly patients with hip fracture,and provide theoretical basis for feasible prevention and early intervention. METHODS:Case data of 305 elderly patients with hip fractures who underwent surgical treatment at Wuxi Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine between January and October 2020(training set)were retrospectively analyzed.Using univariate and multivariate logistic regression analysis and Hosmer-Lemeshow goodness of fit test,receiver operating characteristic curve was utilized to analyze the diagnostic predictive efficacy of independent risk factors and joint models for postoperative pulmonary infections.Tools glmnet,pROC,and rms in R Studio software were applied to construct a nomogram model for predicting the risk of postoperative pulmonary infection in elderly patients with hip fractures,and calibration curves were further drawn to verify the predictive ability of the nomogram model.Receiver operating characteristic curves,calibration curves,and decision curves were analyzed for 133 elderly patients with hip fractures(validation set)receiving surgery at the same hospital from November 2022 to March 2023 to further predict the predictive ability of the nomogram model. RESULTS AND CONCLUSION:(1)The postoperative pulmonary infection rate in elderly patients with hip fractures in this group was 9.18%(28/305).(2)Single factor and multivariate analysis,as well as forest plots,showed that preoperative hospitalization days,leukocyte count,hypersensitive C-reactive protein,and serum sodium levels were independent risk factors(P<0.05).The Hosmer-Lemeshow goodness of fit test showed good fit(χ2=4.57,P=0.803).Receiver operating characteristic curve analysis was conducted on the independent risk factors and their joint models mentioned above,and the differentiation of each independent risk factor and joint model was good,with statistical significance(P<0.05).(3)The graphical calibration method,C-index,and decision curve were used to validate the nomogram prediction model.The predicted calibration curve was located between the standard curve and the acceptable line,and the predicted risk of the nomogram model was consistent with the actual risk.(4)The validation set used receiver operating characteristic curve,graphic calibration method,and decision curve to validate the prediction model.The results showed good consistency with clinical practice,indicating that the model had a good fit.The nomogram risk prediction model constructed for postoperative pulmonary infection in elderly patients with hip fractures has good predictive performance.The use of the nomogram risk prediction model can screen high-risk populations and provide a theoretical basis for early intervention.

Objective:To survey the experiences and perception of caregivers on home care service for community-dwelling elderly.Methods:From August to December 2021, individual semi-structured in-depth interviews were conducted with caregivers of the elderly from five community health centers in Beijing Xicheng and Miyun districts selected by purposive sampling.Results:Nine caregivers,2 males and 7 females aged 49-76 (62.8±9.4) years were interviewed in this study. The nursing care period was 3-48 (17±13) years. Four themes were extracted from the interview data: older people′s own condition was the primary factor influencing the home care needs; medical needs for home care were determined by the caregivers′ factors; community health service was important for meet home medical needs; and supporting of home care services for the elderly need to be strengthened.Conclusion:The experience of elderly home caregivers in using community home medical services is affected by many factors, and in the future, the content of home medical services should be improved, and the skills training of community elderly home caregivers should be strengthened, so as to improve the quality of life at home and promote the health literacy of the elderly.

Objective:To investigate the perspective of family doctor teams on the status quo of home care for community-dwelling elderly.Methods:The focus group interviews on the status quo of home care for community-dwelling elderly were conducted from August 19 to December 28, 2021. One urban area and 1 suburban area of Beijing was selected by purpose sampling method as target areas. Five community health service centers were selected from each area, and 5 family doctor team members were selected as interviewees in each center. The outline of interviews was as follows: what kinds of home care does the family doctor team provide for the community-dwelling elderly; how does the family doctor team evaluate the existing community-based home care; what suggestions on developing community-based home care for the elderly in the future. The data of the interview were analyzed by the thematic framework.Results:Xicheng district and Miyun district were selected as the study sites in the urban and suburban areas of Beijing, and 41 family doctor team members were interviewed. Three themes and 6 sub-themes were extracted. The study showed that: (1) the family doctor contracted service for the elderly was carried out smoothly in the community; (2) the current situation of home care for the elderly in the community varied, the chronic disease management for the elderly was effective, the health education in the community was popular, the implementation of free annual health check for the elderly in urban areas was more difficult than that in suburban areas, and the family doctor team provided home visits as needed and required; (3) the members of family doctor team usually undertook multiple tasks due to the insufficiency of auxiliary staff, and the incentive mechanism of the home visit was not perfect, which needed to be improved.Conclusion:From the perspective of family doctor teams, the contract service for the elderly is generally carried out smoothly in Beijing communities, but it varies in different types of home care for the elderly, and the work and incentive mechanism of family doctor team need to be improved.

Human Papillomavirus (HPV) infection is very common in sexually active men and women. HPV vaccination is the most effective measure for primary prevention for HPV infection and HPV-related diseases ultimately. HPV infection can cause condylomata acuminata in males, and is also associated with penile cancer, anal cancer and oral cancer; however, most male HPV carriers do not have signs or symptoms, so prevention and treatment of HPV infection in men can effectively reduce the risk of HPV infection in their partners. In most countries the HPV vaccination coverage among females is far lower than targeting expectation, and the effective herd immunity has not been achieved yet. Men can directly benefit from HPV vaccination, which is also beneficial for their partners, therefore HPV vaccination for men is worth considering. In this article we briefly describe HPV vaccination in males and overview their awareness and acceptance of HPV vaccination, so as to provide references for promoting HPV vaccination among men in the future.

Objective:To understand the attitude and perception of the community-dwelling elderly on the provision of ways of aged-care and home care services by primary health care institutions.Methods:The focus group interviews were conducted from July to December 2021 among 40 home-bound older adults aged≥65 years, selected by purposive sampling method from 5 community health service centers in Beijing Xicheng District and Miyun District, and 4 eligible participants from each community. The topics of the interview were home care and home medical services. The recorded data were transcribed, coded, and analyzed. The themes of interview contents were extracted, summarized and refined with NVivo12 software.Results:Among 40 participants, 20 were males and 20 were females with an average age of (70.95±4.62) years (65 to 83). Three themes were extracted from the interviews: the mode of provision for aged care is influenced by various factors; the role of community medical services for home-based care of the elderly is limited; the contents of community home medical services need to be expanded.Conclusions:The home-bound elderly have a need for home medical services provided by the community, which are limited at present. The implementation of telemedicine and increasing service coordination in the community will be conducive to convenient home medical services for the home-bound elderly.

Objective:To investigate the experience and perception of general practice residents on standardized training based on stratified progressive teaching model.Methods:From January to April 2022, focus group interviews were conducted among general practice residents who received standardized training at Peking University First Hospital.Results:Seventeen residents were selected by the purpose sampling method in the study, including 7 males and 10 females aged 24-39 years. Four themes were extracted from the interviews: lower levels of basic knowledge and feeling pressure at clinical work felt by junior residents; lack of clinical research ability and systematic training felt by senior residents; the rotation form and teaching contents were mono in grassroots practice bases; desire of raising salary levels for residents.Conclusions:In order to upgrade the quality of general practice residency training, it is necessary to strengthen the knowledge, skill training and research ability training of general practice residents, improve their treatment, and perfect the standardized training program accordingly.

With the rapid population aging in China, healthy elderly care has become a consensus of the whole society. As an important part of healthcare system, community health service plays a vital role in health maintenance and promotion for the elderly, and it is an extremely important foundation for realizing healthy endowment. In this article we summarize the status quo of home-based care for the aged, in which the community health service plays an important role, and also make suggestions for further improvement.

Objective To improve the recognition of Pancreatitis, Panniculitis, and Polyarthritis syndrome (PPP syndrome). Methods We described the diagnosis and treatment of a patient with PPP syndrome, including the clinical, radiological, and pathological features. Results Here we report a 67-year-old man with chronic calcified pancreatitis with multiple subcutaneous nodules and polyarthritis, but without any abdominal pain or other abdominal symptoms. His serum pancreatic amylase and lipase were markedly elevated. Abdomen CT scan showed features of chronic calcified pancreatitis. MR imaging of ankle revealed intramedullary fat necrosis. Biopsy from subcutaneous swellings revealed fat necrosis without vasculitis and typical "ghost-like cells". He failed to response to corticosteroids therapy. When the diagnosis of pancreatitis was confirmed, he was managed conservatively with supportive measures, and recovered. Conclusion The diagnosis of PPP syndrome is often difficult when abdominal symptoms are absent, be aware the association between panniculitis and polyarthritis with pancreatic disease may lead to a prompt diagnosis and management.

Objective To determine the extent of off-label antiepileptic drugs (AEDs) use in a tertiary pediatric epileptic center in China,so as to provide baseline data for getting acquainted with the extent of off-label AEDs use for the future.Methods Collected demographic information and prescriptions related to AEDs of all hospitalized children diagnosed with epilepsy from April 1st to September 30th 2016 were collected in Peking University First Hospital.According to person-time,prescriptions,different AEDs,various categories of off-label use,the incidence of off-label AEDs use was calculated respectively.Risk factors (age,gender,number of drug use,type of seizure and status epilepticus) were analyzed through the methods of single factor chi-square and muhi-factor Logistic regression analysis.Results A total of 291 person-times,749 prescriptions and involving 12 kinds of AEDs were collected.The rates of off-label drug use were 35.11％ (263/749 items) and 66.32％ (193/291 person-times) in prescriptions and person-times respectively.The main categories of off-label drug use were seizure types (38.40％,101/263 items),dosage (10.27％,27/263 items),mono/multidrug therapy (9.89％,26/263 items),scope of disease (0.76％,2/263 items) and age (72.62％,191/263 items),while 30.30％ (79/263 items) prescriptions were equal or more than 2 different categories of off-label drug use.The incidences of different drugs were different,with 100％ in Nitrazepam,Vigabatrin,Clobazam,Zonisamide,1.78％ (3/169 items) in Valproate but 0 in Clonazepam,Phenobarbital.According to the results of single factor chi-square and multi-factor Logistic regression,ages and seizure types were correlated with off-label AEDs use.The groups of infants and preschoolers had higher incidences of off-label AEDs use than the group of school and adolescence.The group of focal seizures only had lower incidences of off-label AEDs use.Conclusions Off-label AEDs use in the tertiary pediatric epileptic center in China is common.Younger patients (infant and preschool) have higher incidences of off-label AEDs use,while patients with focal seizures have lower incidences of off-label AEDs use.

Objective To investigate the incremental value of 99Tcm-MIBI SPECT/CT imaging in the preoperative diagnosis of PHPT.Methods Forty-one patients (13 males,28 females,age range:14-82 (50.0± 13.2) years)with PHPT were retrospectively enrolled.99Tcm-MIBI dual-phase planar scan,SPECT/CT imaging,CT and neck ultrasound were performed before surgery.All patients had pathological results.McNemarx2 test was used to compare the detection rates of the four imaging methods.ROI method was applied to calculate the uptake ratio (T/NT) and Pearson correlation analysis was used to evaluate correlation between T/NT and serum intact PTH,Ca,the lesion volume measured after parathyroidectomy.Results A total of 42 parathyroid lesions were confirmed by pathology.There were 39 patients with parathyroid adenoma (2 with double adenomas,and 37 with single adenoma containing 2 ectopic adenomas) and 1 patient with parathyroid carcinoma.The detection rate of planar scan,SPECT/CT imaging,CT and neck ultrasound were 78.0％ (32/41),92.7％ (38/41),73.2％ (30/41) and 70.7％ (29/41) respectively.Detection rate of SPECT/CT imaging was significantly higher than that of planar scan,CT or ultrasonography (x2 =4.17,4.90,5.82,all P＜0.01).However there were no remarkable differences between the detection rate of planar scan and that of CT or ultrasonography (x2=0.08,0.36,both P＞0.05).Detection rates of CT and ultrasonography were not significantly different either (x2 =1.90,P＞0.05).T/NT in delayed planar imaging were significantly correlated with PTH,Ca and the lesion volume measured after parathyroidectomy (r =0.56,0.54,0.56,all P＜0.01).Conclusions Compared with 99Tcm-MIBI dual-phase planar scan,CT and ultrasonography,SPECT/CT imaging could be of important clinical value for preoperative localization of PHPT because of its higher detection rate and accurate anatomical localization ability.