Objective:To explore the implementation effects of an proactive health management model for elderly patients with multimorbidity in comprehensive hospitals based on the concept of people-centered integrated care (PCIC).Methods:This study was a randomized controlled trial. Elderly patients who were hospitalized in the Department of General Practice at Shanghai East Hospital Tongji University and also suffered from hypertension, type 2 diabetes and dyslipidemia from November 2022 to January 2024 were included, and were divided into the control group (traditional health management, n=25) and the intervention group (proactive health management, n=25) using the random number table method. A research team comprising experts in general medicine, pharmacy, nutrition, rehabilitation medicine, psychology, and other relevant specialties was formed. Based on literature analysis, clinical experience, and hospital resources, the team collaborated to develop a comprehensive, hospital-based proactive health management model for elderly patients with comorbidities based on the PCIC concept. Patients in the control group were managed using the traditional health management model. Patients in the intervention group were managed using the proactive health management model. Baseline clinical data was collected and the patients were followed up for 6 months. At the 6-month follow-up, data on blood pressure, fasting blood glucose, and blood lipids were collected, as well as information on polypharmacy, activities of daily living (ADL) ability, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and unplanned rehospitalization were recorded. Results:A total of 50 patients were enrolled, with 25 patients in each group. The control group had an average age of (70.40±6.54) years, with 15 males(60.0%). The intervention group had an average age of (71.20±5.14) years, with 16 males(64.0%). At the 6-month follow-up, the standardization rates of blood pressure, fasting blood glucose, glycated hemoglobin, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG) in both groups were higher than those in the baseline (all P<0.05).In addition, patients in the intervention group had the compliance rates for higher blood pressure, fasting blood glucose, 2-hour postprandial blood glucose, HbA1c, LDL-C, non-HDL-C, and TG than the control group (all P<0.05).At the 6-month follow-up, the 10-year ASCVD high-risk patient percentage decreased in the intervention group compared with baseline ( P=0.023) and was lower than that of the control group ( P=0.045), and the unanticipated readmission rate of patients in the intervention group was also lower than that of the control group ( P=0.042). Conclusions:A proactive health management model for elderly patients with geriatric multimorbidity in a comprehensive hospital, based on the concept of PCIC, was applied to an elderly population with concurrent hypertension, type 2 diabetes and dyslipidemia. The results of the management were favorable.

Objective:To explore the implementation effects of an proactive health management model for elderly patients with multimorbidity in comprehensive hospitals based on the concept of people-centered integrated care (PCIC).Methods:This study was a randomized controlled trial. Elderly patients who were hospitalized in the Department of General Practice at Shanghai East Hospital Tongji University and also suffered from hypertension, type 2 diabetes and dyslipidemia from November 2022 to January 2024 were included, and were divided into the control group (traditional health management, n=25) and the intervention group (proactive health management, n=25) using the random number table method. A research team comprising experts in general medicine, pharmacy, nutrition, rehabilitation medicine, psychology, and other relevant specialties was formed. Based on literature analysis, clinical experience, and hospital resources, the team collaborated to develop a comprehensive, hospital-based proactive health management model for elderly patients with comorbidities based on the PCIC concept. Patients in the control group were managed using the traditional health management model. Patients in the intervention group were managed using the proactive health management model. Baseline clinical data was collected and the patients were followed up for 6 months. At the 6-month follow-up, data on blood pressure, fasting blood glucose, and blood lipids were collected, as well as information on polypharmacy, activities of daily living (ADL) ability, 10-year atherosclerotic cardiovascular disease (ASCVD) risk, and unplanned rehospitalization were recorded. Results:A total of 50 patients were enrolled, with 25 patients in each group. The control group had an average age of (70.40±6.54) years, with 15 males(60.0%). The intervention group had an average age of (71.20±5.14) years, with 16 males(64.0%). At the 6-month follow-up, the standardization rates of blood pressure, fasting blood glucose, glycated hemoglobin, low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and triglycerides (TG) in both groups were higher than those in the baseline (all P<0.05).In addition, patients in the intervention group had the compliance rates for higher blood pressure, fasting blood glucose, 2-hour postprandial blood glucose, HbA1c, LDL-C, non-HDL-C, and TG than the control group (all P<0.05).At the 6-month follow-up, the 10-year ASCVD high-risk patient percentage decreased in the intervention group compared with baseline ( P=0.023) and was lower than that of the control group ( P=0.045), and the unanticipated readmission rate of patients in the intervention group was also lower than that of the control group ( P=0.042). Conclusions:A proactive health management model for elderly patients with geriatric multimorbidity in a comprehensive hospital, based on the concept of PCIC, was applied to an elderly population with concurrent hypertension, type 2 diabetes and dyslipidemia. The results of the management were favorable.

Continuing medical education for general practitioners is an important measure to upgrade the quality of primary health care services in China, which is still facing various challenges and need to be further developed and improved. This article analyzes the status quo and existing problems of continuing medical education for general practitioners in China, and proposes suggestions based on the concept of people centered and integrated health care (PCIC), including faculty development, training contents, assessment methods, and experience learning, to provide references for the improvement of continuing medical education for general practitioners.

Multimorbidity management for the elderly is a big challenge for China′s healthcare system and the people centered integrated care (PCIC) is a new concept in health care reform, and the application of the PCIC in multimorbidity management can better improve the health servece for elderly patients. This article applies SWOT analysis to assess the internal strengths and weaknesses as well as external opportunities and threats of applying the PCIC to the geriatric management of multimorbidity; also proposes strategies of geriatric management for elderly patients with Chinese characteristics based on concept of PCIC. The proposed stretegies optimize the personalized assessment with the digital technology, promotes the management with close-knit healthcare system, and strengthen the role of primary medical institutions to improve the long-term management mechanism of multimorbidity.

Objective:To evaluate and summarize the relevant evidence of comprehensive detumescence treatment of lower limb lymphedema in patients with gynecological malignant tumors, and to provide evidence-based basis for clinical intervention of comprehensive detumescence treatment of lymphedema.Methods:This study was an evidence - based nursing research. Databases such as BMJ Best Practice, UpToDate, PubMed, CNKI, Wanfang and other domestic and foreign databases, as well as websites such as the Australian Lymphology Society, the International Lymphedema, and the European Clinical Oncology Association were searched for relevant evidence and evaluation of comprehensive treatment of gynecological malignant tumor-related lower limb lymphedema. The search time was from the establishment of the database to April 1, 2022.Results:A total of 18 articles were included, including 2 guidelines, 5 systematic reviews, 4 expert consensus, 2 evidence summaries, 4 randomized controlled trials and 1 best practice. Twenty-eight evidence were summarized from 7 aspects : treatment cycle and edema stage, free-hand lymphatic drainage, graduated compression stockings, skin care, elastic socks, functional exercise and health education.Conclusions:The evidence summarized in this study can provide reference for clinical medical staff to formulate comprehensive treatment plans for lower limb lymphedema. Evidence-based practice should consider the individual status of patients and clinical scenarios, and provide personalized comprehensive treatment plans for patients with lower limb lymphedema of gynecological malignant tumors as soon as possible to improve the quality of life of patients.

Objective:To retrieve, obtain and summarize the best evidence for the prevention of recurrence in patients with diabetic foot, and to provide reference for clinical practice.Methods:According to the "6S" model of evidence-based resources, JBI, UpToDate, BMJ Best Practice, Cochrane Library, International Working Group on the Diabetic Foot, International Diabetes Federation, National Istitute for Health and Clinical Excellence, PubMed, EmBase, China National Knowledge Internet, Wanfang and China Biology Medicine disc were searched by computer for the prevention of recurrence of diabetic foot patients. The retrieval time limit was from the establishment of the database to April 2022. Two researchers independently evaluated the included literature and extracted the literature that met the quality standards.Results:Totally 12 articles were included at last, including 5 guidelines, 3 expert consensus and 4 Meta-analysis. From the six dimensions of the necessity and risk factors of recurrence prevention in diabetic foot patients, decompression brace prevention, surgery and wound management prevention, nutritional therapy prevention, health education and lifestyle prevention, monitoring and analysis, 18 pieces of best evidence were summarized.Conclusions:The best evidence for the prevention of recurrence of diabetic foot patients was summarized to provide evidence-based basis for management decision makers and decision implementers to prevent recurrence of diabetic foot. In the process of practice, medical workers should also fully evaluate the promoting factors and hindering factors in order to ensure that evidence can be better applied to clinical practice and serve patients.

Gallic Acid/pharmacology* ; Humans ; Senotherapeutics ; Stem Cells

Shanghai East Hospital has built a general practice residency training information system based on "Internet +" technology since 2017. This training system effectively promoted the training quality, improved the clinical and research ability of general practitioners, and strengthened the supervision of the training. It has improved the training satisfaction, increased passing rate of national medical licensing examination and graduation comprehensive examination of trainees. This training system can largely break the time and space limitations, and has strong replicability. It may provide reference to optimize the general practice standardized residency training for other institutions.

The history,hardware,imaging principle and technical characteristics of dual-energy CT machine were described.The causes,clinical diagnosis and treatment of urinary calculi were analyzed.Dual-energy CT had its technical characteristics,clinical significance,advantages and practicality expounded in detail when used to determine the components of urinary calculi.

Objective To investigate the occurrence of postoperative healthcare-associated infection(HAI)in pa-tients with hepatobiliary malignant tumor,explore the related risk factors,so as to provide the basis for taking ef-fective prevention and control measures.Methods The occurrence of postoperative HAI in patients with hepatobili-ary malignant tumor in a hospital from January 2012 to December 2014 were retrospectively analyzed,risk factors for postoperative HAI were analyzed through reviewing and collecting patients’medical data.Results A total of 302 patients were investigated,42 (13.91 %)developed postoperative HAI,no multiple site infection occurred,the main infection site was deep surgical site (n=10,23.81 %),followed by lower respiratory tract (n=9,21 .43%) and digestive system (n=7,16.67%).Of 42 infection cases,38(90.48%)were sent specimens for pathogenic cul-ture,36 pathogenic strains were isolated,31 (86.11 %)of which were gram-negative bacteria,and 5 (13.89%) were gram-positive bacteria.Multivariate logistic analysis showed that operation duration≥2 hours (OR =1 .48), overweight (or obesity)(OR=1 .40),and preoperative radiotherapy (OR=2.98)were independent risk factors for postoperative HAI in patients with hepatobiliary malignant tumor (all P <0.05).Conclusion Incidence of postoper-ative HAI is high in patients with hepatobiliary malignant tumor,risk factors are long length of operation,over-weight (or obesity),and preoperative radiotherapy,effective prevention and control measures against risk factors should be taken.