Objective To investigate the results of ambulatory electrocardiographic(ECG)monitoring in a community-based homebound elderly population and to explore the applicability of wearable long-range ambulatory ECG monitor for them.Methods Elderly volunteers were recruited in Shuangbei Community,Shapingba District,Chongqing,from November 2021 to June 2023.A single-lead wearable ambulatory ECG recorder was applied to them to obtain ECG for 7 consecutive days.The adverse reactions,acceptability,monitoring duration,and arrhythmia detection rate during the wearing were described and recorded.Serious arrhythmic events included frequent atrial premature,atrial flutter,atrial fibrillation(AF),frequent ventricular premature,and RR intervals ≥5 s.Results There were 416 individuals enrolled,with a mean age of 71.2±6.6 years,and a male percentage of 36.1％(150 men).Finally,384(92.3％)participants completed the wearing of the ECG monitor for 7 d,with an average time of 159.2±29.4 h.There were 179 participants(48.5％)reporting no discomfort during wearing,and 175 ones(47.4％)feeling itchy at the wearing site.The monitoring results showed that the common arrhythmias were atrial premature contractions(97.1％),premature ventricular contractions(93.3％),atrial tachycardia(84.6％),bradycardia(46.6％),frequent atrial premature contractions(15.1％),ventricular tachycardia(13.2％),and long RR interval(11.8％).Among them,29.1％of the participants experienced serious arrhythmic events,and the detection rate of certain serious arrhythmic events was comparatively higher in the individuals≥70 years of age and those with history of previous cardiac disease.Conclusion The detection rate of common arrhythmias is quite high in the community-based homebound elderly population.A 7-day long-range ambulatory ECG monitoring may be appropriate.

Objective To analyze and construct systolic blood pressure(SBP)fluctuation trajectory in a community population with hypertension and to analyze the factors influencing different trajectories.Methods This is a community-based retrospective cohort study.A latent class trajectory model was used to identify and construct longitudinal trajectories of blood pressure change.Multinomial logistic regression analysis was performed to identify the associated factors of blood pressure trajectories by adjusting for different confounders.Potential confounding factors were identified using a directed acyclic graph based on a priori knowledge.Results A total of 793 patients with hypertension were enrolled in the analysis.They were divided into 3 groups by LCTM-fitted systolic blood pressure trajectories,namely stable low-level group(n=561,70.74％),declining group(n=170,21.44％)and rising group(n=62,7.82％).Significant differences were observed among the 3 trajectories groups in terms of age,frequency of exercise,ways of follow-up,salt intake,compliance behavior,and referral(P＜0.05).Compared to the stable low-level group and adjusting for corresponding confounding factors,the male patients and the patients with"outpatient follow-up"were more likely to be classified into"declining group",with OR and 95％CI of 1.436(1.016～2.030)and 1.702(1.202～2.410),respectively.The participants aged ≥ 65 years,who did not exercise or occasionally exercised,and had moderate and severe salt intake,were more likely to be classified into the"rising group"(OR=1.949,2.284,2.433,4.540,95％CI:1.145～3.317,1.305～3.998,1.272～4.654,1.291～15.963).Conclusion SBP trajectories in community-dwelling hypertensive population can be divided into stable low-level,declining and rising groups.Gender,age,salt intake,exercise frequency,and follow-up methods may be influencing factors for SBP blood pressure trajectory.

Objective To observe the characteristics of patients with extra long-term hospital stays at an infectious dis-eases hospital,formulate corresponding strategies,and effectively control the length of stays so as to improve the efficiency of medical resource utilization.Methods Data of all discharged patients in 2023,including age,gender,disease name,discharge department,and length of stay,were retrieved from the hospital's medical record management system.Statistical analysis was conducted using Excel and SPSS.Results The analysis indicated that the proportion of male patients with excessively long hos-pital stays was significantly higher than that of female patients.Additionally,prolonged hospital stays were correlated with age,and elderly patients exhibited a higher proportion of extended stays.Most patients were covered by employee medical insurance and resident medical insurance,while only a small portion relied on self-funded medical insurance.Over half of the excessively hospitalized patients were affected with specific infectious and parasitic diseases(A00-B99).Controlling the length of these hos-pitalizations could reduce costs and alleviate patient burdens.Conclusion Controlling excessive hospital stays is effective through strengthened medical quality management,enhanced patient management in key departments,and a focus on specific dis-eases.Additional strategies for controlling extended hospital stay include improving doctor-patient communication,increasing comprehensive patient information sharing,reducing medical disputes,attaching importance to information technology,and rea-sonably utilize medical resources.

Objective:To investigate the comprehensive ability and influencing factors of clinical medicine graduates from a medical college in Xi'an, and provide a scientific basis for improving the training model and comprehensive ability of clinical medicine students.Methods:Based on the Chinese Undergraduate Medical Education Standard-Clinical Medicine Specialty (2016 Edition), we conducted a self-designed questionnaire, the Clinical Medicine Graduate Comprehensive Ability Evaluation Questionnaire, containing 62 items in 4 dimensions, selected the clinical medicine graduates as the research objects by random sampling method, used SPSS 22.0 to make data analysis, and performed multiple linear regression to analyze its influencing factors.Results:Clinical medicine graduates had the highest score in the field of clinical competence (3.05±0.84), followed by the field of professionalism (2.48±0.81), and the lowest score was in the field of science and academics (1.89±0.68). The top three scores of each factor were clinical practice ability (3.39±0.76), theoretical knowledge mastery (3.55±0.48) and medical knowledge mastery (2.98±0.81). The three factors with the lowest scores were literature search ability (1.31±0.64), global health issues (1.49±0.82) and self-improvement willingness and ability (1.81±0.73). Using the multiple stepwise regression method to analyze the influencing factors of comprehensive ability, the optimal equation was obtained: Y=8.412+0.063 X6+0.190 X8+0.266 X10+0.031 X11+0.187 X12 ( X6, working level; X8, academic performance ranking; X10, practical teaching satisfaction; X11, mode of teaching satisfaction; X12, Re-education satisfaction after graduation). Among them, the higher the practical teaching satisfaction, the satisfaction of re-education and the satisfaction of teaching mode after graduation, the higher the student's performance ranking, and the higher the comprehensive ability score of clinical graduates. Graduates whose employment level was in a general hospitals had higher comprehensive ability scores than those of grassroots hospitals such as community/township hospitals. Conclusions:In the process of training clinical medicine students, we should improve the quality of practical teaching and the teaching model, increase the training of science and academic fields, increase the investment in re-education of primary medical institutions, and raise the satisfaction of graduates in education, so as to improve the clinical medicine profession comprehensive ability of graduates.

Objective: To analyze the clinical characteristics of children with Burkitt lymphoma (BL) and to summarize the mid-term efficacy of China Net Childhood Lymphoma-mature B-cell lymphoma 2017 (CNCL-B-NHL-2017) regimen. Methods: Clinical features of 436 BL patients who were ≤18 years old and treated with the CNCL-B-NHL-2017 regimen from May 2017 to April 2021 were analyzed retrospectively. Clinical characteristics of patients at disease onset were analyzed and the therapeutic effects of patients with different clinical stages and risk groups were compared. Survival analysis was performed by Kaplan-Meier method, and Cox regression was used to identify the prognostic factors. Results: Among 436 patients, there were 368 (84.4%) males and 68 (15.6%) females, the age of disease onset was 6.0 (4.0, 9.0) years old. According to the St. Jude staging system, there were 4 patients (0.9%) with stage Ⅰ, 30 patients (6.9%) with stage Ⅱ, 217 patients (49.8%) with stage Ⅲ, and 185 patients (42.4%) with stage Ⅳ. All patients were stratified into following risk groups: group A (n=1, 0.2%), group B1 (n=46, 10.6%), group B2 (n=19, 4.4%), group C1 (n=285, 65.4%), group C2 (n=85, 19.5%). Sixty-three patients (14.4%) were treated with chemotherapy only and 373 patients (85.6%) were treated with chemotherapy combined with rituximab. Twenty-one patients (4.8%) suffered from progressive disease, 3 patients (0.7%) relapsed, and 13 patients (3.0%) died of treatment-related complications. The follow-up time of all patients was 24.0 (13.0, 35.0) months, the 2-year event free survival (EFS) rate of all patients was (90.9±1.4) %. The 2-year EFS rates of group A, B1, B2, C1 and C2 were 100.0%, 100.0%, (94.7±5.1) %, (90.7±1.7) % and (85.9±4.0) %, respectively. The 2-year EFS rates was higher in group A, B1, and B2 than those in group C1 (χ²=4.16, P=0.041) and group C2 (χ²=7.21, P=0.007). The 2-year EFS rates of the patients treated with chemotherapy alone and those treated with chemotherapy combined with rituximab were (79.3±5.1)% and (92.9±1.4)% (χ²=14.23, P<0.001) respectively. Multivariate analysis showed that stage Ⅳ (including leukemia stage), serum lactate dehydrogenase (LDH)>4-fold normal value, and with residual tumor in the mid-term evaluation were risk factors for poor prognosis (HR=1.38,1.23,8.52,95%CI 1.05-1.82,1.05-1.43,3.96-18.30). Conclusions: The CNCL-B-NHL-2017 regimen show significant effect in the treatment of pediatric BL. The combination of rituximab improve the efficacy further.
Adolescent ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Burkitt Lymphoma/drug therapy* ; Child ; Disease-Free Survival ; Female ; Humans ; Lactate Dehydrogenases ; Lymphoma, B-Cell/drug therapy* ; Male ; Prognosis ; Retrospective Studies ; Rituximab/therapeutic use* ; Treatment Outcome

Objective:To explore the effect of closed-loop nursing on self-efficacy and nursing satisfaction in children with nephrotic syndrome (NS) .Methods:From March 2019 to January 2021, convenience sampling was used to select 104 children with NS and their accompanying parents in Henan Provincial People's Hospital as the research object. The children were divided into the control group and the observation group by random number table method, 52 cases in each group. The control group received routine nursing, and the observation group carried out closed-loop nursing on the basis of the control group. The scores of the General Self-efficacy Scale and Satisfaction Scale were compared between the two groups.Results:After three months of intervention, the children's self-efficacy score in the observation group was higher than that in the control group, and the parents' satisfaction with nursing was 94.23% (49/52) , which was higher than 78.85% (41/52) in the control group. The differences were all statistically significant ( P<0.05) . Conclusions:The closed-loop nursing can improve the self-efficacy of children with NS and the satisfaction of their parents, which is worthy of clinical promotion.

Objective:To investigate the influencing factors of the scientific research performance and analyze the differences between subjective and objective ones among the different characteristics of staffs in work and then propose tailored management strategies based on the research findings.Methods:A total number of 963 young researchers under the age of 45 (including doctors, medical technicians, scientific researchers) were surveyed and the impact on the scientific research performance of four subjective and objective factors including demographic characteristics and research motivation, self-efficacy, team support and the external environment were analyzed through self-developed questionnaire.Results:The academic degree, age, time spent overseas, administrative position, postgraduate mentor, professional title and levels, category of departments on the scores of scientific research performance had reached statistical significance ( P <0.05) by using Single factor analysis. The results showed that the impact on the scientific research performance followed a descending order of the category of postgraduate mentors, academic degree, professional title levels, the category of departments, self-efficacy, time spent overseas, and professional title series. Conclusions:According to the survey, this research focuses on the predictive factors which affecting scientific research performance as the important methods of scientific research promotion and talent training, and puts forward to the ideas of talent training, scheme of optimizing talent selection, carrying out accurate policy implementation and scientific assessment.

Objective To make good use of the incentive function of the reward policy of scientific research achievements in hospitals ,shorten the reward cycle of scientific and technological achievements ,reduce the management cost ,achieve the ul-timate goal of details management of scientific and technological achievements .Methods Through retrospective analysis of the incentive process to identify possible barriers ,reconstruct the rewarding procedures of scientific and technological achievements by bringing in informatization and publicity strategy ,compare the bonus distribution cycle with the traditional model .Results The results show that the reward model based on the scientific research management system reduces the bonus arrival waiting period by about 62％ ,saves management costs and improves staff compliance .Conclusions According to the 4-year practice experiences ,the new management model has further released the positive impact of the hospital award policy ,solved the key problem of restricting the rewarding effect by technological means in the process of rewarding scientific research achievements .

Objective To indentify the cognitive status of Chinese patients to acne and the influencing factors to theirs' cognitive status,so as to provide solid evidences for the prevention and treatment of acne.Methods A self-designed questionnaire was made to conduct this survey of 16,156 acne patients,who seeked to the treatment in the dermatological departments from 112 hospitals in China.The survey consisted of several parts,including the general status of patients,the patients' cognition of occurrence,development and risk factors of acne,whether the first choice was seeking treatment at the hospital when the patients had acne and the condition of selection of skin care products.The factors were analyzed,which could impact the cognition of the patients' behavior of treatment,how did the patients' cognition to influence their medical behavior and skin care as well as the consistency of assessment of the severity of acne by doctors and patients themselves.Results The acne patients studied had the best knowledge of "acne is a skin disease","it not only occurs in the period of adolescence" and "the disease can be prevented and cured",which accordingly accounted for 80.65％,69.16％ and 65.49％ of the total patients respectively.However,the awareness of acne patients to heredity,high sugar and dairy products as risk factors for acne was insufficient,which accounted for 48.72％,42.40％ and 18.25％ of the total patients,respectively.Gender,age,educational level,occupation and health knowledge were the main factors affecting the cognitive level of patients;the survey also found that men,patient with educational level of junior high or even lower educational condition,occupation of labor workers or farmers and patients were lack of health education with poor knowledge of the genetics and dietary were risk factors for acne;patients with age over 36 years or with mild illness had poor knowledge of dietary risk factors for acne;the difference was statistically significant (P＜0.05).The analysis of the influence of cognitive status on medical treatment behavior and skin care showed that the better the cognition,the higher the probability of patients would choose medical treatment as the first choice as well as choosing functional skin care products;the difference was statistically significant (P＜0.05).The consistency of assessment of the severity of acne by doctors and patients was poor (Kappa value ＜0.4),and the assessment of severity of acne by patients was more serious than doctors' assessment.Conclusions Patient's cognitive status will affect their medical behavior and skin care,and there is also a phenomenon that patients have a more serious assessment of their acne condition.It is suggested that health education for acne patients should be strengthened in clinical medicine so as to improve their knowledge of acne as well as preventing from acne effectively.