OBJECTIVE To analyze the risk factors contributing to piracetam-associated thrombocytopenia and develop a predictive model for risk prediction. METHODS The electronic medical record information of inpatients treated with piracetam was collected retrospectively from the First Affiliated Hospital of Guangxi Medical University from January 2021 to December 2023， including gender， age， underlying diseases， combined medication， and laboratory data， etc. Patients were divided into the occurrence group and the non-occurrence group according to whether thrombocytopenia occurred， and the differences in clinical data between the two groups were compared. The independent risk factors were determined through univariate/multivariate Logistic regression analysis. A nomogram was drawn to visually present the independent risk factors， and a risk prediction model was constructed. The predictive efficacy of the model was evaluated using the receiver operating characteristic （ROC） curve， Bootstrap internal validation and calibration curve. RESULTS A total of 224 patients were included， among which 196 cases were in the non- occurrence group and 28 cases in the occurrence group. The incidence of thrombocytopenia was 12.50%. The results of the univariate Logistic regression analysis showed that the proportion of patients using three or more combined antibiotics and the level of serum creatinine in the occurrence group were significantly higher than those in the non-occurrence group， while the level of hemoglobin was significantly lower （P＜0.05）. The results of the multivariate Logistic regression analysis revealed that the use of three or more combined antibiotics， low hemoglobin level and high serum creatinine level were independent risk factors for piracetam-associated thrombocytopenia （P＜0.05）. The constructed risk prediction model was LogitP＝ －1.114+1.256×three or more combined antibiotics－0.017×hemoglobin level+0.009×serum creatinine level. The AUC of the ROC curve of this model was 0.757， and the optimal cut-off value was 0.474； the AUC of the ROC curve of the Bootstrap internal validation was 0.733； the apparent curve and the bias-corrected curve were close to the ideal curve. CONCLUSIONS The use of three or more antibiotics， along with low hemoglobin level and high serum creatinine level， are identified as independent risk factors for piracetam-associated thrombocytopenia. The developed risk prediction model demonstrates good predictive value.

Objective To investigate the effect of patient motivation model on blood glucose and quality of life in community type 2 diabetes mellitus ( T2DM) patients. Methods The study recruited 258 eligible adult patients who were residents with health records from Waigang community health centers of Shanghai Jiading District. The subjects were randomly divided into incentive group ( n= 123 ) and control group ( n= 135 ) . We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management was used to carry out the tele-medicine. The type 2 diabetic patients, who were set goals in blood glucose, managed by the general practitioners, the daily health behaviors of the patients were regulated. The study group received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 1-year study period. The control group would not receive any incentives but would be provided with diabetes education booklet and to follow group educational courses for diabetes mellitus control as usual. Results After 12 months, there were significant differences in HbA1C , fasting blood glucose, and the on-target rate of HbA1C in both two groups as compared with the baseline levels(P<0.05). In the investigation of quality of life( QOL) , we found a significant differences in the scores of total QOL, the degree of satisfaction, and the degree of influence between the incentive group and the control group in one year after intervention( P<0.05) . Conclusion The objective motivation model seems to exert a positive effect on blood glucose control and self-management for those with T2DM.

Objective To construct the competency model of excellent and common clinical medicine undergraduates according to the competency theory . Methods Literature search was used to screen competency model. Behavioral event interview was used to interview 32 excellent clinical experts. Open questionnaire survey was conducted to 100 clinical medical undergraduates. We compiled the primary competency dictionary based on the above results. To determine the final competency dictionary, Delphi method of 50 experts was used to determine the final competency dictionary. According to the competency dictionary, a questionnaire survey was made to test the excellent and ordinary undergraduate students. Results The 38 features of behavioral event interview and 42 features of open questionnaire survey were combined to 51 features, which were used as the first round of expert questionnaire. Two rounds of expert consultation reached a high degree of coordination. 4 first level indicators: knowledge and skills, social role+values+service characteristics, self-concept and consciousness, personality quality and motivation and 36 features were established as final compentency model. 80 excellent clinical medical undergraduates got score of 143.65 ±23.53, while 100 ordinary undergraduates got score of 133.55 ±35.31 (t=2.29,P=0.023), which indicated the competency model could distinguish excellent and ordinary clinical under-graduates . Conclusion This competency model of clinical undergraduate students is reliable and practical, which can be used in future clinical undergraduate training and evaluation.

Objective To evaluated the effectiveness and influence of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes. Methods The large-sample prospective study recruited 1359 eligible adult patients who were residents and had health record from three community health centers of Shanghai Jiading District. The method of randomized complete block design was used to classify the subjects into 4 groups. The physicians incentive group included 337 subjects, while the patients incentive group 338 subjects, the physicians and patients incentive group 331 subjects, the control group which the physicians and the patients would not have the incentive 353 subjects respectively. We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management system was used to carry out the tele-medicine. The type 2 diabetes mellitus patients, which were set goal in blood glucose and blood pressure control, managed by the general practitioners, the daily health behavior of the patients were regulated. All subjects in the patients incentive groups received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 2-years study period. The control group would not receive any incentives but would be provided with diabetes education booklet and group educational courses for diabetes mellitus control as usual. Results After 12 months and 24 months, HbA1C , systolic blood pressure, diastolic blood pressure, total cholesterol, fasting blood glucose in the four groups were all lower than baseline levels (P<0. 05), while the time of related exercise parameters and the rate of HbA1C achieving target in the study groups were higher than baseline (P<0. 05). Besides, the time of related exercise, time of moderate exercise intensity, time of strenuous exercise intensity, and the rate of HbA1C achieving target ( after 24 months:49. 0％, 53. 2％, 51. 8％, 54. 4％, P<0. 05 ) had statistical significance among the physicians incentive, the patients incentive, the physicians and patients incentive, and the control groups. Logistic regression analysis showed that the duration of diabetes, the baseline HbA1C , whether using the insulin, taking hypoglycemic drugs are the main factors of the study with statistical significance (all P<0. 05). Conclusions Based on general practitioners-specialist cooperation tele-medicine, by regulating the daily health behavior and using the intervention of pay for performance, the new diabetes care model could improve the treatment effect of type 2 diabetes to some extent, especially the exercise time and its intensity. Besides, the duration of diabetes, the baseline of HbA1C , the using of insulin and hypoglycemic drugs turned out to be the main factors of the study.

Objective To evaluate the necessity and practicability of optimizing the management of type 2 diabetes mellitus in community after acquiring the peer education and the music therapy to their physical and mental issues and sleep problems. Methods Totally 179 type 2 diabetes mellitus patients who were followed up in Ruijin 2nd community health service center, the random numbers table used to randomize the patients into 2 groups:control group ( 97 cases) and experiment group ( 96 cases), the conventional treatment was used in control group. Besides the conventional treatment measures, the peer support was used by patients in the experiment group. In the second step, 45 patients were met the inclusion and the exclusion criteria, the random numbers table used to randomize the patients into 2 groups:the multiple intervention group (22 cases) and the conventional treatment group (23 cases), the multiple intervention included the music therapy, the peer support and the sleep health education, the conventional treatment included the conventional treatment and the sleep health education. The t test was used to compare the patient's HbA1c and other quantitative data in two groups of patients after the intervention. Results In the first stage of research, compared with the control group patients, the patients 'HbA1c in intervention group was significantly improvement after 6 months(7.26%±1.37%vs.7.53%±1.63%,t=2.148, P<0.05),besides, the intervention group individuals achieved significant improvement in diabetic self-management behaviors and self-efficacy after 6 months, and the improvement in self-efficacy of peer support group was significant different compared with routinely educated patients(104.09±16.40 vs.110.96± 13.86,t=2.120,P<0.05), and the PHQ-9(5.95 ± 4.02 vs.2.55 ± 1.67,t=2.630,P<0.05)between the two group had significant difference, while no improvement was found in PSQI, BMI, and WHR between intervention group and control group. Conclusions Peer support could improve the blood glucose metabolism in patients with type 2 diabetes. With the effect of yoga music and physical exercises, peer support can improve the quality of sleep and decrease depression in T2DM patients, who also have sleep disorders and mild depression.

Objective:To investigate and assess the systemic functional training in the prevention of lower limb trauma fracture surgery knee stiffness effect. Methods: Select General Hospital of PLA (301 Hospital) traumatic lower extremity Department of orthopedics from 2009 since April admissions of fractures in patients with 126 cases, according to the nursing methods of postoperative patients were divided into experimental group 63 cases and control group 63 cases, control group was given routine nursing after traumatic fracture of lower limb, the experimental group received training rehabilitation care plan and patient in the control group. Postoperative follow-up, the time of 5 months-2 years, two groups of patients were muscle strength, extension and flexion degree and the patients with complications were analyzed statistically, and the comprehensive evaluation of knee joint function recovery of patients. Results:The postoperative knee flexion strength and degree than the control group;experimental group, the complication rate was 15.9%in the control group of patients swelling after seven cases, the complication rate was 28.6%; comprehensive evaluation knee function two groups of patients in the experimental group was 82.5% excellent (52/63), good rate of the control group was 65.1% (41/63);said comparison items were statistically significant differences (x2=12.6, P<0.05). Conclusion: Lower limb trauma fracture surgery rehabilitation for patients with systemic functional training rehabilitation care, joint function recovery is remarkable, scientifically valid methods, should be further promoted.

ObjectiveTo assess the effectiveness of tele-medicine and self-management goal(SMG) setting technique used in the diabetes management in the community setting.Methods It is a control-group study.415 type 2 diabetic residents were recruited from the Shanghai Wuliqiao community based on existing medical records.The subjects were divided into two groups,the study group was cared by general practitioners (GPs) specialists cooperation through the tele-medicine mechanism,the other was a control group.For the study group,a cooperation pathway between community health care centers and general hospitals were established.Standardized training and guidelines were provided to community health workers,regarding the setting of management goals of blood glucose and blood pressure,treatment plan,patient education,and SMG techniques.Fasting blood glucose ( FBG ) and 2 h postprandial blood glucose (2hBG) in the study group were monitored,followed by community health workers visiting monthly with seminars for diabetes education.At the baseline and the 12tb month,FBG,2hBG,HbA1C,blood pressure,triglyceride,total cholesterol,body mass index,waist-hip ratio were determined in each group.A survey was conducted to evaluate the costs of diabetes treatments,the knowledge base related to their disease,lifestyle,and the awareness of the new care model.The rates of achieving the goal of blood glucose,blood pressure,and HbA1Ccontrol were calculated.Internet case discussion between GPs-Specialists and referral to certain specialists were implemented when some patients did not reach the control goal.ResultsBy the 12 month follow up,FBG,2hBG,HbAIc,blood pressure of the study group were lower than the baseline,and as well as the control group with statical significance (P＜0.05).There are other improvcments:diabetes knowledge (29.1％ vs 5.5％ ),healthy diet (9.6％ vs -10.4％ ),blood glucose monitoring (30.3％ vs 10.8％ ),support for diabetes care in community (35.7％ vs 9.4％ ),and the preference of the new model (63.8％ vs 17.9％ ) with statistical significauce (P＜0.01 ).As for the medical costs,the study group's monthly costs were consistently lower than the control's.( -3.39Yuan vs 32.26 Yuan,P＜0.05).ConclusionsThe new diabetes care model based on GPs-Specialists tele-medicine and SMG in community opens the door to the community based care model formulation in regard to the health quality and costs control.The deployment of more technologies and management techniques could be explored further to improve the outcomes of community based chronic disease care model.

Objective To understand patient pathway and clinical characteristics of chronic diseases in urban areas of Shanghai. Methods A total of 10 002 residents were enrolled and assigned to the chronic disease group (including hypertension, diabetes, coronary heart disease, myocardial infarction, and ischemic stroke) and the non-chronic disease group. Body mass index,fasting blood glucose, triglyceride,total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were tested.Difference of patient pathway and clinical characteristics of those chronic diseases was compared. Results Above chronic diseases were observed in 37.7% participants. About 2/3 diseases were confirmed and 80% patients were followed up in healthcare units not far away from home. Patients with coronary heart disease and myocardial infarction showed more outpatient visit to tertiary hospitals (P＜0. 05 ). However, patients with ischemic stroke had health check, rehabilitation and pharmacy done mainly in local healthcare centers (P＜0. 05 ). Diastolic blood pressure of patients visiting local doctors was significantly decreased (P＜0. 05). Conclusion Some differences in patient pathway were found in this study. Communication and cooperation between medical institutions should be intensified for effective chronic disease control.

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.

Sixty-eight cases undergoing living related renal transplantation in First Hospital of Sun Yat-sen University between April 2004 and August 2007 were selected.The informed consent was obtained from the donors and recipients.The clinical data about operation assistance were retrospectively analyzed,including the pre-operation air sterilization in operation room,preparation of apparatus,one-off utensils and medicine,donor position fixation,assistance in kidney perfusion and preparation,management and usage of medicines,and steps of assistance during operation by instrument nurse.The results show the operational apparatus and utensils were prepared well,and the nurses knew well operation process and worked in harmony with the surgeons.For the 68 donor kidneys,the warm ischemic time was 1-6 minutes,and cold ischemic time was 10-118 minutes.The operations for both donors and recipients ran smoothly and lasted for 2.5-4 hours.Blood loss was less than 200 mL.Vital signs were stable during operation,and no complications happened.Good pre-operative preparation,strict management of personnel participating in operation,and training of assistant techniques are the preconditions for operation assistance.Rigorous aseptic management and correct preservation of organs are the keys for assistance for living donor kidney transplantation.Short warm and cold ischemic time of the donor kidneys are of great importance for the success of operation and the long-term survival of transplanted patients.