Objective:To develop the training syllabus of palliative care for general practitioners.Methods:Twenty-nine experts in fields of general practice and hospice care from different teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April 2022 and August 2022. Based on results of Delphi consultation a preliminary training syllabus was established through data analysis, synthesis and process.Results:Of the 29 experts, 11 (37.9%) were male with age of (52.9±8.9) years and working experience of (17.0±7.2) years. The expert activity coefficient of the two rounds of consultation was 100.0% (29/29) and 96.6% (28/29), authority coefficient was 0.815 and 0.870, and opinion coordination coefficient was 0.359 and 0.515, respectively ( P<0.05). The training syllabus comprised of 4 first-grade indicators, 19 second-grade indicators and 58 third-grade indicators. The weight coefficients of the 4 first-grade indicators, namely objective of training, theory courses and theoretical knowledge, clinical base rotation contents and requirements, community base rotation content and requirements, were 0.251, 0.251, 0.250 and 0.248, respectively. Conclusions:A preliminary training syllabus of palliative care for general practitioner has been developed in this study, which provide a basis for standardized training of community palliative care.

Objective:To develop standards of hospice care specialized clinical training base for general practitioners.Methods:Twenty nine experts in fields of general practice and hospice care were invited to participate in two rounds of Delphi expert consultation from April 2022 to August 2022. Based the results of Delphi consultations the standards of clinical training base for general practitioner hospice care specialized training were developed through data analysis, synthesis and process.Results:The age of 29 consulting experts was (52.9±8.9) years old, and their working years were (17.0±7.2) years, 69.0% (20/29) of them had senior professional titles. In the two rounds of expert consultation, the expert positive coefficient was 100.0% (29/29) and 96.6% (28/29), the expert authority coefficient was 0.791 and 0.830, and the expert opinion coordination coefficient W of the importance of all indicators was 0.177 and 0.296, respectively ( χ2=133.54 , 223.46; P<0.01). Finally, a set of clinical base standards for general practitioner hospice care specialized training was established, which consisted of 4 first-level indicators and 23 second-level indicators. The 4 first-level indicators were basic conditions, teaching conditions, teacher conditions and teaching management, with the weight coefficients of 0.250, 0.250, 0.251 and 0.253, respectively. Conclusions:The clinical training base standards of hospice care specialized training for general practitioners have been established in this study, which will be helpful in selecting appropriate hospitals as the specialized clinical training base for general practitioners.

Objective:To develop standards of hospice care community training base for general practitioners.Methods:Twenty-nine experts in general practice and hospice care from different teaching hospitals and community health service centers were invited to participate in two rounds of Delphi consultation from April to August 2022. Based on the consultations a set of standards of hospice care community training base was developed.Results:The age of experts was 38-75 (52.9±8.9) years, and their working years were 5-32 (17.0±7.2)years. In the two rounds of expert consultation, the expert positive coefficient was 100.0% (29/29) and 96.6% (28/29), the expert authority coefficient was 0.791 and 0.830, and the expert opinion coordination coefficient W of the importance of all indicators was 0.137 and 0.289, respectively ( χ2=114.83, 226.94; P<0.05). A set of hospice care community training base standards for general practitioner was established, which consisted of 4 first-level indicators and 27 second-level indicators. The 4 first-level indicators were basic conditions, teaching conditions, teacher conditions and teaching management, with the weight coefficients of 0.247, 0.248, 0.250 and 0.252, respectively. Conclusion:The standards developed in this study may be used for constructing and evaluating hospice care community training base for general practitioners.

Objective:To construct an evaluation index system for community hospice comfort care.Methods:This was a cross-sectional study. Two rounds of expert consultations were conducted using modified Delphi method from June to September 2023, 14 experts in the field of palliative care nursing were invited to participate in the consultations. Based on the consultation results, an evaluation index system for comfort care of community hospice was preliminarily developed.Results:All consultation experts were females, with an average age of (48±8) years; 9 held senior professonal titles, and 12 had more than 5 years of palliative care-related working experiencs. The positive coefficient of correspondence in two rounds of consultations was 100%, and the degree of authority was 0.841 and 0.834, respectively. The expert coordination coefficients for the importance of secondary indicators were 0.281 (χ 2=182.65) and 0.284 (χ 2=132.98), and the expert coordination coefficients for the operability of secondary indicators were 0.231 (χ 2=150.12) and 0.252 (χ 2=118.01), respectively. The constructed evaluation index system of hospice comfort care consisted of 5 primary indexes and 32 secondary indexes. The five primary indexes were environmental comfort, physiological comfort, psychological comfort, spiritual comfort and social comfort with a weight coefficient of 0.202 3, 0.205 3, 0.205 3, 0.199 4 and 0.187 7, respectively. Conclusion:An evaluation index system for comfort care in community hospice has been preliminarily developed in this study, after validation it would provide a reference for assessing the comfort needs of patients with palliative care.

Objective:To investigate the status quo of pain management for cancer patients in hospice care wards of community health service centers.Methods:The electronic medical records of 373 cancer patients admitted in hospice wards of Kangjian Community Health Center of Xuhui District and Jinshanwei Town Community Health Center of Jinshan District from January 2015 to July 2021 were collected. The characteristics of cancer pain, the use of analgesic drugs, the effects of analgesic drugs and its influencing factors were analyzed.Results:The incidence of cancer pain in 373 patients was 93.0% (347/373), and the proportion of moderate to severe cancer pain was 55.6% (193/347). Analgesics were used in 304 patients, among whom 233 (76.6%) patients used oral analgesics, 297 (97.7%) used on time, 97.6%(285/292) used sustained-release opioids, and 94 (30.9%) used combinedly. Breakout pain occurred in 100 cases (32.9%), all of which was controlled with immediate-release morphine. Cancer pain was not relieved in 132 cases (43.42%), and multivariate logistic regression analysis showed that the pain degree on admission (moderate: OR=3.69, 95 %CI:2.09-6.49; severe: OR=5.52, 95 %CI:2.43-12.53), the presence of burst pain ( OR=3.28, 95 %CI:1.77-6.06), the type of analgesics used (non-steroidal+weak opioids: OR=0.39, 95 %CI:0.20-0.76; nonsteroidal+strong opioids: OR=0.20, 95 %CI:0.08-0.51) and the adverse reactions ( OR=1.92, 95 %CI:1.03-3.60) were the influencing factors of pain relief in cancer pain patients (all P<0.05). Conclusion:The pain of cancer patients admitted to community palliative care wards cannot be ignored. Although most cancer pain patients use analgesic drugs in a standard way, there are still a high proportion of patients whose pain is not controlled. Various factors affect the effect of analgesic treatment.

Myxococcus xanthus is a Gram-negative soil bacterium capable of performing sophisticated cellular behaviors and growing one of the most intricate bacterial single-species biofilms in nature. During the process of biofilm formation, social behaviors of M. xanthus cells dominate key steps of the biofilm establishment, e.g., cellular motility on solid surface, predatory behavior by the grouped cells, kin recognition in the community, fruiting body development, myxospore differentiation, and programmed cell death. This review introduces the recent research progress about the M. xanthus biofilms.

Objective To establish an animal model by placing one end of PICC in the hepatic portal vein of a beagle dog and leaving the other end out of its body.Methods Six Beagle dogs were given respiration anesthesia through orotracheal intubation.An incision was made through the right rectus abdominalis to locate the superior mesenteric vein (SMA) and the main hepatic portal vein.The left branch of SMA was separated and cut to put PICC into the main hepatic portal vein before being ligated and fixed.The other end of PICC was elicited through the right abdominal wall and passed beneath the skin to the back neck and fastened in case of movement.Results The anesthetic effect was good and all the operations were successful.The mean operation time was about an hour and the mean blood loss was about 15 ml.The incision healed 5-7 d after operation.Conclusion The establishment of the model can improve the effects of liver-targeting drugs,which can cut down the dosage,lower the cost of treatment and experiment and reduce the adverse effect of medicines.Through PICC,we can directly draw blood from the hepatic portal vein to measure the blood concentration before the first pass elimination.Then according to the concentration,we can calculate the absorption rate in the gastrointestinal tract,which can facilitate related experimental studies.

BACKGROUNDThe various risk factors for retinal hard exudates are still poorly understood in type 2 diabetic patients. The aim of this study was to determine the association between urinary albumin excretion rate (UAER) and hard exudates in macular region in north Chinese patients.

METHODSA total of 272 patients (272 eyes) were enrolled for this study, including 154 subjects from group 1 (mild hard exudates), 91 subjects from group 2 (moderate hard exudates) and 27 subjects from group 3 (severe hard exudates) confirmed using colour fundus photography, optical coherence tomography (OCT) as well as slit-lamp biomicroscopy with 78 diopter (D) lens. Each participant underwent a comprehensive assessment that included biochemical, clinical characteristics test and detailed ophthalmic evaluation. One-way analysis of variance (ANOVA) test and chi-square test were performed to analyze the fasting blood glucose (FBG), glycated hemoglobin (HbA1c), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), triglycerides (TG), full blood counts, urinary albumin excretion rate (UAER), blood creatinine (CREA), duration of diabetes, body mass index (BMI), systolic blood pressures (SBP) and diastolic blood pressures (DBP) between groups. Ordinal logistic regression analysis was further performed in order to eliminating the possible confounding factors.

RESULTSThree groups were matched in terms of age and gender. Risk factors which showed significant difference between groups include FBG (P < 0.001), HbA1c (P < 0.001), LDL (P < 0.001), UAER (P < 0.001), duration of diabetes (P = 0.001), TC (P = 0.005), SBP (P = 0.026), CREA (P = 0.004) and haemoglobin (Hb) (P = 0.012). There was no significant difference between groups for the TG, HDL, DBP, platelet, total white blood cells and BMI. Using ordinal Logistic regression analyses, of all the variables, HbA1c, LDL and UAER which were independent risk factor for hard exudates showed a significantly odds ratio of 1.25, 3.07, and 1.39, respectively. There were also significant differences in UAER level between patients with mild, moderate, severe hard exudates groups (P < 0.001).

CONCLUSIONSUAER was an independent risk factor associated with retinal hard exudates in macular region in type 2 diabetic patients. This study highlights the need for close monitoring and fundus examination for hard exudates in patients with elevated UAER to prevent irreversible visual loss.

Aged ; Albuminuria ; physiopathology ; Diabetes Mellitus, Type 2 ; physiopathology ; urine ; Female ; Humans ; Macular Edema ; physiopathology ; urine ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

The corticosteroids are the first-line therapeutical agents for non-infectious uveitis patients, but systemic corticosteroids are ineffective for some chronic or recurrent patients, and have many long term usage-related side effects; these patients may need treatment of immunosuppressive agents and/or biologic agents. However, the mechanism, indication, efficacy and side-effects of each type of the immunosuppressive agents or biologic agents are not identical. In clinical practice, we should use different and sensitive immunosuppressive agents or biologic agents for different types of uveitis, and watch their efficacy and toxic effects closely. In order to improve the effectiveness of the treatment, the classification,efficacy and existing concerns of commonly used uveitis drugs need to be further clarified.

Objective To study the methodology and results of the auricle repair with expanded skin flap in mastoid process area and Medpor support in children with congenital malformation.Methods Thirty cases of congenital malformation were enrolled with age ranged from 5～16 years old.Whole auricles were all reconstructed with an expanded skin flap in mastoid process area and Medpor support.Resuits In all successful cases.their repaired auricles had the natural complexion and profile,and the positions were symmetric with healthy one,but in 2 cases(age group of 11-16 years),the expanded skin flap had less skin grafting.Conclusion It is suggested that optional operation time might be selected before 10 years old,because their psychological trauma could be avoided owing to microtia and in that age the size of the expanded flap is larger enough to reconstruct the ear as their auricle iS well-developed.