Objective:To investigate the recognition of the post competency index system among rural general practice assistant physicians and its influencing factors.Methods:This study was a cross-sectional survey. A questionnaire survey on the recognition of post competency index system was conducted from October 2020 to September 2021 among rural general practice assistant physicians from 10 provinces/municipalities selected by stratified cluster sampling method. The recognition of rural general practice assistant physicians at all levels of indexs and the factors influencing recognition were analyzed.Results:A total of 1 123 questionnaires were distributed and 1 024 valid ones were collected with a recovery rate of 91.18%. Of the 1 024 respondents, 529 were male(51.7%) and 435 were aged 40-49 years(42.5%), which was the highest proportion by age group. The average overall recognition score of the index system was 4.41, and the scores of the primary indexes were 4.32-4.45. Three primary indexes had the highest recognition scores: professional competence, basic health care services, and interpersonal communication and teamwork. The recognition scores on the second level index were 4.18-4.61, and the proportion of recognition scores greater than 4 was over 80%. There were significant differences in the recognition scores of the index system among assistant physicians with different working years, educational background, professional title and work unit ( F/H=6.41, 14.83, 12.45, 7.53, P<0.01). Educational background(associate degree: B=0.091, P=0.015; bachelor degree and above: B=0.196, P<0.001) and professional title(intermediate professional title and above: B=-0.234, P<0.001) were the independent factors influencing the recognition degree of the index system for rural general practice assistant physicians. Conclusions:The post competency index system is generally recognized by rural general practice assistant physician, and academic qualifications and professional title status may influence its recognition.

Objective:To survey the status quo and influencing factors of contracted family doctor pay services in urban communities of Suzhou city.Methods:This study was a cross-sectional study. A questionnaire survey on the status quo and influencing factors of contracted family doctor pay services was conducted from July to October 2022 among 750 residents from 40 communities of 4 subdistricts in Suzhou Gusu District, selected by stratified random sampling method. A self-designed questionnaire was used for the survey, which included demographic information, status quo of pay services among residents and factors influencing the service contracting. Chi-square test and binary logistic regression were used to analyze the influencing factors of contracted family doctor pay services.Results:A total of 750 questionnaires were distributed, with 720 valid ones returned at a recovery rate of 96.0%. Among the 720 residents, 370 (51.4%) were female, and 300 (41.7%) were between the age of 35 and 60 years old. There were 71 residents who had contracted pay services with a contracting rate of 9.9% (71/720), and the renewal rate was 80.3% (57/71). The top 3 reasons for signing the contract were health guidance (67.6%, 48/71), medical counselling (63.4%, 45/71) and 3 free consultations (57.7%, 41/71). The top 3 reasons for not signing a contract were not needing services (49.9%, 324/649), not knowing about contracted services (41.9%, 272/649) and rarely visiting the community health service center (25.6%, 166/649). Age ( χ2=21.072), marital status ( χ2=10.969), knowing the family doctor team ( χ2=145.954), knowing the family doctor contract system ( χ2=133.981), knowing the content and the rights of the contracted services ( χ2=132.905), using primary medical institutions as first choice for common and chronic diseases ( χ2=13.532), multiple comorbid chronic diseases ( χ2=30.024), being agreed by family members ( χ2=46.258), signing contract in family members ( χ2=108.833) or relatives and friends ( χ2=47.492), and experience in community health service centers ( χ2=26.116) were significantly associated with the contract signing (all P<0.05). Logistic regression analysis showed that knowing family doctor team well ( OR=23.13,95% CI:5.05-105.97) or very well( OR=95.28,95% CI: 10.71-847.68); having ≥3 chronic diseases compared to no chronic diseases ( OR=5.60, 95% CI: 1.88-16.75, P<0.05); contracting agreed by family members compared to not agreed ( OR=2.66, 95% CI: 1.03-6.84, P<0.05); signing contract in family members compared to not signing ( OR=4.42, 95% CI:2.05-9.55, P<0.05) were independent influencing factors of signing contract of family doctor pay services. Conclusions:The rate of contracted of family doctor pay services in Gusu District of Suzhou City is relatively low. Knowing the family doctor team, having multiple comorbid chronic diseases, agreement among family members, and signing contract in family members are influencing factors of contracted family doctor pay services.

Objective:To explore the impact of health self-focused attention on knowledge, attitude and practice of health management in patients with essential hypertension.Methods:This was a cross-sectional study. A total of 190 patients with essential hypertension were randomly selected from Shanghai Dapuqiao Community Health Service Center to participate in a questionnaire survey from October to December, 2021. The contents of the questionnaire included the general information of the patients, the degree of influence of hypertension on individuals, and the patients′ knowledge and personal cognition of hypertension, self-management behaviors, health self-focused attention, and blood pressure control. SPSS 25.0 and AMOS 24.0 were used to develop a structural equation model for analysis.Results:The recovery rate of questionnaires was 100.0% (190/190). Of the 190 patients, there were 82 males and 108 females with a mean age of (71.2±8.5) years. According to blood pressure, 190 hypertensive patients were divided into blood pressure controlled group ( n=119) and blood pressure non-controlled group ( n=71). There were significant differences in the total scores of hypertension self-management behavior and health self-focused attention between the two groups ( P<0.05). Correlation analysis showed that the degree of influence of hypertension on individuals was negatively correlated with the disease knowledge and personal cognition, and the performance of hypertension self-management behavior ( r=-0.39 and -0.28, P<0.01), while the disease knowledge and personal cognition were positively correlated with the performance of hypertension self-management behavior and health self-focused attention ( r=0.29 and 0.27, P<0.01). Hypertension self-management behavior was positively correlated with health self-focused attention and blood pressure control ( r=0.28 and 0.48, P<0.01), and health self-focused attention was positively correlated with blood pressure control ( r=0.21, P<0.01). The equation model analysis showed that health self-focused attention had a driving effect on patients′ disease knowledge and cognition and self-management behavior. Health self-focused attention significantly affected patients′ mastery of disease knowledge and formation of correct cognition (path coefficient=0.28). In addition, hypertension patients′ disease knowledge storage and internal recognition of prevention and treatment strategies determined their self-management behavior (path coefficient=0.20). On the other hand, the impact of hypertension on patients life, work and economic burden played a negative role in their acceptance of disease management knowledge, formation of correct concepts, and adoption of self-management behaviors with adjustment coefficients of -0.48 and -0.22, respectively. Conclusion:Health self-focused attention may play an initial role in the process of changing the knowledge, attitude and behavior of hypertension patients.

Objective:To explore the efficacy of online pulmonary rehabilitation (PR) management among community-dwelling patients with stable chronic obstructive pulmonary disease (COPD).Methods:This study was a single-center randomized controlled trail with an unblinded design. A total of 130 patients with stable COPD who visited Zhuanqiao Community Health Service Center in Shanghai Minhang District from October 2020 to March 2022 were randomly divided into study group and control group with 65 cases in each group. Both groups received conventional treatment, while patients in study group attended online rehabilitation management, including face-to-face rehabilitation instruction and multiple online guidance. Pulmonary ventilation function including forced vital capacity (FVC), forced expiratory volume in the first second (FEV 1) and percentage of forced expiratory volume in the first second to forced expiratoty volume (FEV 1%pred), modified British Medical Research Council Dyspnea Scale (mMRC), chronic obstructive pulmonary disease assessment test (CAT), score of 6 minutes walking distance (6MWD) and DOSE (dyspnea, degree of airflow obstruction, smoking status, the number of exacerbation) index were measured at baseline and after 8 weeks of rehabilitation, and compared between two groups. Results:The baseline data of the two groups were comparable. After 8 weeks of management, FVC, FEV 1, FEV 1%pred, mMRC, CAT, 6MWD and DOSE index of both groups were improved compared with the baseline level(control group: t=-7.799, -7.581, -9.010, 3.565, 9.887, -16.677, 3.795; study group: t=-12.623, -13.914, -17.644, 7.404, 22.457, -26.826, 7.968; all P<0.05). The FEV 1%pred, CAT and 6MWD in the study group were better than those in the control group ( t=-2.939, 2.277,-2.130, all P<0.05); while there were no significant differences in FVC, FEV 1, mMRC and DOSE index between the two groups( t=-0.162, -1.280, 0.925, 1.939,all P>0.05). Conclusions:The online pulmonary rehabilitation management can better improve lung function, dyspnea symptoms and exercise tolerance of patients with stable COPD, which can be used for rehabilitation training and management of community-dwelling patients.

Objective:To survey the continuing medical education training needs for village doctors in Beijing suburbs.Methods:A qualitative study on the continuing medical education training needs for village doctors was conducted in Beijing Huairou district from March to July 2021. Six township hospital managers, 19 village doctors, 15 village cadres and 30 villagers from 15 villages of 3 townships in the district selected by purposive sampling method attended the face-to-face, individual, in-depth interviews. A semi-structured interview outline was developed based on literature review and expert consultation. The content of the interviews was analyzed by the thematic framework method.Results:Among 19 rural doctors, 11 preferred the full-time training, while 8 were unable to participate in the full-time training. Most of township hospital managers and village doctors thought the ideal form of training was "classroom knowledge teaching teaching" (5/6, 16/19)and "outpatient clerkship"(6/6, 13/19). The training contents for village doctors were basic medical knowledge and skills, including diagnosis and treatment of common diseases, identification of common symptoms and management of chronic diseases; the appropriate techniques of traditional Chinese medicine including acupuncture, moxibustion, cupping and scraping; and public health including epidemic prevention and control, infectious disease detection and reporting.Conclusion:For improving the applicability and practicality of training for village doctors, it is necessary to apply rational training methods and forms, and develop targeted training program and contents based on training needs.

Objective:To investigate the correlation between CHA 2DS 2-VASC score and the recurrence risk of paroxysmal atrial fibrillation after radiofrequency ablation. Methods:It was a retrospective cohort study. A total of 150 patients who underwent radiofrequency ablation for paroxysmal atrial fibrillation in Xingtai People′s Hospital from January 2017 to January 2021 were consecutively included in the study. According to the preoperative CHA 2DS 2-VASC score, patients were divided into high score group (≥3 points, n=90) and low score group (<3 points, n=60). Baseline clinical data was collected. All patients underwent circumferential pulmonary vein isolation, and those with atrial flutter before ablation also underwent tricuspid isthmus isolation. Holter and electrocardiogram examinations were performed at 3, 6 months and 1 year after ablation to evaluate whether there was recurrence of atrial fibrillation. Univariate and multivariate Cox regression was used to analyze the risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Results:Among 150 patients 90 were males and 60 were females with a mean age of (64.0±3.6) years. There were no significant differences in age, sex, and proportion of hypertension, diabetes, chronic heart failure and stroke or transient ischemic attack (TIA), medication of antiarrhythmic and anticoagulant drugs between the two groups (all P>0.05). The longest duration of atrial fibrillation in the high score group was significantly longer than that in the low score group (26.0±6.1) hours vs. (10.0±2.1) hours, P<0.05). There were no patients with cardiac tamponade, atrial esophageal fistula and severe vascular puncture complications in the two groups. During the follow-up period, the recurrence rate in the high score group was significantly higher than that in the low score group (16.7% (15/90) vs. 8.3% (5/60), P<0.05). Multivariate Cox regression analysis showed that CHA 2DS 2-VASC score≥3 was an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation ( HR=3.84, 95% CI: 1.87-7.89, P=0.02). Conclusion:CHA 2DS 2-VASC score≥3 is an independent risk factor for atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation.

The clinical data of 160 elderly patients with upper urinary tract stones who underwent flexible ureteroscopic lithotripsy (FURL) in Beijing Hospital from May 2021 to November 2022 were retrospectively analyzed, including 80 patients with ambulatory surgery (study group) and 80 patients with the traditional surgery (control group). The efficacy and safety were compared between two groups. There were no significant differences in the rate of complete stone removal (91.3% (73/80) vs. 90.0% (72/80), P>0.05), operation time (60.0 (41.0, 90.0)min vs.61.0(50.0, 96.5)min, P>0.05), and incidence of postoperative systemic inflammatory response syndrome (SIRS) (8.8% (7/80) vs.12.5% (10/80), P>0.05) between two groups, while the postoperative length of hospital stay (5.0 (5.0, 6.0)h vs. 18.0 (16.2, 30.0)h, P<0.05) was shorter and the medical expenses ((20 696.7±4 645.5)Yuan vs. (31 030.8±6 275.1)Yuan, P<0.05) was less in the study group than those in the control group. The study indicates that the day surgery mode of flexible ureteroscopic lithotripsy has advantages of faster recovery and less cost over the traditional surgery mode for elderly patients.

A 6-month primary care quality improvement (QI) project was conducted for 63 general practice residents at Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from November 2021 to April 2022. The effectiveness of the QI project on the post competency of general practice residents was comprehensively assessed by three dimensions: self-satisfaction, objective evaluation and teacher-evaluation. The overall satisfaction score of general practice residents was significantly increased after the implementation of QI project((3.83±0.67) vs. (3.41±0.63), t=3.35, P=0.009). The total score of objective assessment was increased from (73.48±8.04) before the project implementation to (78.14±5.24) after the implementation ( t=3.37, P=0.001). The total score of training effectiveness significantly increased from (57.57±11.84) before the project implementation to (79.27±8.40) after the implementation ( t=30.07, P<0.001). The results indicate that the primary care QI project can improve the post competency of general practice residents, and also improve the self-satisfaction of residents for active learning and participation in the training.

The community teaching bases play an important role in training of general practice talents. To raise the training quality, the development of their own capacity is crucial, but community medical institutions also need close cooperation with the departments of general practice in medical schools and the higher-level general hospitals. This article discusses the integration model of management, teaching and research in general practice talent training based on the cooperation of community teaching bases with relevant governmental departments, professional societies/associations, general hospitals and medical schools.

Poststroke cognitive impairment (PSCI) is a common complication after ischemic stroke, which seriously affects the recovery of neurologic function and lowers the quality of daily life of patients. In a considerable portion of patients, the PSCI is reversible. This article reviews the influencing factors of cognitive impairment after ischemic stroke, including genetic predisposition, demographic factors, lifestyles, clinical manifestations, imaging findings and drug administration, etc. to provide references for prevention and intervention of PSCI.