Objective This study aims to assess the effect of Problem-Based Learning(PBL)and Case-Based Learning(CBL)based on the Plan-Do-Check-Act(PDCA)cycle on the quality control training for clinical residents in medical record writing on the first page.Methods A total of 293 clinical residents who participated in first page of medical record writing train-ing in 2021 in a hospital were selected as control group,and 243 clinical residents who participated in first page of medical record writing training in 2022 were selected as observation group.The control group were trained only with the PBL+CBL teaching method,while the observation group with the PDCA cycle in combination with PBL+CBL teaching methods.Upon completion of the training,the two groups were compared in terms of scores on basic theoretical examinations.Results The observation group showed a significantly higher average theoretical score compared to the control group(84.41±12.27 vs.74.32±14.39,P＜0.05).Conclusion PBL and CBL teaching methods based on PDCA cycle can enhance the effect of quality control training for clinical residents in medical record writing on the first page,ultimately improving the quality of medical record writing on the first page and ensuring that objectivity,accuracy,and authenticity of information on the first page.

Objective Based on the problems existing in the DRG grouping of non-enrolled medical records in a tertiary hospital,analyze the impact of disease nature on surgical coding,propose solutions,and continuously improve the quality of med-ical record data.Methods From January to June 2022,the medical records reported to the DRG group in the medical records room were found by the data center platform of the DRG inpatient medical service detection and analysis system,and the number of cases in which the medical records were not included in the DRG group due to the disease nature of the surgical operation name was found,and the defects were cited,classified,counted and analyzed.And the statistical analysis of the cost before and after the revision of the surgical code,and discuss the solution.Results After statistical analysis,it was found that the causes of 377 non enrolled medical records were related to the main diagnosis and surgical procedures,accounting for 85.46%.The main diag-nosis and surgical procedures were 55 cases of mismatched surgical procedure codes due to the nature of the disease.Conclusion The issue of not being included in the medical record is essentially a matter of the nature of the disease and surgical procedures in the main diagnosis.Medical record information managers should strengthen the management and training methods of medical record writing,improve their ability to diagnose and write medical records,ensure the accuracy of medical record homepage data and DRG grouping data,and improve enrollment rates.

Objective:To evaluate the effect of maternal depressed mood at pregnancy and postpartum on the risk of emotional or behavioral disorders of offspring by meta-analysis. Methods:The following Mesh words and free words were searched in 7 online databases, including the PubMed, Embase, Web of Knowledge, PsycINFO, Cochrane, WanFang databases and China National Knowledge Infrastructure from January 1, 2000 to October 31, 2020: " maternal" AND " depression" AND " child OR offspring" AND " neuropsychology" . According to the inclusion and exclusion criteria, case-control and cohort studies reporting the effect of maternal depressed mood during pregnancy or postpartum on the risk of emotional or behavioral disorders of offspring were reviewed. Meta-analysis was performed by RevMan 5.3. Results:Fourteen studies involving 3 914 in the case group and 17 016 in the control group were included.Children whose mother with depressed mood during pregnancy or postpartum had 2.03 times risk of emotional or behavioral disorders than those whose mothers without depressed mood ( OR=2.03, 95% CI: 1.55-2.65). Both depressed mood at pregnancy and postpartum could increase the incidence of emotional or behavioral disorders in children, but there was no significant difference between these two periods ( Z=-0.371, 95% CI: 0.796-1.168). Moreover, the effect of maternal depressed mood on emotional or behavioral disorders in offspring could last to the preschool and school period, and the children in the school period may have higher incidence of emotional or behavioral disorders than those during the preschool period ( Z=-2.340, 95% CI: 0.643-0.962). Conclusions:Maternal depressed mood can increase the incidence of emotional or behavioral disorders in offspring, which are long-lasting and do not decrease with age.

The oral cavity of each person is home to hundreds of bacterial species.While taxa for oral diseases have been studied using culture-based characterization as well as amplicon sequencing,metagenomic and genomic information remains scarce compared to the fecal microbiome.Here,using metagenomic shotgun data for 3346 oral metagenomic samples together with 808 published samples,we obtain 56,213 metagenome-assembled genomes(MAGs),and more than 64％of the 3589 species-level genome bins(SGBs)contain no publicly available genomes.The resulting genome collection is representative of samples around the world and contains many genomes from candi-date phyla radiation(CPR)that lack monoculture.Also,it enables the discovery of new taxa such as a genus Candidatus Bgiplasma within the family Acholeplasmataceae.Large-scale metagenomic data from massive samples also allow the assembly of strains from important oral taxa such as Por-phyromonas and Neisseria.The oral microbes encode genes that could potentially metabolize drugs.Apart from these findings,a strongly male-enriched Campylobacter species was identified.Oral sam-ples would be more user-friendly collected than fecal samples and have the potential for disease diagnosis.Thus,these data lay down a genomic framework for future inquiries of the human oral microbiome.

Objective:To explore the effects of Zusanli acupoint massage combined with abdominal touching on feeding intolerance (FI) of premature infants. Methods:A total of 100 premature infants meeting the inclusion criteria in neonatal ward of the hospital from January 2018 to June 2020 were divided into control group (50 cases) and observation group (50 cases) by random number table method. The control group was given routine treatment and feeding, while observation group was given Zusanli acupoint massage and abdominal touching on the basis of control group. The feeding observation indexes, three immunoglobulin indexes, FI and complications were compared between the two groups. Results:The feeding transition time (8.57 ± 2.35 d vs. 11.60 ± 4.38 d, t=4.310) and the time of returning to birth weight (9.11 ± 1.79 d vs. 10.48 ± 2.34 d, t=3.289) in observation group were significantly shorter than those in control group ( P<0.05), and feeding efficiency (9.48 ± 2.07 ml/min vs. 7.16 ± 2.30 ml/min, t=5.302) was significantly higher than that of control group ( P<0.05). The incidence rates of FI [14.0% (7/50) vs. 42.0% (21/50); χ2=9.722, P<0.01] and apnea [12.0% (6/50) vs. 32.0% (16/51); χ2=5.828, P<0.01]. Conclusion:Zusanli acupoint massage combined with abdominal touching is beneficial to improve feeding performance of premature infants, recover birth weight as soon as possible, achieve total intestinal feeding and improve early feeding tolerance.

OBJECTIVES: To assess the accuracy and influential factors for hypertension prevalence based on questionnaire interview by on-site measurement. METHODS: Data were from the baseline surveys for chronic diseases among residents ages ≥18 years old in 4 districts/counties of Changsha between 2013 and 2014. All surveys adopted multi-stage random sampling to select samples. The Bootstrap resampling method was used to randomly select 1 000 repeated samples with replacement to obtain robust estimate of subgroup prevalence rates. Hypertension prevalence was calculated by using the data from both questionnaire interview and on-site measurement. Using the results of on-site measurement as the golden standard, the accuracy of questionnaire interview and 95% uncertainty interval were estimated. Multivariate logistic regression was used to investigate the influential factors for the underestimated hypotension prevalence based on questionnaire interview. RESULTS: The hypertension prevalence from on-site measurement among the residents in the 4 districts/counties of Changsha was significantly higher than that from questionnaire interview (prevalence ratio: 1.26-2.31). Taking the results of on-site measurement as the golden standard, the sensitivity of questionnaire interview on hypotension prevalence range from 41.76% to 74.83% among the 4 districts/counties, and the specificity fell between 98.51% and 99.46%. The underestimation in questionnaire interview was more likely to occur in the youngest age group (18-34 years old), males, and residents were at lower levels of education in all 4 districts/counties. CONCLUSIONS Compared with the on-site measurement, questionnaire interview significantly under-estimate the hypertension prevalence, suggesting that the on-site measurement method should be firstly considered in epidemiological surveys for hypertension prevalence. If only the questionnaire method can be used to collect data due to conditions, it is necessary to make corresponding corrections to the questionnaire results with reference to relevant research evidence.
Adolescent ; Adult ; China ; Humans ; Hypertension ; epidemiology ; Logistic Models ; Male ; Prevalence ; Risk Factors ; Surveys and Questionnaires ; Young Adult

Objective To explore the value of contrast-enhanced ultrasound (CEUS) in improving the diagnosis ability for xanthogranulomatous cholecystitis ( XGC ) and wall-thickening gallbladder cancer ( GBC) . Methods Forth-three patients with XGCs and 31 patients with wall-thickening GBCs proved by pathology were enrolled in this study ,the features on conventional ultrasound and CEUS were recorded ,and the preliminary diagnosis before and after CEUS were given by doctors . Results Significant differences were found in continuous gallbladder inner wall and arterial blood supplement on conventional ultrasound , 58 .1％ (25/43) had continuous inner wall and 34 .9％ (15/43) had arterial blood flow in XGCs compared to 19 .4％ (6/31) and 100％ in GBCs . On CEUS ,72 .1％ (31/43) demonstrated continuous gallbladder inner wall and 48 .8％ (21/43) had hypoechoic nodules in the wall in XGCs compared to 16 .1％ (5/31) and 19 .4％ (6/31) in GBCs ,respectively ( P <0 .05) . No significant difference was found in intra-calcification , infiltration to adjacent organs ,gallbladder stones and fast-in and fast-out enhanced pattern( P >0 .05) . The area under ROC curve was improved from 0 .701 to 0 .899 after combining with CEUS ( P < 0 .05 ) . Conclusions Conventional ultrasound combining with CEUS could help acquiring more effective ultrasonic information and may improve the differential diagnosis ability of XGCs and GBCs .

Objective:To investigate the insured and uninsured status of medical insurance among residents in Hunan province and the influential factors for uninsured status.Methods:A stratified,muti-stage,cluster sampling was used to select 7 rural counties and 7 urban districts from 122 counties/districts.In each selected county/district,5 towns were chosen at random.2 villages (or communities) were further selected in each given town randomly.At last,households were selected from sample villages (or communities) using systematic sampling and all members of selected households were surveyed through face-to-face interview.Complex sampling weights were considered to estimate the coverage rate of medical insurance and 95％ confidence interval.We used logistic regression to identify significant factors for not purchase insurance.Results:The overall coverage rate of medical insurance was 95.76％(95％ CI 93.04％ to 98.49％) in Hunan residents,and 4.24％ (95％ CI 1.51％ to 6.96％) of surveyed residents did not participate in any medical insurance program.Particularly,the proportion of residents not participating in any medical insurance program approached 10.17％ among urban residents under 18 years.Age,household income per capita,without chronic disease,were found being associated with uninsured status of medical insurance.Conclusion:To achieve the goal of universal health coverage by 2020,social medical insurance department should take measures to raise the coverage rate of medical insurance among residents.

To evaluate the status and influential factors for prenatal care and postpartum visit among pregnant women in Hunan Province from 2008 to 2013 based on the data from the First Health Service Survey in Hunan Province.
 Methods: Based on the data of prenatal care and postpartum visit among pregnant women from the First Health Service Survey of Hunan Province in 2013, proportion of pregnant women, who didn't meet the criteria for prenatal care and postpartum visit, were calculated (≥5 times for prenatal care and ≥2 times for postpartum visit, according to the National Basic Public Health Service program, 2009 Edition). Multivariable logistic regression models were used to identify the influencial factors.
 Results: A total of 1 035 eligible women were included in data analysis. The proportion of pregnant women who did not meet the criteria were 40.12% (95% CI 24.91%-55.33%) for prenatal care and 64.88% (95% CI 39.70%-90.06%) for postpartum visit. After adjusting other confounding factors, pregnant women with middle- and high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.41 and 0.39, respectively. Multiparae had higher proportion of not meeting the criteria than primiparas, with adjusted odds ratio of 1.54, and pregnant women with age 25-34 years and 35-64 years had lower proportions of not meeting the criteria than those with age 15-24 years. In term of postpartum visit, pregnant women with middle- to high-income had lower proportions of not meeting the criteria than those with low-income, with adjusted odds ratios of 0.50, 0.46 and 0.54, respectively; multiparae had higher proportion of not meeting the criteria than primiparas, with the adjusted odds ratio of 2.30.
 Conclusion: Proportions of pregnant women of not meeting the criteria are high in Hunan Province. Local government should strengthen the management to decrease the proportions of pregnant women who do not meet the standard in prenatal care and postpartum visit, especially for those mulparae with low family income and young age.
Adult ; Age Factors ; China ; epidemiology ; Female ; Health Services Accessibility ; statistics & numerical data ; Humans ; Income ; statistics & numerical data ; Logistic Models ; National Health Programs ; statistics & numerical data ; Odds Ratio ; Parity ; Postnatal Care ; statistics & numerical data ; Pregnancy ; Prenatal Care ; statistics & numerical data ; Surveys and Questionnaires

Objective To investigate the bacteria identification and clinical features of brucellosis in Qingdao City.Methods A retrospective analysis was performed on the clinical data,including general situation,clinical symptom,bacterial culture and laboratory findings,etc of 34 patients with brucellosis in the Affiliated Hospital of Qingdao University from April 2010 to November 2014.Results Among the 34 patients,24 were male and 10 were female,aged from 12 to 71.The main clinical manifestations included fever,diaphoresis and arthralgia,and merged multiple organ symptoms.After cultured for 3 to 5 days,16 blood samples were positive,6 tissue samples were positive,with 2 positive in both samples.Thirty-four cases were identified Brucella species.Besides liver parameters abnormality and anemia,elevation of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were the most common laboratory findings.Patients got better prognosis after antibiotic combination therapy.Conclusions With increasing numbers of brucellosis cases in non-endemic areas,we should pay attention to bacteriological culture and other confirmation tests.On the other hand,techniques such as morphology and growth characteristics of Brucella should be mastered to prevent laboratory infection.