Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-03-26 Cooperative journals: 《中国全科医学》
Abstract： Background The level and quality of diagnosis and treatment of Helicobacter pylori（Hp）infections in Shanghai's community health service Institutions is unclear，and there is a lack of systematic evaluation and monitoring. Objective To understand the current status of diagnosis，treatment and management of Helicobacter pylori（Hp）infection in community health centers in Shanghai，to evaluate the quality of diagnosis and treatment，and to explore the problems and improvement measures. Method A questionnaire was distributed to a total of 249 community health centers in 16 administrative districts of Shanghai and 3 875 general practitioners（GPs）working in the community health centers from May to June 2022 to investigate the standardization of prescriptions for the eradication of Hp infections in the community health centers，the detection of Hp infections，the provision of drugs for the eradication of Hp infections，the management of Hp infections，the difficulties of Hp infections in the treatment of Hp infections，as well as the knowledge of community-based GPs on the diagnosis and treatment of Hp infections. Result The result of the prescription eradication program for Hp infection in primary health care facilities in Shanghai was only 32.0 percent correct. The proportion of health service centers with the ability to conduct Hp infection testing in primary healthcare institutions in Shanghai is high，nearly 80%. Most of the community health service centers were able to equip the basic medicines needed for the eradication of Hp，but the rate of bismuth equipment was low，54.6%. The rate of Hp diagnosis and treatment standard supervision was 80.0%. The demand for the training of standardized diagnosis and treatment of Hp infections was high，accounting for 66.7%. The main difficulties in Hp infection diagnosis and treatment were incomplete drug provision，insufficient doctor's diagnosis and treatment ability and insufficient equipment. Community general practitioners do not have enough basic knowledge about the diagnosis and treatment of Hp infection. Conclusion The capacity to conduct Hp testing needs to be further strengthened in primary care organizations in Shanghai，especially in remote community health service centers，including the purchase of more Hp-related testing equipment and reagents，and the completion of related medications needed for the eradication of Hp. In addition，it is necessary to further strengthen the standardized diagnosis and treatment training of Hp infection for community health centers，improve the diagnosis and treatment ability of general practitioners on Hp infection，and at the same time，strengthen the supervision of Hp diagnosis and treatment standardization，so as to further improve the diagnosis and treatment ability of community general practitioners on Hp infection.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-03-04 Cooperative journals: 《中国全科医学》
Abstract： Background Surgery is one of the main means of treating colorectal cancer. However，patients with colorectal cancer need to face many physical and psychological problems after surgery，which seriously affects patients’ treatment outcomes and quality of life，so how to carry out effective postoperative management is extremely important. Objective To investigate the effectiveness of an integrated hospital-community-patient chronic disease management pathway intervention for postoperative colorectal cancer patients. Methods Based on different postoperative interventions，colorectal cancer patients were divided into a control group （n=40） and a co-management group （n=36），with the control group implementing conventional postoperative interventions and the co-management group following a constructed integrated chronic disease pathway for co-management. Changes in laboratory indices，recurrent metastasis，death，postoperative complications，quality of life，and anxiety were compared between the two groups before and after surgery. Results At 3 and 6 months postoperatively，patients in the co-management group had lower carcinoembryonic antigen levels than patients in the control group （1.4 ng/mL vs.3.2 ng/mL，χ2 =-4.653，P<0.001；2.6 ng/mL vs. 3.8 ng/mL，χ2 =-3.634，P<0.001）. The incidence of recurrent metastases was not significantly different from that of the control group at 3 months postoperatively （P>0.05），while at 6 months postoperatively，the incidence of recurrent metastases was lower in the co-management group than in the control group （5.6% vs. 22.5%，χ2 =4.395，P=0.036）；in addition，the incidence of complications was lower in the co-management group than in the control group at both 3 and 6 months postoperatively（0 vs. 16.2%，χ2 =3.981，P=0.046；5.6% vs. 25.0%，χ2 =5.388，P=0.020）.However，the difference in mortality at 6 months postoperatively between the two groups was not significant （2.8% vs. 7.5%，χ2 =0.165，P=0.685）. In quality of life scores at 6 months and 1 year postoperatively，the co-management group was higher than control patients ［（48.74±2.16）points vs. （44.73±3.41）points，t=-5.922，P<0.001；（42.03±1.94）points vs.（36.98±4.65）points，t=-5.952，P<0.001］，and the anxiety scores were lower in the co-management group than in the control patients ［（60.12±6.23）points vs.（63.56±4.72）points，t=2.650，P=0.010；（66.49±5.67）points vs.（72.41±5.25）points，t=4.600，P<0.001］. Conclusion The integrated hospital-community-patient chronic disease management pathway can reduce postoperative complications，decrease recurrence and metastasis of colorectal cancer，improve quality of life，and improve anxiety symptoms，and is of great value to the prognosis of postoperative colorectal cancer patients.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： Primary health care institutions undertake a range of crucial health-related responsibilities. With the continuous advancement in the medical field，community health service institutions have significantly improved their hardware conditions and effectively enhanced their capacity for health information systems，thereby highlighting the growing demand of individuals to receive specialist diagnosis and treatment within the community. This paper discusses the significance， connotation，implementation strategy，and method of constructing specialized disease diagnosis and treatment technology in the community. The article emphasizes that developing specialized disease diagnosis and treatment technology in community health services can enhance the proficiency of general practitioners，improve primary medical technology standards，elevate community health service levels，and meet public demands for specialized disease diagnosis and treatment. The development of comprehensive-specialty integration entails not only advancing specialized diagnostic and treatment technologies based on general practice work but also collaborating with higher-level hospitals to introduce a series of specialized technologies for joint diagnostic and treatment efforts. In terms of specific implementation strategies，it is essential to identify appropriate specialized technologies based on local diagnostic and treatment needs while conducting applied basic research on clinical method deficiencies throughrecruited expertise. Gradually establishing distinctive technical brands will help build momentum towards creating a specialization#2;focused development base.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： The professional capacity and infrastructure of general practitioners in grass-roots medical and health institutions in China are relatively weak，and the energy of specialists in general hospitals is limited and resources are abundant， so we will further integrate the medical resources of community health institutions and general hospitals and strengthen the cooperation between general practitioners and specialists. In order to better protect the quality of medical care and promote the health of patients. This paper systematically sorts out the typical practices and experiences of the construction of outpatient clinics of combination of general practice and specialty，and takes the source，connotation，construction path and construction path of the concept of full-specialty combination of outpatient clinics Development effectiveness，existing problems and strategic recommendations are elaborated. Point out the challenges that may be faced in the construction of outpatient clinics of combination of general practice and specialty management model. In addition，in view of the innovative practices of each region，five aspects of suggestions are put forward in combination with existing problems: Improve the rules and regulations for the construction of outpatient clinics of combination of general practice and specialty，coordinate and unify the outpatient path of outpatient clinics of combination of general practice and specialty，pay attention to the protection of outpatient clinics of combination of general practice and specialty teams，clarify the population of outpatient clinics of combination of general practice and specialtyservices，and improve the health evaluation system for the outcomes of outpatient clinics of combination of general practice and specialty.In order to provide reference for the country to carry out the construction of outpatient clinics of combination of general practice and specialty in depth.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-01-31 Cooperative journals: 《中国全科医学》
Abstract： The development of the clinical diagnosis and treatment technology combined with general practice and specialist is an important measure to improve the comprehensive service level of community health centers（CHCs），promote the more reasonable medical order，and implement hierarchical medical system. In this article，we find that most of CHCs in the city have carried out the clinical diagnosis and treatment technology combined with general practice and specialty，by analyze the documents related to the development of community health in Shanghai and published literature，and combine the survey results of these technologies carried out by Shanghai community health institutions. It has become an important strategy for CHCs to improve their clinical capacity，the development of these technologies，by focusing on common and frequently-occurring diseases in the community，and combining its own medical advantages，to select appropriate disease types. However，during the development of the clinical diagnosis and treatment technology combined with general practice and specialist，there are some difficulties，such as the lack of relevant talents in the community and awareness of some experts on community specialized services，the difficultyof in-service education of general practitioners，besides，specialized drugs in the community and brand publicity on community characteristic technologies are also indispensible. The development of the clinical diagnosis and treatment technology combined with general practice and specialist in the community needs the policy support of the health administrative department. We suggest that CHCs should carry out the training of the combination of general practice and specialist in combination with the professional development of general practitioners，increase the drugs for specialty and special disease diagnosis and treatment，propagate the community characteristic technology in multiple ways，and explore the general practice and specialist combined diagnosis and treatment mode innovatively.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-03-28 Cooperative journals: 《中国全科医学》
Abstract： The construction of general practitioner（GP）workforce has tended to be mature over recent years，but the overall insufficient competencies of GPs is still one difficulty to be tackled for the construction of GP workforce. Clinical reasoning plays a central role in connecting various abilities in competency training of GPs in China，which is the key to improving the quality of general medical services. To cultivate the clinical reasoning of GPs，Tongji University offers a compulsory course named Clinical Reasoning in General Practice for general practice master students. The course is framed using the Miller's pyramid framework，includes three parts of core module（containing inquiry ability，physical examination，auxiliary examination and patient-doctor communication），case module（covering undifferentiated illnesses，chronic disease management，coexistence of multiple diseases，psychosomatic diseases and health management）and practice module（including patient reception practice and medical record writing），which fully reflect the basic characteristics of GPs' competencies. The course requires 32 credit hours，and is taught in multiple forms，including theory teaching，class discussion，problem-based learning and practical sessions. The effectiveness of course learning is assessed using the objective structured clinical examination，which is divided into four test stations: medical history collection，physical examination，patient-doctor communication and wring SOAP notes.Compared with relevant previous courses with separation between course design and actual community services，this course fully reflects the characteristics of general medicine，and helps students to enhance their competencies via improving the level of clinical reasoning.
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