Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Acute ischemic stroke（AIS）is characterized by high rates of disability，mortality，and recurrence，posing a significant burden on patients and society. In the era of big data，predictive models are increasingly used in patient diagnosis，treatment decisions，prognosis management，and healthcare resource allocation，highlighting their growing importance. Machine learning methods have become a crucial tool for predicting the prognosis of AIS patients and have been widely applied. This review explores recent advancements in the study of AIS prognosis prediction，focusing on machine learning methods. It discusses current issues and challenges faced by machine learning models，aiming to provide new insights and references for methods of early assessment and prediction of prognosis outcomes in AIS patients.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Previous studies have found that inter-arm blood pressure difference（IAD）and mild cognitive impairment（MCI）are both associated with cardiovascular risk factors，but it is unclear whether there is an association between IAD and MCI. Objective To explore the relationship between IAD and MCI in rural elderly persons and to provide a scientific basis for clarifying the mechanisms of cognitive decline in elderly persons. Methods From July to August 2019，the rural elderly residents aged 60 years and older were selected using the multi-stage cluster sampling method from 5 townships in 2 counties（districts）of Guizhou Province，and questionnaire surveys，general physical examinations，cognitive function assessments，and bilateral arm blood pressure measurements were carried out among them. Cognitive function was evaluated using the Mini-Mental State Examination（MMSE） scale，and activities of daily living were assessed using the Activities of Daily Living（ADL） scale. Spearman rank correlation analysis and binary logistic regression model were used to investigate the association between IAD and MCI in the elderly persons. Results A total of 1 795 questionnaires were distributed，and data from 1 088 participants were finally included in the study by excluding subjects with incomplete information on the questionnaires，those who did not undergo blood pressure measurements，and those who did not undergo blood tests. Among the 1 088 rural elderly residents，138 patients（12.68%）with MCI，99 patients（9.10%）with systolic inter-arm blood pressure difference（sIAD） ≥ 10 mmHg，and 80 patients（7.35%）with diastolic inter-arm blood pressure difference（dIAD） ≥ 10 mmHg were detected. Individuals with IAD ≥ 10 mmHg had a higher prevalence of MCI and lower MMSE scores，orientation scores，language scores，and delayed recall scores compared to those with IAD <10 mmHg （P<0.05）. The results of correlation analysis showed that the sIAD was significantly negatively associated with the total MMSE score （rs=-0.094），orientation score （rs=-0.082），verbal ability score （rs=-0.065） and delayed recall score （rs=-0.104）；and the dIAD was significantly negatively associated with the total MMSE score （rs=-0.080），orientation score （rs=-0.094），and attentional calculation score （rs=-0.063）（all P<0.05）. Multivariate logistic regression analysis showed that the risk of MCI increased by 8.80% for each 1 mmHg increase in sIAD （OR=1.088，95%CI=1.046-1.131；P<0.001）；sIAD ≥ 10 mmHg （OR=2.169，95%CI=1.262-3.728；P<0.05） and dIAD ≥ 10 mmHg （OR=1.926，95%CI=1.047-3.542；P<0.05） were the influencing factors for the occurrence of MCI in the elderly. Conclusion The prevalence of MCI in rural elderly was 12.68%，and their elevated IAD was associated with an increased risk of MCI. And the risk of MCI was higher in elderly with IAD ≥ 10 mmHg than in those with IAD <10 mmHg.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Although the number of case reports on pulmonary infarction（PI）secondary to pulmonary embolism（PE）is increasing in recent years，its misdiagnosis remains common，mainly as pneumonia. In patients with intermediate and high-risk pulmonary embolism，delays in diagnosis and timely treatment would lead to poor prognosis. Objective By analyzing the pneumonia-misdiagnosed cases of patients with PI，we summarized their clinical characteristics and related risk factors，and constructed a multivariate joint model to improve the accurate diagnosis rate at early stage. Methods This retrospective study included the hospitalized patients with pulmonary embolism at the First Affiliated Hospital of USTC from January 2017 to December 2023. In the group of pneumonia-misdiagnosed patients with intermediate to high-risk PI，we analyzed the clinical characteristics and compared the differences between the misdiagnosed groups and control group. Furthermore，using a multivariate logistic regression analysis，we explored the independent predictive factors of the delayed diagnosis，analyze the predictive value of various indicators for the misdiagnosis by ROC curves，and compared the AUC values using Delong test. Results Among 101 cases of PI patients，70 of them were misdiagnosed as pneumonia. Comparing with the control group，the characteristics of misdiagnosed patients were old age，higher incidences of fever and chest pain with unlikely presence of dyspnea. From 2017 to 2023，the misdiagnosis rate gradually decreased in percentages of 100.0%，83.3%，74.1%，71.4%，63.2%，66.7%，and 50.0%，respectively. Based on the results of multivariate logistic regression analysis，the characteristics of over sixty-years-old age（OR=18.271，95%CI=4.373-76.339，P<0.001），fever（OR=16.073，95%CI=3.510-73.786，P<0.001），chest pain（OR=6.660，95%CI=1.571-28.233，P=0.010）and non-dyspnea（OR=9.027，95%CI=2.049-30.249，P=0.003）were independent predictive factors for the misdiagnosis. Therefore，a multivariate joint model was constructed as the following equation：Y=-6.624+0.095×A（factor of age）+2.510×F（factor of fever）+2.683×N（factor of non-dyspnea chest pain）. The model indicated the PI misdiagnosis parameters as AUC under the curve（OR=0.880，95%CI=0.802-0.959，P<0.001），best cutoff value（0.854），sensitivity（0.871）and specificity（0.806）. Therefore，the predictive values are superior to single-factor indicators of age（Z=2.771，P=0.006），fever（Z=4.653，P<0.001）and non dyspnea chest pain（Z=4.014，P<0.001）. Conclusion Although the misdiagnosis rate of pulmonary infarction has decreased in recent years. Clinicians should keep alert to the differential diagnosis of pulmonary infarction and pneumonia in elderly PE patients with symptoms of fever and non-dyspnea chest pain.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background In patient involvement，patients are transforming from mere recipients to collaborators in medical services by integrating their experiences and needs throughout the entire healthcare process into medical practice. This aims to enhance the effectiveness，efficiency，and quality of healthcare services. However，the implementation of proven patient#2;centered strategies for patient involvement in the quality improvement among chronic obstructive pulmonary disease（COPD）in our country remains to be explored.Objective This scoping review systematically reviews and analyzes the existing strategies for patient involvement among patients with COPD to provide a reference for implementation that in China.Methods Employing the scoping review guidelines of Joanna Briggs Institute in Australia as the methodological framework，the relevant studies on patient involvement among patient with COPD were searched by computer on PubMed，Embase，Cochrane Library，CNKI，Wanfang Database，China Biology Medicine disc. A thematic analysis was methodically applied to distill and synthesize findings. Results A total of 37 articles were included in this review. The categorization of patient involvement was divided into three types：direct involvement in medical care，organizational-level，and clinical research. Based on the intensity of involvement，categories were further classified into three levels：consultation，engagement，and collaborative leadership. A nine-category matrix of patient involvement behaviors was constructed through intensity and type. The implementation of COPD patient engagement was primarily reflected in five categories encompassing eight behaviors，including：integration in direct medical care（patients expressing their preferences and wishes regarding treatment plans）；consultation at the organizational management level（assessing patient treatment experiences and organizing discussions around patients' concerns）；as well as involvement in clinical research，including consultation（listening to patient needs）and engagement（expressing preferences and wishes for interventions，involved in the development of assessment tools，and in discussions about research design and implementation）. Assessing patient treatment experiences（10 articles，27.03%）and expressing patient preferences and wishes regarding interventions（10 articles，27.03%）were the two most frequently implemented behaviors of patient involvement in COPD. Conclusion There are numerous measures for patient involvement in the improvement of medical quality，but there is still limited practice in the field of COPD. Very few studies have assessed the impact of patient involvement on clinical outcomes and quality of life，indicating that the practice of patient involvement in China requires further exploration.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Hypertension is a common chronic disease that seriously endangers the health of the population. The primary-care doctors are the main force in the management of hypertension. However，the doctor-induced therapeutic of inertia greatly affects the achievement of primary-care hypertension control. Objective The aim of this study is to investigate the current status of therapeutic inertia among primary healthcare providers in the diagnosis and treatment process of hypertension，and analyze the causes of therapeutic inertia，providing a reference basis for improving hypertension control rates in China. Methods A simple random sampling method was used to distribute questionnaires to primary healthcare providers in 32 primary healthcare institutions in Tianjin from July to August 2023. The therapeutic inertia in the diagnosis and treatment process of hypertension was evaluated from three dimensions: knowledge mastery of hypertension diagnosis and treatment，“soft reasons”and “overestimation of treatment efficacy” as well as “medical insurance policies.” Binary logistic regression analysis was employed to explore the influencing factors of therapeutic inertia.Results A total of 407 questionnaires were distributed in this study，and 386 valid questionnaires were collected，yielding an effective response rate of 97.96%. (1) The average score for primary healthcare providers' knowledge of hypertension diagnosis and treatment was 6 (0.5)，with a scoring rate of 61.19% (5.50/9.00). The total score for therapeutic inertia in hypertension management was 48 (7.0)，with a scoring rate of 56.55% (45.24/80.00). (2) The scores for the “soft reasons” dimension，“overestimation of treatment efficacy” dimension，and “medical insurance policies” dimension were 26 (4.8)，10 (2.0)，and 6 (2.5) respectively，with scoring rates of 51.97% (25.89/50.00)，65.42% (9.81/15.00)，and 44.64% (6.96/15.00) respectively. When comparing the average scores of the three dimensions of therapeutic inertia，the “medical insurance policies” dimension had the lowest score compared to the other two groups (P<0.05). Multivariate analysis showed that male gender，rural areas，lower mastery of hypertension diagnosis and treatment knowledge，and a weekly patient volume of less than 10 hypertensive individuals were associated with a higher tendency towards therapeutic inertia among primary healthcare providers (P<0.05). Conclusion therapeutic inertia is prevalent among primary healthcare providers in the diagnosis and treatment process of hypertension. Low levels of hypertension treatment cognition，overestimation of treatment efficacy，and “soft reasons” are the primary factors contributing to therapeutic inertia among primary healthcare providers. It is recommended to strengthen education on therapeutic inertia in hypertension，conduct diversified training on diagnostic and management knowledge，and promote clinical informatization and artificial intelligence decision-making systems to effectively improve the therapeutic inertia of primary healthcare providers in hypertension management.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-27 Cooperative journals: 《中国全科医学》
Abstract： Background Diabetes mellitus is difficult to cure and has a long process . The level of self-care is crucial for determining the regression and health outcomes of patients with diabetes. A comprehensive and theory-based tool is urgently needed to assess the level of self-care of diabetes. In this way，the self-care of patients with diabetes can be kept up to date and accurate nursing care can be carried out. Objective To examine the psychometric properties of the Chinese version of Self-care of Diabetes Inventory（SCODI），and provide a scientifically validated assessment tool for the self-care of Chinese patients with diabetes. Methods The Brislin Translation Model was used for translation and cultural adaptation of the English version of the SCODI into Chinese. A total of 261 adult patients with diabetes were enrolled using a consecutive sampling method at the First Affiliated Hospital and the Affiliated Sir Run Run Hospital of Nanjing Medical University from December 2022 to June 2023. Data were collected using a self-developed general information questionnaire and the Chinese version of SCODI. Exploratory factor analysis was used to assess the structural validity. Cronbach's α，split-half reliability and composite reliability were used to describe the reliability. Glycosylated hemoglobin was used as a criterion to assess the criterion-related validity. Spearman's rank correlation analysis was used to examinate the correlation between the Chinese version of SCODI score and glycosylated hemoglobin. Results The Chinses version of SCODI contained 4 dimensions and 40 items：self-care maintenance score（75.94±13.15），self-care monitoring score（70.65±18.71），self-care management score（69.16±18.24），and self-care confidence score（85.41±13.63）. In the self-care maintenance dimension，4 factors were identified：complication screening behaviors，exercise behaviors，hygienic care behaviors and diet-medication behaviors. The self-care monitoring dimension had 2 factors：physical monitoring and symptom identification. The self-care management dimension included 2 factors：autonomous behaviors and counseling behaviors. Two factors were extracted from the self-care confidence dimension：monitoring and managing confidence，health maintenance confidence. The Cronbach's α，split-half reliability and composite reliability values for the total scale were 0.915，0.836 and 0.912，respectively. The Cronbach's α for the four dimensions were 0.709-0.908. A significantly negative correlation was observed between each subscale and glycosylated hemoglobin（rs=-0.160，-0.300，-0.177，-0.192；P<0.001），serving as a criterion. Conclusion Based on the middle-range theory of self care of chronic illness，the Chinese version of SCODI exhibits strong psychometric properties，making it a valid and reliable instrument for evaluating self-care of Chinese patients with diabetes.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-24 Cooperative journals: 《中国全科医学》
Beijing Hypertension Association
China Association of Gerontology and Geriatrics
Beijing Community Health Service Association
Beijing Community Health Promotion Association
Abstract： Hypertension，Diabetes，and Dyslipidemia are collectively referred to as the three highs ，which often coexist in the same individual. It significantly increasing the risk of hospitalization，death，and related burdens for patients. So it is necessary to jointly control the risk and standardize the treatment. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention，treatment，and management of the three highs ，but there are no applicable norms，consensus，and guidelines for the co-management of the three highs in primary healthcare institutions at domestic and foreign. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from many fields such as cardiovascular，endocrine，pharmacy，and public health services to participate in the consensus. It widely soliciting clinical practice needs of primary healthcare workers，integrating and evaluating the evidence related to the prevention and treatment of the three highs in primary healthcare institutions. After multiple rounds of discussions，revisions，and voting，the consensus for primary healthcare in the prevention and treatment of the three highs was formed，which includes 21 recommended opinions. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the three highs ，and provide scientific strategic support，implement management with primary healthcare characteristics，and lay a solid foundation for comorbidity co-management.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-24 Cooperative journals: 《中国全科医学》
Abstract： Background After being completely promoted for less than seven years，China’s contracted family doctor service work still faces a number of development problems. The primary obstacle impeding the work of contracted family doctor service is an inadequate guarantee mechanism. There is an urgent need for scientific and reasonable policies on contracted family doctor service to guarantee the effective development of the work. Objective To quantitatively analyze the textual content of China’s contracted family doctor service policies，to explore the focus and shortcomings of the existing policies，and to provide the basis and reference for the development and optimization of the subsequent contracted family doctor service policies. Methods Policy texts were collected by visiting the official websites of the China government and the National Health Commission of the People’s Republic of China on 2023-01-10，and 15 policy texts on contracted family doctor service from 2015-01-01 to 2022-12-31 were selected to construct a three-dimensional analytical framework of policy tools-stakeholders-policy strength，to categorize，code，and analyze the policy documents. Results Supply-based，demand-based，and environment-based tools accounted for 30.5%（69/226），19.0%（43/226），and 50.5%（114/226） of the policy tool dimension. Family doctors，contractors，non-contractors，primary medical and health care institutions，hospitals（secondary and above），and the government accounted for 29.2%（123/422），14.7%（62/422），9.2%（39/422），21.3%（90/422），13.3%（56/422），and 12.3%（52/422） of the stakeholder dimension. The average strength of China’s contracted family doctor service policies was 2.2 points. In the cross-dimension of policy tools-stakeholders，the distribution of stakeholders in supply-based and environment based tools was relatively poor. There were some sub-tools that were absent from the policy tools. In the cross-dimension of policy tools-policy strength，environment-oriented policy instruments were used more often as policy strength increased. In the cross dimension of stakeholders-policy strength，there were large differences of the policy strength matching scores among various stakeholders. Family doctors had the highest score（311 points） with non-contractors the lowest score（90 points）. Conclusion From the perspective of policy tools，policy tools should be allocated rationally，with the weight of use continuously adjusted，the internal structure optimized，and the rationality of the distribution of policy tools among stakeholders improved. From the stakeholder’s perspective，all stakeholders should be taken into account，their respective positions need to be clarified，and the demand of the non-contractors should be emphasized. From the perspective of policy strength，the policy supervision and management capacity ought to be strengthened to continuously improve the implementation of the policy of contracted family doctor service.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-23 Cooperative journals: 《中国全科医学》
Abstract： Background Currently，the treatment of refractory epilepsy（RE）in children is still a difficult point in epilepsy treatment. In China，pirenzapine（PER）is still a new drug for treating RE in children，and there is currently a lack of recommendations for adding PER to the treatment of RE in children. And in Chinese reports，the sample size of RE patients treated with PER is relatively small. Therefore，the efficacy of PER for pediatric RE，especially for young children with RE，still needs to be further studied with a large sample size. Objective To explore the efficacy，possible indications，adverse reactions，and tolerability of PER addition therapy for RE in children. Methods A self-control and retrospective analysis was conducted on children with RE aged 0-18 who were treated at the Women and Children's Hospital affiliated with Qingdao University from January 2022 to January 2023. The frequency of seizures at different observation points before and after the addition of PER treatment was compared，and the effective rate of PER was evaluated. Adverse drug reactions and drug retention rates were recorded，and the clinical characteristics of the effective and ineffective groups of PER were analyzed. Result A total of 192 study subjects were included. After adding PER treatment，the effective rates at 12，24，and 36 weeks were 56.3%（108/192），62.1%（113/182），and 69.7%（122/175），respectively，and the seizure free rates were 19.3%（37/192），21.4%（39/182），and 24.6%（43/175）. The incidence of adverse reactions was 16.1%（31/192），mainly including dizziness，irritability，weakness，and drowsiness. The last follow-up drug retention rate was 91.1%（175/192）. There was a statistically significant difference（P<0.05）in the onset age，duration of anti-epileptic treatment，type of origin，seizure form，frequency of seizures before the addition of PER，number of combined anti-epileptic drugs（ASMs），and ketogenic diet/surgical treatment between patients with RE who received continuous medication for 12 weeks. In addition，178 children underwent EEG examination，and 167 children underwent cranial magnetic resonance imaging examination. There was a statistically significant difference （P<0.05）in the electroencephalogram（EEG）and head magnetic resonance imaging（MRI）results between patients who received effective and ineffective treatment. In the results of electroencephalogram examination，the effective rate of discharge in the anterior（anterior，middle，temporal anterior，and middle）part of the brain is higher；In the results of cranial imaging examination，the normal group had a higher effective rate，followed by children with mainly white matter damage. Conclusion The overall effective rate and retention rate of PER addition therapy for RE in children are high，with mild adverse reactions and good drug tolerance. It is more effective for children with RE who have a late onset age，seizures in the form of motor seizures，focal origin，short course of anti-epileptic treatment，fewer combination medications，and less frequency of seizures. In electroencephalography，patients with normal discharge in the anterior（anterior，middle，anterior temporal，and middle temporal）of the brain and normal results in cranial magnetic resonance imaging have a higher effective rate.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-23 Cooperative journals: 《中国全科医学》
Abstract： Background The clinical reasoning of general practitioners is the key to providing quality medical services to patients，but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed. Objective This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching. Methods From September to December 2022，38 master's degree students of the Medical School of Tongji University were divided into the in-service group（16） and residential training group （22）. The course consists of three modules，namely core，case and result，and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale，while the content of subjective evaluation comes from multi-source feedback. SPSS 22.0 was used for statistical analysis. Results The final course scores for the core and case modules were statistically significant for both groups（P<0.05），but the first course scores were not（P>0.05）. The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared，and there was statistical significance （P<0.001）. Subjective evaluation can be divided into positive evaluation and improvement evaluation. It is found that with the deepening of the course，the number and percentage of positive evaluation of core modules and case modules continue to rise，while the number and percentage of improvement evaluation continue to decline. Conclusions Programmatic assessment can enrich the evaluation system of general clinical reasoning，promote students' construction of general clinical reasoning in order，and also found that "flipped classroom" is a form of procedural evaluation.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-22 Cooperative journals: 《中国全科医学》
Abstract： Background Previous studies have confirmed that screen exposure is widespread in preschool children and is related to children's emotional and behavioral problems. Most of the existing studies focus on normal preschool children， but the research on screen exposure and emotional and behavioral problems of preschool autistic children is relatively rare. Objective To investigate the screen exposure and the abnormal detection of emotional and behavioral problems in preschool children with autism，and to explore the association between screen exposure and emotional and behavioral problems in preschool children with autism. Methods Preschool children with autism who met the diagnostic and Statistical Manual of Mental Disorders（DSM-V）autism diagnostic criteria and visited the Department of Child Development and Behavior of the Third Affiliated Hospital of Zhengzhou University from February to August 2022 were selected as the autism group. At the same time， children with normal development in kindergartners in Zhengzhou were selected as the normal control group. The screen exposure questionnaire and the Strengths and Difficulties Questionnaire（parent version）were completed by the main caregivers of the children in the two groups. Results There were significant differences between the two groups in terms of screen time，parents' response to screen management，and screen deprivation （P<0.001）. Compared with the control group，the children in the two groups had significantly higher detection rates of prosocial behavior，total difficulties，and sub-dimensions（emotional symptoms，conduct problems，hyperactivity/inattention problems，and peer problems） （P<0.001）. Logistic regression showed that the influencing factors of emotional and behavioral problems in preschool ASD children included placing electronic devices in the sleeping or playing space，whether caregivers interacted with each other during watching，caregivers' attitudes toward children's electronic screen watching，whether they were active or passive participants in touching electronic screens，and children's reactions to forced turning off electronic screens（P<0.05）. Conclusion Screen exposure can affect the emotional and behavioral problems of preschool children with autism. Parents should rationally plan screen use for preschool children with autism.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2024-05-21 Cooperative journals: 《中国全科医学》
Abstract： Background Pharmacotherapy is the cornerstone of primary and secondary prevention of atherosclerotic cardiovascular diseases（ASCVD），but the values and preferences of community patients for pharmacotherapy remain unclear. Objective To understand the values and preferences surrounding pharmacotherapy among community patients at risk of or undergoing treatment for ASCVD，which would help clarify the individualized treatment burden and provide patient centered clinical practice. Methods This study employed a sequential exploratory mixed-methods design. Firstly，we recruited eligible patients in West China Hospital of Sichuan University and Yulin Community Health Service Center in Wuhou District，Chengdu City from November 2021 to January 2022. for a focus group discussion，aiming to collect qualitative insights into their experience，values，and preferences for medication use. The software MAXQDA 2020 was used to support qualitative data analysis，and Colaizzi's seven-step approach was further used to identify themes. After completing the qualitative phase，a questionnaire was designed based on the emergent themes to further quantitatively analyze the values and preferences regarding pharmacotherapy. Results Four themes emerged from the qualitative data，including knowledge and use of medications，barriers of medication use，facilitators of medication use，and need for medical services. A total of 186 valid questionnaires were collected in the quantitative study（response rate of 93.5%）. The quantitative data showed a commonality in missed dose and confirmed the existence of social stigma and treatment burden in this group of participants. Although preferences in medication use were highly heterogeneous，participants generally preferred taking fewer medications with less frequency，and were less likely to use injectable medications. Conclusion The study suggests that it may be appropriate to increase the use of compound preparations，and make treatment plans in accordance with patients' daily lives and work to reduce the treatment burden of pharmacotherapy. In addition，we should be active in managing the misconceptions and improper practices in pharmacotherapy in order to improve patients' medication adherence.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Atherosclerosis（AS）is the main pathological basis of cardiovascular disease and is characterized by vascular endothelial inflammation，thus targeting inflammation-related mechanisms is the key to prevention and treatment of AS. Objective To investigate the effect of the hexosamine biosynthesis pathway（HBP）on adhesion molecules and its regulatory role in vascular endothelial inflammation. Methods From August to December 2022，24 SPF grade C57BL/6 female mice were divided into control group，DON group，HFD group，HFD+DON group according to randomized block design method using body weight stratification. Serum and aortic tissue from the mice were collected after 15 weeks of administration of high-fat diet and intraperitoneal injection of DON. The lipid levels of mice were detected using biochemical kits before and after intervention，pathological changes in the aortic root were detected by HE staining，and the expression levels of intercellular adhesion molecule-1（ICAM-1）and vascular cell adhesion molecule-1（VCAM-1）were detected by immunofluorescence staining，ELISA and Western blot. Results After 15 weeks of intervention，compared with the control group，the levels of LDL-C and TC were increased significantly in the HFD group，while HDL-C was reduced significantly（P<0.05）；There was no change in the lipid levels between the HFD group and the HFD+DON group. HE staining results showed that the vascular intima was thickened，the morphology of vascular smooth muscle was abnormal，the structure was disorganized，and a largenumber of foam cells were seen in HFD group. The smooth muscle cells of mice were neatly aligned，the endothelial cell layer was continuous，the number of foam cells was reduced significantly，and the cell gap was normal basically in the HFD+DON group. The results of immunofluorescence staining，ELISA and Western blot showed that the expression of ICAM-1 and VCAM-1 was down-regulated in the HFD+DON group compared with the HFD group. Conclusion Inhibition of HBP can down-regulate the expression of ICAM-1 and VCAM-1，and play a role in improving vascular endothelial inflammation.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Chronic obstructive pulmonary disease（COPD） is one of the most common respiratory diseases in elderly patients，and a decrease in oxygen saturation during activity is a common phenomenon correlated with the prognosis. Current assessment of exercise-induced hypoxia（EID） has yielded controversial results. Objective To explore methods suitable for inducing EID in community and home-based COPD patients. Methods This was a retrospective study involving 76 patients with stable COPD admitted to China-Japan Friendship Hospital from January 2021 to August 2023. Resting oxygen saturation and the lowest oxygen saturation during exercise（ΔSpO2） in the six-minute walk test 6MWT） were recorded. Based on the criterion of ΔSpO2 ≥ 4% for the diagnosis of EID，patients were assigned into non-EID group and EID group. Pulmonary function indicators，ΔSpO2 during 30-second sit-to-stand-test（30s STST），and COPD Assessment Test （CAT） were compared between the two groups. The correlation of ΔSpO2 in 6MWT with ΔSpO2 of 30s STST and CAT scores was identified. The predictive value of ΔSpO2 of 30s STST，CAT score，andΔSpO2 of 30s STST combined with CAT score in predicting EID was analyzed using the receiver operating characteristic（ROC） curves. Results There were significant differences in the ΔSpO2 of 30s STST and CAT score between non-EID group and EID group. The cut-off value of ΔSpO2 of 30s STST in predicting EID was 2，with the sensitivity，specificity and area under the curve（AUC） of 59.6%，82.8%， 0.730（95%CI=0.614-0.846，P<0.05），respectively. The cut-off value of CAT scores in predicting EID was 13，with the sensitivity，specificity and AUC of 48.9%，79.3%，0.712（95%CI=0.596-0.828，P<0.05），respectively. The cut-off value of ΔSpO2 of 30s STST combined with CAT scores in predicting EID was 0.593，with the sensitivity，specificity and AUC of 70.2%，72.4% and 0.765 （95%CI 0.659-0.871，P<0.001），respectively. Conclusion ΔSpO2 of 30s STST ≥ 2% and CAT score ≥ 13 points alarm the development of EID. The 30s STST and CAT can be used as community and home-based measures to predict the induction of EID in patients with stable COPD.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-20 Cooperative journals: 《中国全科医学》
Abstract： Background Carotid atherosclerosis（CAS）is often considered an early warning signal for cardiovascular diseases（CVD）. The diagnostic technique of carotid artery Doppler ultrasonography has not been included in public health service programs，and the Framingham Risk Score（FRS）lacks accuracy in assessing CAS risk，hindering the identification of CAS by primary healthcare personnel. Currently，there is a lack of research on machine learning methods to identify CAS in the medium-high risk population assessed by FRS. Objective To construct a CAS risk prediction model for the medium-high riskpopulation assessed by FRS using machine learning methods，compare its discriminative efficacy，select the optimal model，and assist primary healthcare personnel in identifying CAS more conveniently and accurately. Methods A total of 674 local residents from two townships in Liuzhou City，Guangxi Zhuang Autonomous Region，who met the inclusion criteria from 2019 to 2021 and 2023，were selected as the study subjects. Relevant information was collected，and biochemical indicators were measured in fasting blood and urine samples. FRS was used to assess the risk of CVD occurrence，and carotid ultrasound was used to diagnose CAS. Among the 517 subjects from 2019 to 2021，a random 8 ∶ 2 split was used to create a training set and a validation set. The training set was used to build Logistic regression，Random Forest（RF），Support Vector Machine（SVM），Extreme Gradient Boosting（XGBoost），and Gradient Boosting Decision Tree（GBDT）models，while the validation set was used for internal validation. The 157 subjects from 2023 served as the test set for external validation. Feature variables were selected using Lasso regression analysis，and discriminative efficacy was evaluated using sensitivity，specificity，accuracy，F1 score，and area under curve（AUC）value. External validation assessed the generalization ability of the optimal model using AUC value，and the Shapley Additive exPlanation（SHAP）method explored the important variables influencing the optimal model's identification of CAS. Results Lasso regression analysis identified 15 feature variables：age，BMI，systolic blood pressure（SBP）， smoking，drinking，hypertension，total cholesterol，high density lipoprotein cholesterol，C-reactive protein（CRP），fasting plasma glucose，apolipoprotein B（ApoB），lipoprotein（a）（LPA），aspartate aminotransferase （AST），AST/ alanine aminotransferase，urinary microalbumin creatinine ratio. The constructed Logistic regression，RF，SVM，XGBoost，and GBDT models exhibited high AUC values，with the GBDT model showing the best discriminative performance. Its sensitivity， specificity，accuracy，F1 score，and AUC value were 0.755 1，0.836 4，0.798 1，0.778 9，and 0.834 9，respectively，and the external validation AUC value was 0.794 0. The SHAP method revealed that age，SBP，CRP，LPA，and ApoB were the top five factors influencing the GBDT model's identification of CAS. Conclusion Logistic regression，RF，SVM，XGBoost，and GBDT models for identifying CAS based on machine learning all demonstrated high discriminative performance，with the GBDT model exhibiting the best comprehensive discriminative efficacy and strong generalization ability.
Subjects: Medicine, Pharmacy >> Traditional Chinese Medicine and Chinese Materia Medica submitted time 2024-05-17 Cooperative journals: 《中国全科医学》
Abstract： Background Establishing the advantageous diseases in the field of traditional Chinese orthopedics treated with manual therapy will promote the development of manual techniques and dominant discipline. However，the current evaluation and selection lack a quantitative evaluation process based on evidence-based medicine. Objective To systematically review systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy using evidence mapping methodology and explore the advantageous diseases in this field. Methods Computerized searches were conducted in PubMed， EMbase，The Cochrane Library，Web of Science，SinoMed，China National Knowledge Infrastructure，Wanfang Data，and VIP database to collect systematic reviews of diseases in the field of traditional Chinese orthopedics treated with manual therapy from inception to March 5，2023. The evidence distribution characteristics were presented using a combination of charts and text. Results A total of 126 systematic reviews published from 2003 to 2023 were included，showing an overall increasing trend in the quantity of relevant studies both domestically and internationally. Methodological quality assessment results indicated that 13 reviews were of moderate quality，64 were of low quality，and 49 were of very low quality. The evidence map showed that the research evidence in the field of traditional Chinese orthopedics treated with manual therapy mainly focused on 18 clinical diseases，including cervical spondylosis，low back pain，knee osteoarthritis，lumbar disc herniation，ankle sprain，adhesive capsulitis of the shoulder，cervicogenic headache，atlantoaxial subluxation，distal radius fracture，lateral epicondylitis of the humerus，carpal tunnel syndrome，lumbar sprain，scoliosis，hip osteoarthritis，fibromyalgia syndrome，myofascial pain syndrome，rotator cuff injury，and supracondylar fracture of the humerus，demonstrating beneficial or potentially beneficial effects. Conclusion Manual therapy is widely used in the clinical practice of traditional Chinese orthopedics. However，due to methodological shortcomings and a lack of research evidence on safety and cost-effectiveness，future efforts should focus on multi-level inter-agency cooperation to establish sound evaluation standards and systems，improve research quality，update research evidence，and further explore the advantages of manual therapy in the field of traditional Chinese orthopedics.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-17 Cooperative journals: 《中国全科医学》
Abstract： Background Acute coronary syndrome（ACS） is a group of pathological clinical syndromes with coronary atherosclerotic plaque rupture or erosion，followed by complete or incomplete occlusion of thrombosis. The selection of specific and sensitive serological markers and detection methods has important clinical value for rapid and accurate early diagnosis，assessment of the condition，and adoption of treatment measures in ACS patients. Objective Explore the relationship between plasma nucleolin（NCL） levels in ACS patients and the stability and severity of coronary artery plaques in ACS patients，as well as the value of NCL in predicting ACS. Method 117 patients admitted to the Cardiovascular Department of Changsha First Hospital in 2022 and completed coronary angiography were selected as the study subjects，all of whom met the ACS standards. 36 cases were unstable angina（UA group），36 cases were non ST segment elevation myocardial infarction（NSTEMI group），and 45 cases were ST segment elevation myocardial infarction（STEMI group）（all considered ACS patients）， with 39 non ACS patients selected as the control group. Collect patient blood samples and general clinical data，and detect plasma levels of nucleolin，C-reactive protein（CRP），and low-density lipoprotein cholesterol（LDL-C）. According to the results of coronary angiography，ACS patients were divided into non lesion group，single vessel lesion group，double vessel lesion group， and multi vessel lesion group. According to ultrasonic echo characteristics，ACS patients were divided into vulnerable plaque group and stable plaque group. Those without atherosclerotic plaque were classified as plaque free group. Evaluate the correlation between NCL expression levels and CRP and LDL-C levels in various groups of ACS patients；Analyze the correlation between the number of coronary artery lesions，severity of coronary artery lesions，and Gensini score in NCL and ACS patients；Multiple logistic regression analysis was used to identify independent risk factors for the occurrence of ACS in plasma NCL，and receiver operating characteristic（ROC） curves were used to evaluate the optimal threshold for predicting ACS occurrence in NCL. Result The levels of NCL，LDL-C，and CRP in the UA，NSTEMI，STEMI groups were significantly higher than those in the control group，and there was a positive correlation of NCL levels with LDL-C and CRP （P<0.05）. After comparing the NCL levels of patients with different degrees of carotid plaque，it was found that the level of the vulnerable plaque group was higher than that of the stable plaque group，while the level of the stable plaque group was higher than that of the plaque free group. Therefore， the NCL level was positively correlated with the degree of carotid plaque（P<0.05）. The NCL levels of patients with multivessel coronary artery disease were higher than those of patients with double-vessel coronary artery disease（P<0.05），while the levels of double-vessel disease patients were higher than those of patients with single-vessel coronary artery disease （P<0.05）， indicating a significant positive correlation of NCL levels with the number of diseased coronary vessels （P<0.05）. The NCL levels in high Gensini score group were significantly higher than those in the low and medium groups（P<0.05），and there was a significant positive correlation of the number of diseased coronary vessels with Gensini score （P<0.05）. Multivariate logistic regression analysis showed that NCL was an independent risk factor for ACS，and ROC curve analysis suggested that the optimal diagnostic threshold for NCL was 0.765. Conclusion The expression level of plasma nucleolin has certain clinical significance for evaluating plaque stability in ACS patients，and has certain reference value for ACS identification and risk stratification prediction. The plasma NCL level is positively correlated with the number of coronary artery lesions and Gensini score，and can serve as a reference indicator for predicting and evaluating the severity of coronary artery lesions to a certain extent. Elevated plasma NCL levels may be an independent risk factor for the occurrence of ACS and have predictive diagnostic value for ACS.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： Background Body roundness index（BRI）is a simple measure of central obesity and is strongly associated with cardiovascular disease. People with metabolically obese normal weight（MONW）have a higher risk of cardiovascular disease and are significantly associated with central obesity. The triglyceride glucose（TyG）index is an indicator of insulin resistance. There are limited studies on the relationship between BRI，TyG index and MONW phenotypes in gender#2;specific elderly populations. Objective To explore differences in the risk of prevalence of the BRI and MONW phenotypes in the elderly population by gender，and to explore the TyG index as a potential factor in their differences by gender. Methods Permanent residents ≥ 60 years of age who underwent physical examination in 10 cities and counties in Anhui Province from 2017-07-01 to 2021-06-30 were selected as study subjects. A unified questionnaire was used to collect information on gender， age，and disease history of the study subjects，collect information on physical examination and laboratory tests，and calculate BRI and TyG indices. Men and women will be classified into metabolically healthy normal weight（MHNW）phenotype and MONW phenotype according to metabolic status and BMI level，respectively：male MHNW phenotype（n=5 384），male MONW phenotype（n=6 251）；female MHNW phenotype（n=4 498），female MONW phenotype（n=8 264）. Males and females were divided into 4 levels according to BRI quartiles，males：M1，M2，M3，and M4，and females：F1，F2，F3， and F4，respectively.Logistic regression analyses were performed to explore the association between BRI quartile levels and the risk of elevated TyG index and the risk of prevalence of MONW phenotypes respectively，using the Z test was used to compare the differences between the OR value of male and female. Results A total of 24 397 investigators were included in this study， including 11 635（47.7%）males and 12 762（52.3%）females，with a median age of 67（64，70） years，and 9 882（40.5%） with MHNW phenotype and 14 515（59.5%）with MONW phenotype. Hypertension，diabetes mellitus，dyslipidaemia，systolic blood pressure，diastolic blood pressure，TyG index，BRI，fasting glucose（FPG），total cholesterol（TC），triglyceride （TG），and low-density lipoprotein cholesterol（LDL-C）in the elderly population of different genders with MONW phenotype were higher than in the MHNW phenotype，and smoking and high-density lipoprotein cholesterol（HDL-C）were lower than in the MHNW phenotype（P<0.05）；prevalence of MONW phenotype，hypertension，diabetes mellitus，dyslipidaemia，TyG index，FPG，and TG were higher than those of low level BRI，and HDL-C was lower than those of low level BRI in the elderly population of different genders with high level BRI（P<0.05）. The results of univariate logistic regression analysis showed that the risk of elevated TyG index was increased at BRI M2/F2，M3/F3，and M4/F4 levels in elderly populations of different genders compared with BRI M1/F1 levels（P<0.05）；and the risk of elevated TyG index increased with increasing BRI levels（Ptrend<0.001 for male，Ptrend<0.001 for female）；and the risk of elevated TyG index was higher at BRI M2，M3，and M4 levels in older men than at BRI F2，F3，and F4 levels in older women（P<0.05）. Multifactorial Logistic regression analyses after correction for confounders showed that the risk of MONW phenotype prevalence was increased at the BRI M2/F2，M3/F3，and M4/F4 levels in the elderly population of different genders compared with the BRI M1/F1 level（P<0.05）；and the risk of MONW phenotype prevalence increased with the increase of the BRI level（Ptrend<0.001 for male，Ptrend<0.001 for female）；and the risk of the MONW phenotype was higher in older men than in older women at BRI levels M2 and M4（P<0.05）. Conclusion BRI levels were significantly and positively associated with the risk of the MONW phenotype in older adults of different genders，with high levels of BRI more strongly associated with the risk of the MONW phenotype in older men，with the TyG index being a potential factor contributing to the gender difference.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring，placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle，chronic disease prevention and control are becoming more and more important. In recent years，as scientific and technological innovation in the field of healthcare develops in depth，and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country，the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient， which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient，and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition，the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods，this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans，assisted medical diagnosis，and timed medication reminders，the intelligent robot is committed to improving patients' quality of life，reducing the pressure on healthcare resources，and promoting the development of intelligent healthcare management globally.
Subjects: Medicine, Pharmacy >> Clinical Medicine submitted time 2024-05-15 Cooperative journals: 《中国全科医学》
Abstract： Background Responsiveness is a key goal in evaluating the performance of the health system，and is also an essential basis for improving the capacity of primary health services. Currently，many studies confuse the concepts of responsiveness and satisfaction，and the evaluation of responsiveness is not comprehensive enough，focusing on the level of responsiveness but ignoring its distribution. Objective To understand the responsiveness evaluations of community health services among residents of different ages in Zhejiang Province and to analyze its influencing factors. Methods Utilizing the method of purposive sampling and convenience sampling，six community health service centers in Hangzhou and Taizhou， Zhejiang Province，were selected as the investigation sites from July to August 2022 to assess the responsiveness scale of outpatient residents. The weights of the eight components of responsiveness recommended by the WHO were used to calculate the overall level and distribution of responsiveness. Univariate analysis and multiple linear regression were used to explore the influencing factors on the responsiveness level among residents of different ages. Results The score of responsiveness for community health services in Zhejiang was（8.31±1.04）points，and the responsiveness distribution index was 0.13；residents of different age groups expressed their higher satisfaction with the dimensions of dignity and social support，with scores of（8.60±1.24）points and（8.63±1.20）points，respectively. In contrast，the dimensions of selectivity and autonomy received lower ratings，with scores of（7.96±1.56）points and（8.04±1.33）points，respectively. Household registration was an influencing factor for responsiveness evaluation of community health services among young people，while education level and monthly income were influencing factors for responsiveness evaluation among middle-aged individuals. Conclusion The overall level of community health service responsiveness in Zhejiang Province is good，and the distribution is more balanced. More attention should be paid to the demand and responsiveness of community health services among young people with urban household registration and middle-aged people with a college/bachelor's degree or above. Primary care community health service centers still need to improve in providing patients with access to information about health service plans and the freedom to choose community doctors/nurses，thereby better satisfying the reasonable healthcare service demands of residents.
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