Objective To investigate the influencing factors in the service volume of primary health care institutions in Chengdu, and provide references for promoting the hierarchical diagnosis and treatment. Methods A self-administered questionnaire was used to investigate the service volume of a total of 390 primary health care institutions (including community health service centers and township hospitals) across 22 districts and counties of Chengdu from October to November 2016. Rank sum test, rank correlation analysis and multiple linear regression model were used to analyze the influencing factors of outpatient visits in the institutions. Results The median annual amount of outpatient visits was 60 493 in community health service centers and 31 374 in township hospitals. Between community health service centers and township hospitals, the difference in median daily visits per doctor was not significant (14.41 vs. 13.29), but the median daily visits per doctor in general practitioners (12.22 vs. 8.16), rehabilitation physicians (10.10 vs. 6.34) and traditional Chinese medical doctors (4.82 vs. 6.17) varied considerably. Multiple linear regression analysis showed that the amount of outpatient visits in community health service centers was related to the amount of intermediate physicians, while the amount of outpatient visits in township hospitals was related to the setup of dental clinics, the amount of primary physicians, the amount of beds and population to be served (P<0.05). Conclusions Differences exist in the service volume among primary health care institutions in Chengdu. It’s necessary to make proper plans for the management of administrative offices and the allocation of personnel, so as to improve medical services of primary health care institutions.
ObjectivesTo analyze the research status and hot spots of hypertension-related clinical trials in special Chinese population registered on the Chinese Clinical Trial Registry (ChiCTR), so as to provide a basis for the development of hypertension-related research in special population in China.MethodsThe ChiCTR was searched online (up to August 31st, 2019, no limitation in the status of trial registration), all clinical trials on hypertension in special population were collected, and the general characteristics, researched diseases, research types, intervention measures and main outcomes of the trials were analyzed.ResultsA total of 64 hypertension-related clinical trials in special population registered in the ChiCTR were included, including 41 (64.1%) trials registered in last 3 years. The registration status of 46 (71.9%) trials was pre-registration. The registered authors were mainly from colleges and universities or medical institutions (n = 61, 95.3%), of which 60.9% were registered in Beijing, Shanghai, Guangdong, Zhejiang, Jiangsu and Hebei. The researched diseases mainly included elderly hypertension and hypertensive stroke, accounting for 50% of the total. Additionally, 37 (57.8%) clinical trials were intervention studies, of which 21 (56.7%) were drug-based intervention studies. Blood pressure, blood glucose, cardiovascular and cerebrovascular events, blood lipid, cranial MRI and Glasgow Coma Scale were the commonly used outcomes, accounting for 58.5% of the total outcomes. Most blood pressure measurements did not indicate the measurement method (n = 22, 64.7%).ConclusionsThe quantity of hypertension-related clinical trials in special population registered on the ChiCTR is increasing, however, there exists regional imbalance. The drug intervention-related clinical trials of elderly hypertension have become a research hot spot. However, blood pressure measurement method is not indicated in most trials, and some researchers do not register in time. Therefore, it is suggested that researchers should further strengthen the awareness of carrying out high-quality clinical trials.
Objective To understand the residents’ demands and utilization of the community health services and provide a basis for the construction of reasonable medical service system. Methods From July to September 2015, a purposive sampling questionnaire survey on general team mode service to bring benefits to the community residents was conducted in 20 provincial-level administrative regions of the country. SPSS 13.0 software was used for data analysis. Results A total of 1 300 questionnaires were distributed, and 1 273 valid questionnaires were recovered. In the 221 residents who were aware of the composition of general team, the awareness rate of general team composed of traditional Chinese medical doctors and gynaecologists/pediatricians was low (70.14%, 75.11%, respectively). The awareness rate of medical services including disease diagnosis and treatment, health consultation, health education and prescription in the 1 273 residents was 70.46%, 61.19%, 59.62% and 67.56%, respectively; the residents’ top five willing to accept medical services was prescribing medicine (77.77%), infusion (74.08%), health consultation (73.21%), health education (70.54%), and planned immunization (64.49%). The biggest change of the 433 patients with chronic diseases before and after treatment in the community was the increase in self-health management (70.67%) and the healthy lifestyle improvement (56.35%). Conclusion Community general team should be oriented by the objective needs and real demands of the residents; based on the ability of medical services supply, the adjustment of the key points of medical services should be made and the rational use of medical services should be guided for the residents.
Objective To evaluate the methodological and reporting quality of systematic reviews/meta-analyses related to the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia. Methods PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, WanFang Data and VIP databases were searched by computer, and the systematic reviews/meta-analyses of corticosteroid hormone as an auxiliary means for the treatment of severe pneumonia which were published from establishment of the databases to October 25th, 2018 were searched. A Measurement Tool to Assess Systematic Review-2 (AMSTAR-2) was used to assess the methodological quality of the included studies, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to evaluate the quality of literature reports. Results A total of 16 systematic reviews/meta-analyses were included, all of which were non-Cochrane systematic reviews. In terms of methodological quality assessed by AMSTAR-2, there was no plan in all studies; only one study explained the reasons for inclusion in the study type; eight studies did not describe the dose and follow-up time of the intervention/control measures in detail; three studies did not indicate the evaluation tools and did not describe the risk bias; six studies did not explicitly examine publication bias. In terms of reporting quality assessed by PRISMA, all studies had no pre-registered study protocol or registration number; thirteen studies did not describe the specific amount of articles retrieved from each database; three studies did not present their retrieval strategies or excluded reasons in detail; no funding sources were identified in included studies; eight studies reported both whether the study was funded and whether there was a conflict of interest. Conclusions At present, there are many systematic review/meta-analysis studies on the efficacy and safety of corticosteroid-assisted treatment for severe pneumonia, and the overall quality of the study has been gradually improved. However, the common problems in the study are relatively prominent. The follow-up period and dose of intervention in the study of severe pneumonia are different, so the baseline is difficult to be unified. Suggestions: strengthening the training of researchers, standardize the research process, and report articles in strict accordance with the PRISMA statement; subgroup analysis being conducted according to the dose and duration of the hormone.
Objective To investigate the clinical effectiveness of the total Flavones of Hippophae Rhamnoides L. (TFH) and compare its cost-effectiveness ratio with enalapril in patients with essential hypertension. Methods Among 3 971 staff members in two universities, 155 eligible patients with blood pressure (BP) ≥160/100 mmHg were screened and included in this study. By using a random number table, the patients were randomized to the two groups: TFH was given to the treatment group while enalapril in the control group. At the end of the six week, BP, total cost and cost-effectiveness ratio were measured in both TFH and enalapril groups. Results After six weeks, blood pressures in the TFH and enalapril groups decreased by 12.7±11.6/8.1±5.1 mmHg and 15.2±9.7/10.1±7.3 mmHg respectively, while the improvement rates of BP were 73.24% (52/71) and 74.65% (53/71) respectively. There were no differences between TFH and enalapril groups in lowering BP amplitude and total effectiveness rate. The incidence of side effect in TFH group was 11.27% (8/71), which was significantly lower than that of enalapril 29.6% (21/71). The total cost of TFH group was 9 294.6 RMB with the cost effectiveness ratio of 732/1 147 RMB per mmHg and 179 RMB per case. In the enalapril group, the total cost added up to 13 236 RMB with cost effectiveness ratio of 870/1 310 per mmHg and 250 RMB per case. Sensitivity analysis indicated that TFH was better than enalapril with respect to clinical economic value even when enalapril price dropped to 1.8 RMB for tablet (5 mg). Conclusion Compared with enalapril, TFH is an effective and economic drug in treating patients with hypertension.
ObjectivesTo analyze the metrological characteristics of hypertension-related clinical trials registered on Chinese Clinical Trial Registry (ChiCTR), and discuss the characteristics and developmental trends of hypertension clinical trials registration in China.MethodsChiCTR were searched to collect hypertension-related clinical trials from inception to March 25th, 2018. The characteristics of registered trials were analyzed.ResultsA total of 135 registered trials were included, in which the trials from Beijing, Guangdong, Jiangsu, Chongqing and Shanghai accounted for 55.5%. 115 trials were pre-registered. The top three funding sources were from finance (32, 23.7%), self-financing (25, 18.5%) and hospital (20, 14.8%), respectively. Of all 79 randomized controlled trials, 55 were blank/missing in the entry of blinding method.ConclusionsThe number of hypertension-related clinical trials in ChiCTR tends to increase, however there are large regional disparities and incomplete, non-standardiazed information in the registration of clinical trials. The relevant departments should increase the publicity on the registration of clinical trials, raise the awareness of registration, and promote the development and registration of high quality clinical trials.
Objective To investigate the use of oral anti-diabetic drugs and sugar blood control situation in advanced aged patient with diabetic mellitus in a community health centre in order to provide references for rational drug use. Methods A cross-sectional survey about oral anti-diabetic drugs was carried out in senile diabetic patients who visited the community health centre and established complete health documents voluntarily from February 2012 to February 2013. Results There were 176 cases of advanced aged patients with type 2 diabetic mellitus, of which, 107 cases were female and 69 cases were male, whose age ranged from 80 to 94. Among 176 cases, there were 107 (60.80%) patients with type 2 diabetic mellitus combined with hypertension, chronic heart diseases, and stoke; 155 had oral anti-diabetic drugs (88.06%). 67.19% of patients who took one oral anti-diabetic drug chose α-glycosidase inhibitors, followed by sulfonylurea. 53.73% of patients who received combination therapy chose glycosidase inhibitors and sulfonylurea. For the treatment of anti-diabetic drugs, 73.68% of patients met the criteria (fasting blood sugar: no more than 8.0 mmol/L), with control rates of 73.56% for α-glycosidase inhibitors and 72.58% for sulfonylurea. More than half of the patients could not be evaluated for their glycosylated hemoglobin levels were not tested. Conclusion Doctors working in community health centres should choose oral anti-diabetic drugs according to patients’ own conditions when treating advanced aged patients with diabetic mellitus in order to avoid adverse reaction such as hypoglycemia. Glycosidase inhibitors are the mostly used drug in the community health centre because it is safe with less adverse reaction when used in senile people and it could ideally control their blood sugara.
Objective To investigate the prevalence of hyperuricemia and the current status as well as differences of cardiovascular risk factors in hyperuricemia patients between urban and rural areas in Chengdu. Methods We randomly sampled 2 032 patients aged from 35 to 70 years age in urban and rural communities, using a questionnaire, physical examination and laboratory tests. Results a) The prevalence of hyperuricemia was 17.77%, which was higher in urban residents (21.38%) than that in rural residents (14.16%). b) The prevalence of hyperuricemia associated with hypercholesterolemia was higher in urban residents (34.10%) than that in rural residents (13.98%); urban women (39.06%) were higher than rural women (16.13%) and urban men (26.97%) were higher than rural men (12.20%). c) The prevalence of hyperuricemia associated with hypertension which was higher in urban residents (58.06%) than that in rural residents (32.64%); urban women (59.38%) were higher than rural women (35.48%) and urban men (56.18%) were higher than rural men (30.49%). d) The prevalence of hyperuricemia associated with impaired glucose tolerance (IGT) in urban women (28.91%) were lower than that in rural women (45.16%). Conclusion Hypercholesterolemia and hypertension are the most commonly seen cardiovascular risk factors accompanied in patients with hyperuricemia in urban areas, which has obviously higher prevalence than in rural areas. IGT is the most commonly seen cardiovascular risk factors accompanied in patients with hyperuricemia among rural women. But in aspects of hyperuricemia associated with impaired fasting glucose (IFG), hypertriglyceridemia, low high-density fetoprotein cholesterol, abdominal obesity and obesity, there is no difference between urban and rural areas.
ObjectiveTo analyse the hundred top-cited articles in obstructive sleep apnea hypopnea syndrome (OSAHS), and summarize the development trend of OSAHS research.MethodsWe searched the Web of Science core collection for all published articles on OSAHS or sleep disorders from January 1st, 1992 to May 23th, 2018. The hundred top-cited articles with the most frequent citation were selected. The publication time, country of origin, journal, institution, professional field of corresponding author, funding type, publication type, etc. were analyzed.ResultsThe hundred top-cited articles were published between 1992 and 2013, with 300～5 980 citations and a total of 65 719 citations. The main types of articles were clinical studies (73 articles), reviews (20 articles), guidelines (4 articles) and basic research (3 articles). Fourteen authors published more than one first-author paper, and fifteen authors published more than one articles as corresponding authors. These authors were distributed across 22 subject areas. The most cited country was the United States (60 articles), and the most cited institution was the University of Wisconsin (10 articles). The hundred top-cited articles were published in 31 journals, most of which were cited less than 1 000 times, and a few articles were cited more than 2 000 times.ConclusionsOSAHS has attracted much attention in respiratory medicine, neurology, epidemiology and other fields, and many articles about clinical research types of OSAHS have been cited. In addition, most of the highly cited articles in the OSAHS field come from the developed countries; our country needs to devote more resources to OSAHS research.
The Chinese Guidelines on Diagnosis and Management of Atrial Fibrillation, jointly formulated by the Chinese Society of Cardiology, Chinese Medical Association and the Heart Rhythm Committee of Chinese Society of Biomedical Engineering, was first released on June 15, 2023. The guidelines elaborate the various aspects of atrial fibrillation management, in which emergency management of atrial fibrillation is also an integral part. This article interpreted the emergency management part in the guidelines in detail by reviewing relevant literature.