ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
Non-directly affiliated hospitals are an important supplement to directly affiliated hospitals of medical colleges in China. Considering the problems of teaching consciousness, school running form and teachers construction in non-directly affiliated hospitals, this paper takes the medical personnel training of a non-directly affiliated hospital which is subordinate to Shenzhen Luohu Hospital Group as an example, in order to analyze the related exploration methods of non-directly affiliated hospitals under the development of hospital collectivization, and put forward a trinity training mode of general practitioners, which is “medical college-non-directly affiliated hospital-community health center”. This paper further discusses the challenges and possible solutions faced by non-directly affiliated hospitals in the new era.
ObjectivesTo explore the impact of the medical consortium of a tertiary grade A hospital on the economic benefits and business levels of the community hospitals, to summarize the problems of the current medical joint mode, and to provide suggestions for promoting the medical association model.MethodsWe collected the data of economic benefit and business level of a tertiary grade A hospital and its affiliated community hospitals before and after the implementation of the medical consortium model [2016 (pre-implementation) and 2017 (post-implementation)], and analyzed the differences between the two groups. Patients were selected by stratified sampling method before and after the implementation, investigations and follow-up were conducted. The satisfaction and compliance were analyzed.ResultsCompared with the data in 2016, in 2017, the total income of community hospitals increased by 25.13% (2.671 2 million yuan vs. 2.134 7 million yuan), the number of outpatients increased by 15.55% (7 496 vs. 6 487 cases), the number of hospitalizations increased by 59.49% (1 673 vs. 1 049 cases), and the number of students increased the most, reaching 366.67% (14 vs. 3). Finally, a total of 472 patients were included, including 213 in pre-implementation group and 259 in post-implementation group. There was no significant difference in the general data between the two groups (P>0.05). The patients’ satisfaction and compliance in post-implementation group were better than those in pre-implementation group (P<0.05). In June and December 2017, the hospital’s medical staff business test level increased significantly compared with those in the same period in 2016 (t=−7.467、−9.998, P<0.001), and the results in December 2017 were significantly higher than those in June 2017 (t=−4.719, P<0.001). But there was no significant difference in the performance of business level assessment between the results in June 2016 and in December 2016 (t=−1.158, P=0.250).ConclusionAn effective “Three Construction and One Management” model can promote the advancement of medical standards in community hospitals while promoting the effective improvement of economic benefits and improving the patients’ satisfaction.
摘要:目的: 了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。 方法 :采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取24‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata30 进行数据录入、SPSS130进行统计分析。 结果 :共发放问卷240份,收回有效问卷229份(有效回收率954%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为454%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为336%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P 值分别是0033,0001)。 结论 :震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。Abstract: Objective: To investigate the reality of community health service system after earthquake in Mianzhu, the satisfaction of community residents to the community health service as well as the postdisaster emergency response capability of community hospital in order to provide decisionmaking suggestions on better reconstruction of community health service system. Methods : Jiannan and Tianhe community hospital were randomly selected for visiting and 24‰ of community residents in the city zone of Mianzhu were selected by convenience sampling for a facetoface interview using a questionnaire. Data entry and statistically analysis were completed by Epidata30 and SPSS130 respectively. Results :A total of 240 questionnaires were conducted to facetoface interviews, and 229 questionnaires were returned (response rate 954%).The community health service system was badly injured. Residents’ satisfactory degree of the community health service after earthquake was 454%. The proportions of disaster / disaster prevention education was 336%,medicine supply for familiar diseases and the chronic were the main factors which influenced judgements of residents to the emergency response capabilities of community hospitals(〖WTBX〗P =0033,P=0001,respectively). Conclusion :The community health services after earthquake had not been widely satisfied and the emergency response capability of community hospital was far from enough. The proportions of disaster / disaster prevention education were far from enough. The effectiveness of emergency response work of community hospitals can be enhanced by reinforcing medicine preparation.In the course of the reconstruction, community health service system should pay attention to the resumance of basic community health service,reconstruction of basic establishment and construction of firstaid system.
ObjectiveTo know about equipment of pulmonary function tests (PFTs) in community health service centers and the knowledge of pulmonary function in general physicians.MethodsThis questionnaire survey was carried out sponsored by Shanghai Basic Alliance for Respiratory Diseases Prevention and Treatment from June to December in 2016. Most community health service centers in 16 districts of Shanghai participated the survey. The questionnaire included education background, professional qualification, PFTs equipment, and knowledge about PFTs.ResultsThere were 963 general physicians in 131 community health service centers completed the questionnaire. There were 27 (20.6%) community health service centers equipped with simplified pulmonary function test device and 910 (94.5%) physicians knowing PFTs. Out of these 910 physicians, 458 physicians (50.3%) gave the correct answer on question about the items of PFTs. The accuracy of question about the diagnosis of chronic obstructive pulmonary disease (COPD) was 24.0% (218/910).ConclusionsThe rate of community health service centers with equipment on PFTs is low and the knowledge on pulmonary function in general physicians is insufficentt in Shanghai. Training on pulmonary function is essential to adapt the stratified treatment of COPD.
Objective To understand the current situation of Chengdu primary health workers’ performance baseline, and to provide decision-making proof and policy recommendations for Chengdu Coordinated and Balanced Urban-rural Development as well as improve primary health workers’ performance in China. Method See the second study in this series. Result The number of the patients of the Chengdu seven Rural Hospitals / Centers showed a trend of slow increase, and all was higher than the national rural hospital average level except the 2 most remote rural hospitals(“Renhe” and “Bailu”). The seven Rural Hospitals / Centers could provide data about the “Six in One” work, and the performance was generally better than that of the world and the national average level , but showed a decreasing trend from the first circle to the third circle in Chengdu. The rate of patients’ satisfaction and very satisfaction for the Rural Hospitals / Centers “Six in One” work reached 65%-80%, but the rate of health workers’ job satisfaction and very satisfaction only reached 9%-46%, and also showed a decreasing trend from the first circle to the third circle. Conclusion The Chengdu primary health workers provide “Six in One” health service with a higher quality than the world and the national average levels. However, the number of the workers is less than enough; the human managerial structure is irrational; the educational and professional levels are low; their treatment and the work environment are poor. The distribution density , the academic qualification and the structure rationality of professional ranks of health personnel show a decreasing trend, and the difficulty of the service is gradually increasing from the first circle to the third circle, which causes the satisfaction rate of the workers’ job to decrease gradually from the first circle to the third circle. Suggestion: ① To make special performance assessment standard for special health institutions or personnel, and to give the continual oriented training chance for current health personnel. ② To integrate the regional health resources; to establish long-term and stable regional bilateral appointment help policy, technical and rational two-way referral system and indicator systems. ③ To take measures to solve the problems affecting the professional promotion and improvement of the grass-root health personnel.
ObjectiveTo investigate the community residents' awareness of knowledge on cardiovascular disease prevention and control and their access methods to relevant information. MethodsBetween June and August, 2013, the residents aged above 45 who came to community health center for diagnosis or treatment were investigated by questionnaires including the acknowledge of prevention for cardiovascular diseases and the access methods to relevant information. ResultsA total of 1 000 residents were involved in this study, including 394 (39.40%) males and 606 (60.60%) females aged from 45 to 98 with an average of 68.3±10.4. The highest rate of awareness of cardiovascular prevention knowledge was regular physical exercise (89.20%), followed by low salt diet (67.20%) and fried food (6.30%). The highest rate of access to the information was information provided verbally by doctors or nurses (77.50%), followed by television and radio (56.00%). ConclusionCommunity center should strengthen the health education of cardiovascular disease prevention and control. Health education should be practiced in an easy way for the residents.
ObjectiveTo explore the effect of respiratory support in Community Respiratory Support Center on patients with chronic obstructive pulmonary disease (COPD) in stable phase. MethodsSixty-four GOLD gradeⅢpatients with stable COPD over age of 55 years were randomly divided into two groups.A respiratory support group received respiratory support in Community Respiratory Support Center, including health education, long-term oxygen therapy (LTOT), long-term ambroxol for atomization, long-term budesonide and formoterol for inhalation.A control group were prescribed budesonide and formoterol for inhalation when recruited, informed LTOT and long-term ambroxol for atomization at home, and follow-up visits to clinic every month. ResultsAfter 24 months of treatment in the respiratory support group, SpO2, PaO2, FEV1%pred, 6MWD, BMI, and ALB increased, mMRC, CAT, Hb, PaCO2 decreased (P < 0.05).While in the control group, FEV1%pred decreased, mMRC and CAT increased (P < 0.05), other indexes did not change significantly (P > 0.05).The times of acute exacerbation and hospitalization of the respiratory support group was less than that in the control group(P < 0.05). ConclusionsEstablishing Community Respiratory Support Center will benefit patients with stable COPD correct hypoxemia, slow the deterioration of lung function, improve the nutritional status of patients, and can also increase patients compliance to treatment.
Objective To investigate the effects of community self-help group activities on psychological status, quality of life (QOL), social support, and community-based activities of daily living in home-based stroke patients. Methods Stroke patients discharged from Mianzhu People’s Hospital between January 2016 and December 2018 were enrolled. Participants were randomly allocated using a random number table into two groups: the experimental group (community self-help rehabilitation) and control group. Assessments were conducted at baseline and 6 months post-intervention using the Zung Self-Rating Depression Scale (SDS), Zung Self-Rating Anxiety Scale (SAS), Stroke-Specific Quality of Life Scale (SS-QOL), Social Support Rating Scale (SSRS), and a community-based activities of daily living scale. Results A total of 130 patients were included. Among them, there were 63 cases in the experimental group and 67 cases in the control group. No significant baseline differences were observed between groups in demographic characteristics or outcome measures including age, gender, depression (SDS), anxiety (SAS), SSRS, SS-QOL, and community-based activities of daily living scores (P>0.05). At 6-month follow-up, between-group comparisons revealed statistically significant differences favoring the experimental group in depression, anxiety, and SS-QOL scores (P<0.05), while no significant intergroup differences were observed in SS-QOL, and community-basedactivities of daily living scores (P>0.05). The intra group comparison results showed that the depression and anxiety scores in the experimental group were lower after intervention than before intervention (P<0.05). The anxiety score of the control group after intervention was higher than before intervention (P<0.05), and there was no statistically significant difference in the depression score before and after intervention (P>0.05). The SSRS and community-based activities of daily living scores of both groups after intervention were higher than before intervention. The SS-QOL of the experimental group after intervention was higher than before intervention (P<0.05). There was no statistically significant difference in SS-QOL between the control group before and after intervention (P>0.05). Conclusion Community self-help group activities improve psychological status, QOL, and community-based activities of daily living capabilities in home-based stroke patients, but demonstrate no superiority over home-based rehabilitation alone in enhancing community-based daily living capabilities.
Objective To investigate the spectrum of diseases and the current situation of antibiotic use in rural hospitals and community health service centers in Chengdu, so as to provide evidence for selecting essential medicines and promoting rational use of antibiotics. Method We selected 7 township/community health institutions, from which we collected inpatient and outpatient information. Information about antibiotic use was also collected, including categories, cost, and dosage. A standard questionnaire was used to investigate physicians’ prescription behavior for principal diseases. Result Urban and rural areas had different spectrums of diseases. The major diseases in urban areas included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, and respiratory tract infection; while those in rural areas were infectious diseases of the respiratory system, digestive system, and urinary system. The physicians’ prescription behavior was mainly based on their personal experience. Antibiotics accounted for 30-50% of the total medicine cost. The top four types of antibiotics with the highest cost were cephalosporins, penicillin, quinolones, and macrolides. Conclusion Based on the different spectrums of diseases, essential drug lists and standard treatment guidelines appropriate for rural health care should be developed to improve the rational use of drugs. Factors such as the average cost of daily dose and the course of treatment should be taken into consideration to reduce the overall cost of medicine. An antimicrobial resistance monitoring system and special training courses on rational use of antibiotics should be utilized in the rural health institutions.