Diabetes is a disease frequently encountered in hospitals in China. Good glycemic management can improve clinical outcomes and shorten the length of stay of diabetic patients, enhance healthcare efficiency and save medical resources. To provide a reference for clinical glycemic management and associated research, we reviewed relevant literature, then summarized the characteristics and applicable settings of different blood glucose management modes, and detailed the advantages and limitations of three major glycemic management models, including general-specialist consultation, hospital-wide glycemic management program, and smart decision support system for blood glucose management. With the support of information technology, different glycemic management modes will contribute to the continuous improvement of efficiency and quality of hospital care.
Atherosclerosis is a chronic inflammatory disease in which atheromatous plaque long-termly accumulates and obstructs the intima of medium and large arteries, causing first severe stenosis and blood flow disorders, and then ischemia and hypoxia in tissues and organs. Nanomedicines have received widespread attention for their unique advantages over conventional drugs in the treatment of atherosclerosis. This article detailedly reviews several nanoparticle- and exosome-based targeted drug delivery systems in anti-atherosclerosis research, briefly describes the synthesis of representative nanomaterials, analyses their targeting properties and outlines the benefits and inherent challenges of nanomedicines. Despite the challenges that need to be addressed and refined, nanoparticles and exosomes used as drug delivery vehiclesin treatments for atherosclerosis hold great promise and are expected to have wider clinical applications.
As a major public health problem, dementia has attracted great global attention. Early detection and interventions targeting high-risk people of cognitive impairment, can help prevent the onset of dementia and postpone its progression. The rapid increase in the number of elderly people with dementia in China poses challenges in terms of preventive care, health promotion, social support and research innovation. So it is essential to develop a national task list of dementia prevention and treatment action plan, yet it is still in an exploratory stage. In this paper, on the basis of the review of the WHO "Global Action Plan for Public Health Response to Dementia 2017—2025", we proposed a list of tasks of "Dementia Prevention and Treatment Action Plan" for China from the perspective of WHO's global action according to current China's policies and practices and the focuses in dementia prevention and treatment and actual resources, which covers risk factor intervention, person-centred care, social support, information system construction, innovative research and science and technology transformation. It is expected that this action plan will inform relevant dementia prevention and treatment decisions as well as practical responses.
During the prevention and control of the COVID-19, the decrease in routine medical care has spread across countries in various degrees, also affecting the management of chronic disease accordingly. The policies and schemes of prevention and control of the COVID-19 in China have been adjusted since December 2022, health care system has been facing serious challenges, bringing increased pressure on primary care. Based on the experiences of other countries, this paper suggests that primary care in China should pay attention to the promoting of self-management for patients with chronic diseases, providing proactive service for patients with complex situations and high demand, strengthening the application and research of telemedicine, intensifying the community connection of primary care services, focusing on the improvement of the compensation mechanism of health services.
The measurement of health has been developed from mortality-based to focus on length of life such as life expectancy, then the focus has been redirected to healthy life expectancy (HLE) globally, one measure reflecting the quality of life. The year-over-year increase in average HLE has been set by China as a national goal to be achieved during the 14th Five-Year Plan period (2021—2025) . In this article, we briefed the measurements of HLE, and reviewed the experience measuring and using the HLE in international organizations and selected countries. With consideration of the development of health statistics and information system of China, we proposed Global Activity Limitation Index (GALI) as the measurement method of HLE and goal value of HLE, including the share of HLE in life expectancy as well additional year of HLE achieved by the end of 2025. In addition, we concluded as suggestions for achieving the goal.
Chronic obstructive pulmonary disease (COPD) is a common chronic disease of the respiratory system that has high morbidity and mortality across the world. Like other chronic diseases, the development of COPD is a long process, and its prognosis could be improved significantly by early prevention and intervention. As the understanding of COPD in the international academic community gradually deepens, the 2022 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) report first proposed the concept of pre-COPD. We reviewed the development of pre-COPD, analyzed its definition and diagnostic criteria, and summarized the significance of early identification of pre-COPD patients. Pre-COPD results from the widening and deepening of the existing concept of COPD prevention and treatment. A full understanding of pre-COPD will contribute to guiding the direction of COPD pathogenesis research and basic COPD research, and to improving the awareness of primary prevention of COPD in clinical practice, thereby reducing the prevalence and mortality of COPD and the burden of COPD on families and society.
Genetic susceptibility, inflammatory mechanism and unhealthy lifestyle are associated with increased risk of hypertension, a common chronic cardiovascular disease, and asthma, a common chronic respiratory disease. The research on the pathogenesis and management of hypertension with bronchial asthma has become a hotspot recently. We did a review of the latest relevant studies on hypertension and bronchial asthma. It was concluded that the co-morbidity of hypertension and asthma was related to common genetic disorders, systemic inflammation and poor lifestyle. Then gave a summary of the interaction mechanism between the two diseases and related management methods. Calcium channel blockers and angiotensin receptor antagonists were recommended as the first choice for drug treatment. This study aims at offering insights into clinical research on the pathogenesis and scientific management of hypertension with asthma.
Post-treatment recurrence is a major difficulty in the treatment of lung cancer, one of the deadliest cancers worldwide. Minimal residual disease (MRD) as a "bridgehead" for the recurrence of solid tumors, is described as the presence of free circulating tumor cells or other tumor cell derivatives in the biological fluid of patients without any clinical cancer symptoms after the primary tumor treatment. China recently issued its first Consensus on the Detection and Clinical Application of MRD in Lung Cancer, aiming at improving the postoperative individualized treatment for lung cancer patients in accordance with the MRD status detected by the liquid biopsy. We reviewed the latest advances in the use of several most widely used body fluids (peripheral blood, urine, saliva, sputum and pleural effusion) in the detection of MRD in lung cancer, and discussed their values in guiding the precise treatment of MRD in lung cancer.
Evidence-based clinical guidelines are important resources for promoting the provision of high-quality and effective general practice services. Research on the development, application and effectiveness evaluation of guidelines in general practice is insufficient.
To understand the development and application of international guidelines in general practice, informing the development and utilization of relevant guidelines in China.
The PubMed database was systematically searched from August to September 2022 for studies in English related to the development, application and effectiveness of guidelines in general practice published during January 1, 2012 to September 7, 2022. The author information and focused issues as well as publication journals of the studies were extracted. And associated factors of the development, distribution and use, and effectiveness of guidelines were reviewed.
(1) A number of countries, including China, conducted the research using quantitative, qualitative, literature review and theoretical methods. (2) Organisations of general practitioners (GPs) and researchers in general practice leading or participating in guideline development, can improve the guideline acceptability and applicability, and the integration of physician experiences and patient preferences in shaping the guideline. General practice consensus is an appropriate type of the guideline. Referral recommendation is one key component of the guidelines. Guideline analysis and adaptation can be used as a strategy for GPs training. (3) Compared with specialty guidelines, the application of guidelines in general practice has been affected by more factors. Problem-oriented and self-guided guideline trainings are beneficial to the improvement of guideline compliance. Clinical audits and evidence-based medicine journal clubs are common and effective approaches for promoting guideline implementation. GPs' feedback on the guideline contributes to continuous improvement of the guidelines. (4) The impact of these guidelines on GPs' practice behaviour can be assessed observationally, while that on patient outcomes requires to be assessed using more rigorous and complex study designs.
GPs' participation in the development, implementation and evaluation of the guidelines is an enviable trend of the development in evidence-based general practice. GPs' experience and humanism, patients' preferences and expectations, and various internal and external factors associated with general practice, all need to be incorporated into the development, implementation, and evaluation of the guidelines, under collaboration with methodological experts.
In Australia, 28% of the population live in remote and rural areas, where they face many health service utilization challenges due to geographical conditions, and generally have lower health status than those living in coastal metropolitan areas. To address the challenges of accessing health services in remote and rural areas, the Australian Government Department of Health and Aged Care has introduced a geographical classification system to help healthcare providers to improve healthcare services since 1994, and regularly updated the system to adapt to the latest sociodemographic and healthcare status, as well as formulated a range of complementary health policies to support rural and remote areas. From 2018, Australian Government Department of Health and Aged Care has adopted a new classification standard, the Modified Monash Model. We reviewed Australia's practices and concluded that, to better deliver high-quality and accessible healthcare services to areas with weak healthcare resources in China, Australia's experience could be used for reference, during taking actions to promote and refine the geographic classification system for healthcare services in a timely manner, formulating policies supporting the enhancement of access to health workers systematically, and taking advantage of modern, high and new technologies.
As main health service providers in primary care, general practitioners (GPs) undertake the responsibility of gatekeepers for residents' health. Vigorously training GPs will contribute to the transformation of the healthcare delivery model, and the addressing of the issue related to difficult and high cost of getting medical treatment in China. However, the number of qualified GPs is insufficient in China, and low income is a major factor associated with the willingness of medical students to work as a GP. How to take actions to recruit, retain and appropriately employ GPs in primary care is a problem that needs to be addressed urgently in the development of China's primary care workforce. To provide evidence for the improvement of China's payment system for GPs, we collected the information related to the payment for GPs in the United Kingdom, the United States, Australia, and China by reviewing relevant studies and relevant official websites of the four countries, and performed an inter-county comparative analysis of the information in terms of income source, income level, payment methods, payment composition, and performance appraisal. We found that the four countries have the following aspects in common: all of them own a payment system for GPs and an assessment system for service quality and effectiveness of GPs, adopt a mixed payment method for GPs, and use financial incentives to promote GPs to improve the quality of their performance. In addition, the United States and China have explored methods to decentralize the management of medical insurance funds, so that the primary healthcare institutions can independently redistribute the surplus funds which has improved the proactivity of GPs at work. And Australia has set up the "coefficient of difference" and scholarships/subsidies for GPs, and carried out free trainings for improving the service capacities of GPs working in remote areas, to increase the attractiveness of working as a GP.
Dementia is a major public health challenge associated with population aging. This paper introduces the background of the development of WHO "Global Action Plan on the Public Health Response to Dementia 2017—2025", with a focus on targets set across seven areas: dementia as a public health priority, dementia awareness and friendliness, dementia risk reduction, dementia diagnosis, treatment, care and support, support for dementia carers, information systems for dementia, and dementia research and innovation. We found 25 countries (regions) who have developed policies, strategies, plans or action frameworks on dementia since 2009, with targets involving areas of prevention, intervention, research, support, implementation, legislation and evaluation. As China still lacks a national dementia action plan, we put forward the following recommendations on the development of a China's national action plan on dementia: referring to the action priorities and specific measures for containing dementia of the WHO and 25 countries (regions) ; appropriately drawing lessons from successful experiences of WHO Member States in early screening for dementia in high-risk groups, reducing dementia risk factors, developing long-term dementia care insurance, creating a dementia friendly social environment, and building a national dementia monitoring system.
The concept of entrustable professional activities (EPAs) was initiated by a medical professor in the Netherlands in 2005 with the aim of enhancing the implementation of competency-based medical education (CBME) in clinical practice. After more than ten years of development, great progress has been made in EPAs (mainly for training and assessment) in a variety of medical specialties in many countries, which has influenced general practice significantly. Some countries such as Canada, Australia and the U.S. have been developing their own EPAs in general practice, which can be applied to the supervision and assessment of trainees, and the entrustment decisions of supervisors. To our best knowledge, limited research in China has been focused on the EPAs, let alone their applications in general practice. We analysed the research developments, potential challenges and prospects of EPAs in general practice, hoping to provide evidence for future research in China.
The incidence of chronic constipation is high, and it will seriously affect people's quality of life. There are many treatment methods for chronic constipation, including dietary modification, drug therapy, acupuncture and massage, exercise, surgery, etc. Dietary modification or dietary fiber supplementation therapy is often recommended before or in combination with drug therapy, but its application in clinical practice lacks specific norms. Based on evidence-based medical evidence, this paper analyzed the importance of dietary modification in the prevention and treatment of chronic constipation and the clinical efficacy of dietary fiber supplements, natural fruits or food raw materials in the treatment of chronic constipation, and put forward the application principles and specific methods of dietary modification and dietary fiber supplementation in clinical practice, in order to provide useful assistance to specialists, general practitioners and patients with chronic constipation.
Actively Managing Obesity to Reduce the Risk of Cardiovascular Disease
Obesity and Cardiovascular Disease, a statement released by the American Heart Association on April 22, 2021, gives a summary of the impact of obesity on the diagnosis, clinical management and prognosis of atherosclerotic cardiovascular disease, heart failure, sudden cardiac death and atrial fibrillation. In view of the present clinical management of cardiovascular diseases in China, this paper interprets the content of the statement in detail, aiming to provide guidance relevant to domestic cardiovascular management practices.
Prediction and Management of People at High Risk of Sudden Death after Myocardial Infarction Who are not Covered by Guidelines
The prevention of sudden cardiac death after myocardial infarction in contemporary clinical practice primarily relies on the evaluation of left ventricular ejection fraction (LVEF) . However, the single measurement is inadequate to identify people who are truly at high risk of sudden cardiac death. Based on the new clinical evidence that has been emerged in recent years, this review discussed the limitations of risk stratification for sudden death by LVEF, the exploration of early intervention in patients with high risk of sudden death after myocardial infarction, the re-stratification of patients with reduced LVEF for selecting the candidates who would benefit the most from implantable cardioverter defibrillator treatment, and the identification of patients with high risk of sudden death in those with preserved or slightly depressed LVEF. Furthermore, the paper reviewed the role of novel clinical scoring systems, cardiac magnetic resonance, noninvasive electrocardiography, and invasive electrophysiological testing in the prediction and management of sudden death.This review is expected to provide references for the long-term precise management and risk warning of patients with myocardial infarction.
Heart Failure with Mid-range Ejection Fraction——a Comprehension of the Disease
Heart failure is the final main battlefield of various cardiovascular diseases with huge harm, which can cause all kinds of arrhythmias and even sudden cardiac death. The 2016 ESC guidelines formally define heart failure with mid-range ejection fraction (LVEF) in the range of 40% to 49%, aiming to refine the classification of heart failure, in order to arouse the attention of clinicians to the pathophysiology of heart failure and carry out more clinical research to better guide diagnosis and treatment. At present, there are still many controversies about the pathophysiology and treatment of HFmrEF. This article explains the characteristics of patients with HFmrEF from the aspects of epidemiology, clinical characteristics, pathophysiology, and treatment. It is found that HFmrEF is more like a transition between HFpEF and HFrEF patients than a unique phenotype. Four new drugs in the field of heart failure (ARNI, SGLT-2i, SGC, OM) and atrial septal shunts have shown different degrees of benefit in the treatment of HFmrEF patients. In the future, more clinical studies on HFmrEF (such as the HFmrEF subgroup study based on the changing trend of LVEF) are needed to deepen clinicians' understanding and understanding of HFmrEF, so as to better guide treatment.
Analysis of Non-pharmacological Management Strategies for Stable Chronic Obstructive Pulmonary Disease Based on 2021 GOLD's Global Strategy for the Diagnosis，Management，and Prevention of Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is now the third leading cause of death in the world, after ischemic heart disease and stroke. However, in the face of this preventable and curable major public health problem, there are still many problems in clinical diagnosis and treatment in China, such as insufficient health education, missing follow-up data, and non-standardized clinical management, which may be important causes of the deterioration of conditions, leading to increased difficulties in treating and higher possibility of poor outcome after late treatment as well as increased social and economic burden of COPD. Therefore, it is of great practical significance to accelerate the standardization of prevention, diagnosis and management of COPD to improve the accuracy and effectiveness of diagnosis and treatment of COPD. To provide a reference for emergency and respiratory clinicians to better treat COPD patients clinically, in view of domestic diagnosis, treatment and studies regarding COPD, we comprehensively analyzed the non-pharmacological treatment of stable COPD based on the updated GOLD's Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, mainly including pulmonary function measurement and assessment, smoking cessation, pulmonary rehabilitation, oxygen therapy, ventilatory support and surgical interventions.
Application of Biomarker Detection of Exhaled Air Condensate in Respiratory Diseases
Respiratory diseases are getting more and more attention, and their complex and changeable symptoms have brought a series of challenges to medical treatment. Many common clinical examination methods are not enough to comprehensively deal with the situation, and clinical examination methods are urgently needed to provide accurate and effective basis for diagnosis and treatment. The exhaled breath condensate (EBC) is a respiratory tract lining fluid obtained non-invasively, which is a new important source of biomarkers for respiratory diseases with high clinical research value. The EBC-based biomarker detection method can effectively reflect the changes in the patient's condition and optimize the treatment schedule. This method has received increasing clinical attention due to its advantages of simple operation, safety, non-invasiveness, high reproducibility, and good compliance. This article systematically analyzed the application status of biomarkers in EBC in the diagnosis, monitoring, efficacy evaluation and prognosis of respiratory diseases, and proposes corresponding problems in its collections, detection specifications and clinical applications, and provide a strong basis for its wide clinical application.
Ten-year Development of General Practice in China：Opportunities and Challenges
To review the strengths and limitations of the development of general practice in China during the last decade (2010—2020) and to assess the opportunities and challenges for its future development.
Data were collected from statistic reports, journal articles and official policies and guidelines regarding general practice development in China from 2010—2020. Donabedian model was applied to examine and assess the quality of essential general practice services in China. SWOT analysis was used to identify internal and external determinants of general practice development in China.
(1) Structural quality of general practice: the ten-year policies about general practice development were a continuation of the past relevant policies in essence but with developments, with highlights on continuous construction of general practice workforce and discipline, tiered diagnosis and treatment and regional medical consortium, but relevant fiscal and management policies still need improvements. The number of general medical workers has increased rapidly, while the lion's share of them are still allocated at tertiary hospitals. Full-time equivalent is suggested to be used to predict the staffing and assess the performance of these workers. The number of community health centres showed a steady increase, but its growth rate was still slower than that of hospital facilities. Relevant health economics data need to be further supplemented. (2) Process quality of general practice: in 2020, there were 2.045 billion visits in community health centers (stations) and township health centers, that is, 1.5 visits per person per year on average. There was a significant development when found only 1 visit per person per year for primary care in 2010. However, the frequency of visits for primary care was still lower than that of visiting hospital-based outpatients (an average of 2.7 visits per person per year) . The COVID-19 pandemic had a significant impact on community health services/general medical services, and the number of outpatient visits dropped by about 20%. The number of general practice research articles reached a peak in 2018, mainly focusing on bi-directional referrals, tiered diagnosis and treatment, general practitioners (GPs) /family doctors, general medicine, community health services, chronic disease management (especially hypertension and diabetes) , and analysis of factors associated with aspects involved in general medical services. General practice research is expected to provide more support for developing innovative and critical thoughts, more practice-based evidence for clinical services, and more assistance for service quality and patient outcomes improvement as the discipline advances. (3) Results of implementing general medical services: there is no sufficient evidence on the influence of general medical services on people's health. The experiences and views of people including healthy individuals and patients indicated that those receiving general medical services or contracted family doctor services perceived positive experience and expressed high satisfaction, but perceptions and views of general population in the community toward general medical services need to be explored. GPs' own experience and opinions on general practice were quite different. Gender, age, professional title, urban and rural areas, and geographical location may be associated with their experience and job satisfaction. There may be instability in the general practice workforce, mainly due to personal income, workload and time pressure. (4) The major strengths of developing general practice in China are as follows: strong policy-based promotion and government leadership; rapidly constructing and developing GPs teams owing to the excellent resource allocating ability shown by the centralized system from central to all local governments; significantly enhanced general practice education and training systems; increased core professionals as general practice educators and trainers; special development of general practice characterized by the integration of medical sciences and Chinese traditional humanistic theories. (5) The development of general practice in China has been facing limitations similar to those in other countries. Besides that, its special limitations include late development of the discipline, unsatisfactory quality of workforce, high work pressure and high prevalence of burnout in the workforce, as well as impact of generation gap on education and practice among GPs. In addition, the relation between specialists and GPs is on transition of from undifferentiated attachment to self-recognised uniquity, and further seeking transdisciplinary. The teaching competences of GPs teachers, especially those teaching community and clinical care, are inadequate. GPs team building and management need to advance from the formation to the storming and performing phases. (6) Opportunities for further development of general practice in China include strategies for achieving the goals of Healthy China, and an all-round well-off society, the important role of primary health care in sustainable development and universal health coverage reaffirmed by the Declaration of Astana, as well as significantly improved health literacy of people. (7) Challenges for the development of general practice in China include population ageing, and aging-related changes in burden of disease and socio-economic status, the aging and dynamic changes of GPs human resources, the variation of urban and rural areas and regional differences, and the inverted pyramid structure of allocation of medical and health resources (namely, the largest part is allocated to tertiary care while the smallest to primary care) . Relevant recommendations to address these challenges comprise strengthening the advocacy of the development of general practice services, establishing a wide-ranging community collaborative network, and developing general practice professional organizations.
The development of general practice in China is advancing, which is manifested as rapidly increased number of general medical workers, strong government promotion, quickly improved accessibility of essential medical services, and notably increased utilization rate of primary care services. However, the development is facing challenges, such as high discipline and social expectations regarding general practice, instability in the workforce due to high work pressure of the knowledge- and labor-intensive job, GPs' insufficient recognition of their self-identity, and unclear status of financial funding for general practice development. Given that there are unprecedented favorable conditions for general practice development, medical industries and general medical workers are suggested to make efforts to turn challenges into opportunities to develop general medical services, thereby universal health outcomes will be improved.
Epidemiologic Features and Containment of SARS-CoV-2 Omicron Variant
Since the first case of the Omicron (B.1.1.529) variant discovered in South Africa was reported to the WHO on November 24, 2021, a total of 57 countries (regions) had reported Omicron cases as of December 8, 2021. Omicron has become the dominant strain in some African countries and is spreading rapidly. Although Omicron causes mild symptoms, with most cases being asymptomatic and mild, the rapid increase in the number of cases could put a heavy strain on global health systems. In addition, its source, transmission characteristics and vaccine resistance remain unclear, which brings great challenges to pandemic prevention and control in all countries (regions) . We reviewed the latest developments in etiological characteristics, mutation sources, transmission characteristics and possible mechanisms, pandemic status, vaccine protection effect and containment measures regarding Omicron, providing a reference for scientific containment of Omicron mutant.
Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease in China, which greatly negatively impacts public health and patients' quality of life. Recently, multiple guidelines have updated their recommendations to optimize the treatment and management of individuals with DKD. New antihyperglycemic drugs offer new options for DKD. Traditional Chinese medicine (TCM) has a long history in treating DKD, and relevant theories have been continuously enriched and developed. Along with the increasing application of evidence-based medicine in TCM research, the benefits of TCM treatments in DKD have been gradually recognized and valued, such as relieving fatigue, edema, backache and other symptoms, lowering protein in the urine, protecting kidney function, enhancing treatment efficiency, reducing the risk of end-stage renal disease, and improving the long-term prognosis. This article gave a summary and strengths analysis of the latest advances in TCM and Western medicine treatments for DKD.
