General practice research should be in the hands of general practitioners (GPs) . GPs' participation in research is an important condition of development of the discipline. Compared with other clinical medicines, the research activities of GPs need to be enhanced.
Based on the perspectives and actions of GPs worldwide towards research, this study aims to investigate the driving forces and obstacles underlying the development of family medicine.
Rapid literature review, using PubMed data to understand opinions of international general practice colleagues.
Over 90% GPs thought research was very important, 60% of GPs were interested in research, 30% expressed willingness to participate, 10% were actually involving research, and less than 1% of GPs published research results. In terms of attitude and ability, GPs believe that the lack of relevance between research and actual clinical practice weakens the usefulness of research; some GPs believe that research work is not part of their own duties and out of their abilities; less than half of doctors believe research training should provide to registrars. The barriers for research included heavy clinical workloads, too much paperwork, increasing clinical management requirements, doctors' goals of making more money, and lack of research practice, support and research funds. Facilitating factors for research included access to good research mentors, having the opportunity to join well-known and well-designed general practice research projects, or having access to more information resources through research activities. GPs' factors include experience, diligence and hard work, frequent participation in research training, frequent reading of academic literatures, and running or managing their own general practice.
Research activity in general practice is low and high-quality research results are few. Research methodology training is one of the strategies to promote general medical research. Same important, we should also pay more attention to the intrinsic motivation and intensity of doctors' participation in research, provide doctors with research time and funding resources, and encourage the establishment and maintenance of a core team and network for general practice research, as well to develop the research ideas and culture of critical thinking in general practice area.
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.
