Effectiveness of general practice-based health checks: a systematic review and meta-analysis

Background

A recent review concluded that general health checks fail to reduce mortality in adults.

Aim

This review focuses on general practice-based health checks and their effects on both surrogate and final outcomes.

Design and setting

Systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials.

Method

Relevant data were extracted from randomised trials comparing the health outcomes of general practice-based health checks versus usual care in middle-aged populations.

Results

Six trials were included. The end-point differences between the intervention and control arms in total cholesterol (TC), systolic and diastolic blood pressure (SBP, DBP), and body mass index (BMI) were −0.13 mmol/l (95% confidence interval [CI] = −0.19 to −0.07), −3.65 mmHg (95% CI = −6.50 to −0.81), −1.79 mmHg (95% CI = −2.93 to −0.64), and −0.45 kg/m² (95% CI = −0.66 to −0.24), respectively. The odds of a patient remaining at ‘high risk’ with elevated TC, SBP, DBP, BMI or continuing smoking were 0.63 (95% CI = 0.50 to 0.79), 0.59 (95% CI = 0.28 to 1.23), 0.63 (95% CI = 0.53 to 0.74), 0.89 (95% CI = 0.81 to 0.98), and 0.91 (95% CI = 0.82 to 1.02), respectively. There was little evidence of a difference in total mortality (OR 1.03, 95% CI = 0.90 to 1.18). Higher CVD mortality was observed in the intervention group (OR 1.30, 95% CI = 1.02 to 1.66).

Conclusion

General practice-based health checks are associated with statistically significant, albeit clinically small, improvements in surrogate outcome control, especially among high-risk patients. Most studies were not originally designed to assess mortality.     

护士长督导式检查在优质护理服务中的作用

目的探讨实施护士长督导式检查在提高患者优质护理知晓率和满意度中的作用。方法护士长在了解患者基本信息后对患者实施"督导式"检查,与所有住院患者进行面对面交流,询问患者对护理质量和服务的感受,检查护理日常运作,根据督查中发现的护理工作中的低效、缺陷、服务风险和潜在问题指导护士及时纠正。结果实施护士长督导式检查后,患者优质护理知晓率和满意度较实施前显著提高(均P<0.01)。结论实施护士长督导式检查,有利于护士长对护理质量进行监控,增强了护理服务的针对性,是行之有效地提高患者优质护理知晓率和满意度的方法。     

固定矫治器对正畸治疗患者龈沟液检测指标及牙周状况的影响

目的：探讨固定矫治器对正畸治疗患者龈沟液多个检测指标及牙周状况的影响。方法：选取2009年7月-2012年4月于本院采用固定矫治器进行正畸治疗的38例患者为研究对象,将其正畸治疗前及治疗后1、3、5、8及12周的龈沟液量、龈沟液前列腺素2（PGE2）、活化激酶5（PAK5）、β-防御素2（HBD-2）、内毒素（ET）、白细胞介素-1β（IL-1β）及出血指数（BI）、牙周袋深度（PD）、牙松动度（TM）、菌斑指数（PLI）、牙龈指数（GI）、简化口腔指数（OHI-S）进行检测及比较。结果：38例患者治疗前及治疗后1、3、5、8及、12周的龈沟液量、龈沟液PGE2、PAK5、HBD-2、ET、IL-1β均呈现先升后降的趋势,而BI、PD、TM、PLI、GI、OHI-S则从治疗前及治疗后8周呈现持续升高的趋势（P〈0．05）,有显著性差异（P〈0．05）;治疗后、12周与8周别无显著性差异（P〉0．05）。结论：固定矫治器对正畸治疗患者龈沟液多个检测指标及牙周状况的影响较为明显,但至12周时基本稳定。     

脊柱手术患者Time-out前期病房安全核查的实施

目的有效确认脊柱手术患者术前相关信息,保证手术如期进行。方法将脊柱外科择期手术患者180例,根据入院先后顺序分为对照组(82例)和干预组(98例),对照组按常规完成术前准备,术前1d对手术患者术前相关信息进行核查,干预组在对照组基础上按自制的Time-out前期病房安全核查要素对手术所需准备项目进行核查,比较两组手术如期进行率及手术安排满意度。结果干预组手术如期进行率、手术安排满意度显著高于对照组(P0.05,P0.01)。结论对脊柱手术患者实施Time-out前期病房安全核查,可有效确认患者术前相关核查的要素,充分发挥手术安全监测、预警作用,保证术前准备到位,利于提高科室整体医疗质量。     

Multiplex bead-based immunoassay for the free soluble forms of the HLA-G receptors,ILT2 and ILT4

Human leukocyte antigen (HLA)-G is an immune-inhibitory molecule that exerts its function via interaction with two main inhibitory receptors: ILT2 and ILT4. This interaction is considered to be an immune checkpoint. HLA-G can be found as a soluble molecule, but it is not known if its receptors can also be found as soluble molecules. In this work, we present a multiplex luminex-based assay to measure soluble ILT2 (sILT2) and soluble ILT4 (sILT4) molecules together. It is based on two antibody pairs, GHI/75 and HP-F1-PE for ILT2 and 27D6 and 42D1-PE for ILT4. The characterization of our method reveals that it specifically detects the free soluble forms of sILT2 and sILT4, and not those complexed to HLA Class I molecules such as their ligand of highest affinity HLA-G. A study on two small cohorts of cancer patients demonstrated that soluble ILT2 and ILT4 molecules were of low abundance in the plasma of healthy controls, but that elevated levels of plasmatic sILT2 were present in non-muscle-infiltrating bladder cancer patients. This demonstrated that the titration test is indeed working, and that soluble ILT2 molecules do exist in pathological contexts, which relevance may now be sought on larger cohorts and other pathologies.     

PDCA循环法在静脉药物配置中心的实践研究

目的 探讨PDCA循环法在静脉药物配置中心调配药物过程中的应用效果.方法 2015年1月-6月对静脉药物配置中心实施PDCA循环法管理,进行目标性监测,考察计划(PLAN)、实施(DO)、检查(CHECK)、处理(ACT)循环对减少工作环节中各项差错的作用.结果 通过PDCA循环法管理后,静脉药物配制前处理出错率从0.32％下降至0.08％,配制过程中的出错率从0.28％下降至0.05％,经检验差异均有统计学意义.结论 经采用PDCA循环法进行全面质量管理后,部门在各工作环节的差错均有明显减少,保证了配置药品的质量,确保了患者医疗安全.     

遵循JCI标准的门诊手术室安全核查

目的遵循JCI标准,探讨实施门诊手术安全核查的效果与体会。方法制定门诊手术安全核查表,落实门诊手术安全核查制度,并随机抽查实施安全核查制度前后各300例患者,比较实施安全核查前后护理措施漏项人数、漏项数以及患者满意度。结果实施门诊手术安全核查后,护理措施漏项人数及漏项数有显著下降,患者满意度有显著提高,两者相比有显著统计学意义（P〈0．01）。结论门诊手术安全核查的实施,确保了门诊手术患者的安全,提高了患者的满意度,符合JCI的标准,值得继续推行。     

RGC-32与细胞周期调控

RGC-32(response gene to complement-32)是一种重要的补体应答分子,同时也参与了许多其他生物学功能.近来的研究发现RGC-32为细胞周期G2/M检测点关键调控分子,在细胞周期精细调控过程中发挥重要作用,并参与细胞增殖分化、再生修复、炎症反应、肿瘤形成等多种生物学过程.但RGC-32对细胞周期确切的调控机制有待阐明.该文就RGC-32基因及其生物学功能、细胞周期调控以及两者之间的调控关系等作一简要综述.     

Can a Video Curriculum on the Social Determinants of Health Affect Residents' Practice and Families' Perceptions of Care?

IntroductionScreening and management of the social determinants of health (SDH) are critical for child health promotion. We sought to evaluate the impact of a facilitated video curriculum on resident SDH screening competence, parental perceptions of resident practice, resident-initiated referrals to a medical–legal partnership (MLP), and formula distribution to food-insecure families.MethodsThis was a pre–post study with concurrent control performed at a large pediatric residency program. Second- and third-year residents were assigned to control and intervention groups on the basis of their continuity clinic day. The curriculum included videotaped vignettes of screening for SDH and a “day in the life” series of families describing the impact of intervention on their lives. Residents completed self-assessments on screening competence and resource knowledge. After a well-child encounter, families (3 per resident) assessed their level of trust and respect for the resident and the number of SDHs screened for. MLP referral rates and formula distribution were compared.ResultsThe intervention group's self-assessed competence in screening for housing, benefits, and educational concerns was significantly higher compared to controls (each P ≤ .05). Parents' rating of trust and respect was high and did not differ between groups. Screening for each SDH was higher in the intervention group with domestic violence (odds ratio 2.16, 95% confidence interval 1.01–4.63) and depression (odds ratio 2.63, 95% confidence interval 1.15–5.99), reaching statistical significance. MLP referral rates increased (P = .06), and formula distribution (P = .02) reached statistical significance in the intervention group.ConclusionsThis SDH video curriculum improved resident self-assessed screening competence, parental perception of screening, and both MLP referrals and formula distribution.     

不同年龄段勃起功能障碍患者的心理状况与人格特征分析

目的:探讨不同年龄段勃起功能障碍(ED)患者心理状况的差异。方法:回顾性分析郑州大学第三附属医院2018年7月至2019年7月收治的401例ED患者的临床资料。年龄20～60岁。将所有患者按年龄段分为4组：A组158例,年龄20～29岁;B组182例,年龄30～39岁;C组38例,年龄40～49岁;D组23例,年龄50...