Application of scenario-based interactive learning software to generate virtual reality scenarios in medical statistics teaching / 中华医学教育探索杂志

Objective:To explore teaching methods to improve the teaching effect in view of many difficulties in learning medical statistics for clinical medical students.Methods:Taking the clinical medical students of the same grade as the research objects, the students were randomly divided into two groups by cluster sampling in class, i.e. control group and experimental group. The traditional teaching methods and the scenario-based interactive learning software teaching methods were used respectively. The scores of medical statistics courses examinations and the statistical errors in responding to projects of extracurricular research activities were compared between the two groups. SPSS 19.0 was performed for statistical analysis.Results:The results of subject achievements of the students in the experimental group (74.08±11.19) were higher than those in the control group (63.82±10.10) ( t=3.926, P<0.001), especially the comprehensive capabilities of the innovative analysis questions and the multiple-choice questions. The statistical errors of the students in the experimental group was less than those in the control group. There were significant differences between the two groups in the estimation of sample size ( χ2=4.189, P=0.041), statistical design ( χ2=5.558, P=0.018) and data analysis ( χ2=3.971, P=0.046). Conclusion:The results suggest that scenario-based interactive learning software is helpful to improve teaching efficiency, and enhance students' ability to analyze and solve practical problems by using medical statistics knowledge.

Changes in clinical indicators among human immunodeficiency virus patients who failed in antiretroviral therapy during 2004-2016 in Yunnan, China: an observational cohort study / 《全球健康杂志（英文）》

Background:This study aimed to investigate the changes in the clinical indicators and influencing factors of treatment duration among human immunodeficiency virus (HIV) patients in whom antiretroviral therapy (ART) was unsuccessful.Methods:In this retrospective study,a total of 9,418 HIV patients who failed in ART during 2004-2016 were included and divided into two treatment groups-Group 1 (treatment time ≤ 3 years,n1 =5,218) and Group 2 (treatment time ＞ 3 years,n2 =4,200).Patient follow-up data,including age,cluster of differentiation 4 (CD4) count,and viral load,glucose,creatinine,and triglyceride levels,were extracted from electronic health record databases.Covariance analysis for repeated measures was used to analyze the biochemical indicators,and multiple logistic regression modeling was used to compare relevant data extracted from the Group 1 and Group 2 HIV patient cohorts with different treatment time.Results:The median initial CD4 count was 175.0 cells/μl (interquartile range,77.0-282.0),while the initial CD4 counts for Group 1 were lower than those for Group 2 (P ＜ 0.05).A significant interaction between group and time effects was observed (P ＜ 0.05) in total cholesterol (TC).Changes in hemoglobin level among HIV patients were also significantly associated with treatment time (P =0.001).The initial CD4 count (odds ratio [OR] =0.756),female sex (OR =0.713),Zerit (d4T) (OR =1.443),TC (OR =1.285),and aspartate aminotransferase level (OR =1.002) were significantly associated with the survival time of dead patients with HIV (P ＜ 0.05).Additionally,the initial CD4 count (OR =1.456),age (OR =1.022),time interval (OR =0.903),patient's living status (OR =0.597),d4T (OR =2.256),and triglyceride (OR =0.930) and hemoglobin levels (OR =0.997) were significantly associated with the treatment time of HIV patients with drug withdrawal (P ＜ 0.05).Conclusion:The initial biochemical parameters can affect the survival and treatment time of HIV patients.With a comprehensive understanding of the physiological and biochemical indicators of patients,we can reduce the probability of drug withdrawal and prolong the survival time of HIV patients.

Antiretroviral regimen change among people infected with HIV: evidence from a cross-sectional study in China / 《全球健康杂志（英文）》

Background: The rate of death among people living with HIV/AIDS has decreased significantly as a result of treatment with highly active antiretroviral therapy (HAART). However, the issues of drug induced toxicities and complexity of current HAART regimens has remained of great concern. The aim of this study was to determine factors influencing antiretroviral regimen changes among people living with HIV/AIDS in China. Methods: This retrospective study collected data through face-to-face interviews with people living with HIV/AIDS who were receiving HAART, and gathered relevant information from infectious disease hospitals. The following information were collected: social-demographic characteristics, antiretroviral therapies, CD4 cell counts, virus loads, reasons for changing medication and other related data. Mean and percentages were used to describe the frequency of regimen change among patients, and binary logistic regression was employed to test the factors influencing regimen change. Results: 1,123 people who had experienced regimen change were included in the analysis. On average, patients remained on HAART for 10.2 months before changing regimen, and the average CD4 cell count and viral load (VL) were 383.1 cells/μl and 28,132.4 copies/mL respectively when changing regimen. The reasons for modification were determined as treatment failure (52.5％), adverse reactions (32.3％), and other reasons including pregnancy (15.2％). There are significant differences in regimen change among people with different genders (P<0.001), modes of transmission (P<0.001), duration of HAART (P<0.001) and initial CD4 cell counts (P=0.0024). Males, drug users, people taking long-term medication, and those with lower initial CD4 counts when starting HAART tend to change regimen. Conclusion: Treatment failure was the main reason for the change of HAART regimen. Males, drug users, people on long-term medication and those with lower initial CD4 cell counts when starting HAART were most likely to change regimen.

The Economic Burden of Patients with Mental Illness in Shandong Province during 2005 to 2013 / 中国卫生统计

Objective To calculate the social economic burden of mental illness,and to analyze the economic impact of different patients with mental illness in Shandong Province.Methods Direct method was used to calculate the direct economic burden,and human capital method was employed to estimate the indirect economic burden.Results The social economic burden increased from 10.076 billion in 2005 to 31.277 billion in 2013,and the proportion of the social economic burden accounting for GDP of Shandong province was between 0.5 ％ ～ 0.7％.The economic burden caused by women,18-39 years old patients,rural patients and mood disorders was higher than that of men,more than 55 years-old patients,urban patients and other diagnoses,respectively.Conclusions The economic burden brought by mental illness was heavy and increasing during 2005-2013.The economic burden caused by different people was heterogeneous.

Determination of key interventions for the transition from control to elimi-nation of malaria in China / 中国血吸虫病防治杂志

Objective To determine the key interventions transferring from the control to elimination of malaria in China so as to provide the basic information for achieving malaria elimination. Methods Based on the data collected from the document entitled of The National Annual Report on Schistosomiasis,Malaria and Echinococcosis,published by the National Institute of Parasitic Diseases of Chinese Center for Disease Control and Prevention,the malaria incidence and intervention data were se?lected only in the typical endemic provinces during the period of 2004-2010. The correlation between the incidence and interven?tions in the target provinces was analyzed based on the Panel Data Regression Model,and the key interventions were deter?mined. Results Four provinces namely Anhui,Yunnan,Hainan and Henan were targeted with 87.56%of the national malaria figures from 2004 to 2010. When Y was given as vivax malaria incidence,X1 as the log of the number of historical cases receiving radical treatment in the pre?transmission stage(RTPT)(F=14.53,P<0.01,R2=0.72),X2 as the log of risk population receiv?ing RTPR(F=15.90,P<0.01,R2=0.71)and X3 as the number of technicians trained in microscopy(F=11.53,P<0.01,R2=0.61),three space?fixed effect models were established respectively,and X1,X2,as well as X3 had negative effects on Y value. When Y was given as falciparum malaria incidence,X1 as the accumulated technicians trained in microscopy(F=11.06,P<0.01,R2=0.87),X2 as the log of technicians trained in entomology(F=15.28,P<0.01,R2=0.89),two two?way(space and time)fixed effect models were established respectively,and both X1 and X2 had negative effects on Y value. Conclusion RTPT among historical patients and at?risk populations as well as microscopy training influences the variation of vivax malaria inci? dence,while the significant interventions of microscopy training and vector control training indicate that the integrated measures with strengthened capacity in diagnosis and vector control are of importance in the control of falciparum malaria transmission.

Analyzing the Hospitalization Expense and Management Status of Severe Mental Illness / 中国卫生经济

Objective: To analyze the hospitalization expense and management status of severe mental illness, and to provide evidences for rational controls of medical expenses and the management of the patients. Methods:Collecting patients with severe mental illness from 2005 to 2012, analyzing the changing trends of hospitalization cost and management status with descriptive analysis, and use multiple linear regression to analyze the influence factors. Results: The average stay is 51 days, average medical costs by person and by day are RMB 8 319.69 and 169.02; treatment costs, drug costs and bed care costs are the main proportion. The medical costs were significantly affected by prolonged days of hospitalization, age, numbers of hospital admissions, nursing level and admitting diagnosis. The largest proportion of management system is schizophrenia, which counted 74.03% of current patients and the poverty incidence rate is 50.62%. Conclusions: Increasing the financial compensation to patients with severe mental illness, shorting hospital stay, strengthening the screening of patients with severe mental illness and incorporated into the management system would help to reduce the economic burden of the patients.

Clinical feature and antifungal susceptibility analysis of 111 cases of invasive fungal disease / 中国感染与化疗杂志

Objective To describe the clinical features of invasive fungal disease in Huashan Hospital,Fudan University from January 2004 to December 2006.Methods The medical data were reviewed retrospectively for the patients with fungal infection, which was confirmed by positive fungal culture or microscopic examination with blood,sterile body fluid,deep tissue,sputum specimen or isolation of Aspergillus spp.and Cryptococcus spp.from bronchoalveolar lavage.The proven and probable cases of invasive fungal disease were included in this analysis.Results A total of 111 patients were diagnosed as invasive fungal dis-ease,including 104 proven cases and 7 probable cases.Sixty-one cases were community-acquired and the other 50 were nosoco-mial.The most common site of infection was bloodstream (51,45.9%),followed by central nervous system (44,39.6%)and respiratory system (14,12.6%).The most common pathogens were Candida spp.(50,45%),Cryptococcus (47,42.3%) and Aspergillus spp. (12, 10.8%). The community-acquired fungal infections were mostly found in central nervous system (44,72.1%),and respiratory system (12, 19.7%),mainly caused by Cryptococcus and Aspergillus. The nosocomial fungal infections occurred primarily in blood-stream (96.0%),mainly due to Candida spp.No underlying disease or risk factor was identified in more than half of the pa-tients with community-acquired infection,while almost all the patients with nosocomial fungal infection had underlying disease and predisposing factors.Indwelling venous catheter was closely associated with nosocomial bloodstream infection.Indwelling venous catheter lasted for more than 1 week in 64.7% of the patients with Candida bloodstream infection.The same fungal strain was isolated from both the cather and blood of the same patient in 11 cases.The overall mortality of these invasive fungal diseases was 14.4% (16/111).The mortality rate was 18.0% (9/50)in the patients with nosocomial invasive fungal infection, and 11.5% (7/61)in the patients with community-acquired invasive fungal infection.Conclusions The most common site of in-vasive fungal infection is bloodstream,followed by central nervous system,and respiratory system.Majority of the fungal patho-gens are Candida spp.,Cryptococcus and Aspergillus spp.The community-acquired invasive fungal disease is primarily meningitis caused by Cryptococcus.The nosocomial invasive fungal disease is mainly bloodstream infection caused by Candida spp.