There is a growing focus on researching healthcare services to identify factors associated with satisfaction in family contract services in China. However, previous satisfaction studies have mainly focused on the primary healthcare. Currently, the primary healthcare service capacity in China is relatively insufficient, necessitating the involvement of upper-level hospitals in contracted services Thus, the study significantly deepens and broadens previous research on satisfaction in family contract services of hospital. A conceptual model was developed and tested on a sample of customers and patients with hospital contract service (n = 624). Partial least-squares structural equation modelling (PLS-SEM) was used to analyse the data with SmartPLS4.0 software in two steps involving a measurement model and a structural model. Mediation analysis was used to test the proposed indirect effects. Contracted patient satisfaction is directly and positively associated with Perceived value (β = 0.223), Patient experience (β = 0.613) and Customer expectations (β = 0.129). The relationships between Customer expectations, Patient experience and contracted patient satisfaction are all mediated by Perceived value. Patient experience mediates the relationship between Customer expectations and contracted patient satisfaction. Overall, the proposed model explains 61.3

The green-tea manufacturing process showed good effect of flavor improving, debittering and shaping in making Penthorum chinensePursh leaf (PL) tea (PLT), which serves as a polyphenol dietary supplement and beverage raw material. GC–MS results showed that its unpleasant grassy odor decreased by 42.8% due to dodecanal, geranylacetone, and (E)-2-nonenal reduction, coupled with 1-hexadecanol increasing. UPLC-ESI-TOF-MS identified 95 compounds and showed that the debittering effect of green-tea manufacturing process was attributed to decreasing of flavonols and lignans, especially quercetins, kaempferols and luteolins, and increasing of dihydrochalcones which act as sweeteners bitterness-masking agents, while astringency was weakened by reducing delphinidin-3,5-O-diglucoside chloride, kaempferol-7-O-β-d-glucopyranoside, and tannins. The increase of pinocembrins and catechins in aqueous extracts of PLT, maintained its hepatoprotective, NAFLD-alleviation, and hepatofibrosis-prevention activities similar to PL in high fat–diet C57BL/6 mice, with flavonoids, tannins, tannic acids, and some newfound chemicals, including norbergenin, gomisin K2, pseudolaric acid B, tanshinol B, as functional ingredients.

Background Family doctor contract policy is now run by the State Council as an important move to promote the hierarchical medical system. Whether the family doctor contract policy achieves the initial government’s goal should be measured further from the perspective of patient visits between hospitals and community health centers, which are regarded as grass medical agencies. Methods The spatial feature measurement method is applied with ArcGIS 10.2 software to analyze the spatial aggregation effect of patient visits to hospitals or community health centers among 20 districts of one large city in China and analyze the family doctor contract policy published in those areas to compare the influence of visit tendencies. Results From year 2016-2020, visits to hospitals were in the high-high cluster, and the density was spatially overflow, while there was no such tendency in visits to community health centers. The analysis of different family doctor contract policy implementation times in 20 districts reflects that the family doctor contract policy has a very limited effect on the promotion of the hierarchical medical system, and the innovation of the family doctor contract policy needs to be considered. Conclusions A brief summary and potential implications. A multi-integrated medical system along with family doctor contract policy needs to be established, especially integrated in leadership and governance, financing, workforce, and service delivery between hospitals and community health centers, to promote the hierarchical medical system.

Background: Chronic Kidney Disease due to hypertension poses a growing global diseaseburden, with significant disparities across regions. Comprehensive analysis and effective strategies should be provided to tackle the increasing issue. Methods: Using data from the Global Burden of Disease 2021, this study conducted descriptive and statistical analyses to evaluate the CKD burden due to hypertension across different SDI regions. EAPC,risk factors and decomposition were used to analyse the tread and distributional difference Findings: Globally, ASMR increased from 4.29 (95% UI: 3.55–5.11) per 100,000 in 1990 to 5.54 (95% UI: 4.68–6.41) in 2021, with a 0.97% annual increase. High SDI regions saw a sharp rise, with ASMR climbing from 2.4 (95% UI: 1.95–2.86) to 4.09 (95% UI: 3.34–4.71) and an EAPC of 2.23%. Low SDI regions experienced a slight decline in ASMR from 8.69 (95% UI: 7.03–10.73) to 8.62 (95% UI: 7.09–10.51). High systolic blood pressure and kidney dysfunction have consistently been the leading risk factors, female have a higher risk of high body-mass index than men, especially in high SDI regions.Decomposition highlights aging and epidemiological shifts，East Asia demonstrated a unique trend, with a 49.59% reduction in ASMR, ASDR and ASPR despite an aging population, reflecting successful interventions.

Abstract Background: In China’s health reform , community and township health center are with multiple expectations. However, in this process, the fulfillment and challenge in the role of community and township health center managers need to be revealed to maintain the health reform a sustainable development Purpose: The purpose of this study is to describe the factors that influence the fulfillment and challenge in the role of community and township health center managers Method: Analysis of 72 interviews with community and township health center manager was performed with grounded theory methodology. Results: Fulfillment were “seeing positive change ”, “experiencing a variety of relationships”, “being creative to promote development ” and “experiencing professional growth” .Some negative themes that resulted in challenge were “lack of systematically training”, “feeling overwhelmed with the number of hours and duties”, “information system need to be advanced”, “the faculty shortage ”and a “lack of supervision and support from the local administration” Conclusion: By disclosing aspects of fulfillment and challenge of the community and township health center manager role, the development of community and township health center will be affected.

针对医学研究生在选择课程时考虑的因素、学习收获、学习后的感受与预期的差异、如何设置课程从而更好地满足医学研究生培养需要等问题,对西南某高校临床医学院 2022 级博士、硕士研究生进行问卷调查,分析课程选择影响因素、学习预期与收获等,对医学研究生课程建设提出新的思考.

Imatinib is the standard first‐line treatment for advanced gastrointestinal stromal tumors (GISTs); however, most patients eventually develop imatinib resistance, leading to considerable clinical challenges. Few direct comparisons have been made between different post‐first‐line therapies on clinical efficacy in advanced GIST following imatinib failure.

Salted duck egg, as a traditional egg product, are very popular in China. However, its high contents of NaCl brings health hazard. In this work, the influence of successive presoaking with 0.01% acetic acid and 0.35% ethanol and desalination soaking on the water content, salt content, oil yield, maturity, sensory quality and eggshell membrane microstructure of salted duck eggs were explored using atomic absorption spectrometry, chromatic meter, texture analyzer, scanning electron microscope (SEM) and sensory evaluation. For pre-soaking samples, the redness and brightness of the yolk changed to 16.10 and 67.54 after 12-day salinization at 37 ℃, respectively, and the yolk index has reached 95%, suggesting that pre-soaking samples get salted after 12 days, while the control group needed 21 days to get ripe. The salt content of egg protein in the pre-soaking group was assayed to be 1.02% on the 6th day of desalting, which was 18% less than that in the control group, while the oil yield and the hardness of the pre-soaking group reached 50.82% and 2 604. 33 g. The appearance, smell, color, taste and other sensory indicators of the pre-soaking samples were similar to those of the control group, while the control group tasted much more salt. The microstructure observation of eggshell membrane showed that pre-soaking enlarged the space between inner membrane fibers, which improved the two-way permission of water and sodium chloride molecules, resulting in rapid salinization and desalting of pre-soaking samples.

Objective:To establish an index system for evaluating the employment quality of medical students in universities.Methods:Literature review and expert consultation methods were used to formulate preliminary evaluation indicators. Nine experts were selected to conduct three rounds of correspondence through Delphi method, and the indicators and the weights of the first, second and third levels were determined. Excel 2016 and SPSS 22.0 were used to make data entry and analysis.Results:The effective recovery rate of the questionnaire was 100.0%, the average expert authority coefficient was 0.749(>0.700), and the expert coordination coefficients were 0.228 and 0.212 ( P<0.001). Finally, an evaluation index system for the employment quality of medical students in universities was constructed, which was composed of 5 first-level indicators, 31 second-level indicators and 66 third-level indicators. Among them, the weights of the first-level indicators were 0.283, 0.250, 0.200, 0.108 and 0.158, respectively. Conclusion:The employment quality evaluation index system for medical students constructed in this study is systematic, comprehensive and multi-dimensional, which can provide a reference for the evaluation on medical graduate employment quality, and its scientificity and practicability need to be further explored in empirical research.

以赶黄草鲜叶为原料,通过模糊数学模型建立赶黄草代用茶感官评价标准.通过单因素结合响应面试验方法,优化得到赶黄草叶茶最佳工艺条件:烘青水分60％,初烘温度124℃,揉捻时间18 min.采用氨基酸分析仪、高效液相色谱技术、顶空固相微萃取(HS-SPME)和气相色谱-质谱(GC-MS)技术分析赶黄草叶茶茶汤中游离氨基酸组成、没食子酸、总黄酮、槲皮素、乔松素及其挥发性成分变化.优化后的制备工艺降低了游离苦味氨基酸与没食子酸含量,其中没食子酸为主要苦味呈味成分;赶黄草叶以青草味、橙油味、清香、花香为主体特征,叶茶中青草味和橙油味变淡,清香和花香增加.本制备工艺对总黄酮、槲皮素和乔松素等赶黄草主要功效成分的溶出无明显影响.

目的 了解某三甲综合医院患者门诊预约精准性及其影响因素,比较正确预约与错误预约患者在预约可及性因素上的差异,寻找提高门诊预约精准性的干预点.方法 采用现场调查法,于2021年6月14—21日在四川省成都市某三甲综合医院对70例门诊患者进行面访调查.结果 门诊预约精准性低,错误预约患者占36.75％.单因素分析显示,预约精准性正向影响因素包括医疗保险保障度(P=0.004)、线下信息可及度(P=0.049)以及医务人员推荐依从度(P<0.001),负向影响因素包括网络信息依从度(P=0.012)、传统媒体信息可及度(P=0.024)以及自媒体推荐依从度(P<0.001);二分类非条件logistic回归分析显示,预约精准性与听从医务人员推荐正相关(P=0.002),与听从自媒体推荐负相关(P=0.014).结论 医疗机构需要加强宣传力度、丰富宣传内容,提高患者就诊的可及性;建议加强网络及传统媒体虚假医疗信息整治力度能改变门诊患者预约精准性低的现况.

目的 分析"双一流"建设高校临床医学研究生教育关键指标及内在机理,持续提升研究生满意度.方法 选取某"双一流"建设高校2016-2020届1603名全日制临床医学毕业研究生为调查对象,基于大学生满意度量表(Student Satisfac-tion Inventory,SSI)及研究生教育关键环节设计问卷,采用SPSS24.0软件进行问卷信效度及数据分析.结果 这5届临床医学毕业研究生对院校培养满意度呈上升趋势,其中首份工作满意度97.38％、全过程培养受益满意度95％(对外交流学习91.70％、创新创业锻炼88％)、导师指导评价满意度97％、专业教师队伍满意度97％,就学意愿度97％.皮尔逊相关分析显示问卷各个维度间均存在显著的正相关关系(r=0.331-0.670).结论 毕业生首份工作评价、全过程培养受益度、导师指导评价、专业教师队伍整体评价、就学意愿度等关键环节研究生满意度指标是高校回归"以学生为中心"的教育理念重要体现.

Object GP residents’s has the obligation to take task with the public health prevetion. GP residents receive the public health training during their college study period and the residents training. The sudden outbreak of the COVID-19 epidemic, highlight the importance and competence of the community prevention as the front line of epidemic prevention and control, pushing the general practitioner (GP) residents into the front team of epidemic prevention and control. Residents’ participation in epidemic prevention and control is not only a field workload participation in public health disease prevention and control, but also a rare and value-oriented training experience. This study aims to explores the research on the training content, ability improvement and cognitive load of the resident, and to demonstrate past and future training effects of epidemic prevention and control. Methods Object cognitive load scale (NASA-TLX scale) and self-developed questionnaires were adopted to conduct a questionnaire survey on resident doctors who were in GP training program from West China Hospital of Sichuan University, and finally 190 questionnaires were collected. SPSS 23.0 statistical software for statistical analysis of data. Result Most indicators of cognitive load NASA scale are at a “moderate” level by the GP residents, generally indicating that the intensity of on-site epidemic prevention and control (training) can be tolerated. The chi-square test is used to study the status of “How responsible you are for epidemic prevention and control in a community in the future”, the residents grade shows no significant difference while “ how many months after the outbreak when you participated in the epidemic prevention” shows significant difference, the result show that GP residents already have konwledge and skills for the public health prevetion, they need more attitude and mental preparation. Continuing education will have a significant positive relationship with the GP residents’s confidence of the prevetion ofpublic health prevetion. Conclusion Former medical school education and training at the regulatory training stage have a good effect for residents to master the ability of epidemic prevention and control, and to prepare for the needs of epidemic prevention and control physically and mentally. After this stage, the epidemic prevention and control training under the real situation will make a great contribution to the self-assessment and performance improvement of the final general practitioners.

目的:基于"从游教育"理念探索医学研究生班主任工作机制,评估医学研究生班主任工作成效,为医学研究生教育管理提供参考.方法:通过文献研究和德尔菲专家咨询形成医学研究生班主任工作评估体系,采用Likert等级评分法对四川省某高校1131名医学研究生进行问卷调查.结果:医学研究生班主任工作成效评分均值高于理论中值.配置班主任研究生评分均值高于未配置班主任研究生,"学风考纪"(P<0.001)和"危机干预"(P<0.001)评分均值差异最大.纵向配置班主任研究生评分均值高于横向配置班主任研究生,"困难学生关心"(P<0.001)、"人文素养和科学精神培养"(P<0.05)、"安全教育"(P<0.05)评分均值差异最大.结论:医学研究生班主任工作成效显著,在学风引领、危机干预等方面发挥重要作用."从游而学"医学研究生班主任制度,通过濡染观摩教育方式结合专业学习与思想引领,与导师、辅导员形成育人协同体,显现从游既久的良好育人实效.

Objectives Doctors who wish to become general practitioners (GPs) in China are required to attend and complete general practice resident training. In the early stages of the standardized GP training system, GP training supervisors play important roles. This study aims to explore how GP residents perceive their GP supervisors, factors that affect GP residents’ satisfaction level, as well as to offer suggestions based on the implications of this study. Design We conducted a mixed quantitative and qualitative study. Firstly, with respect to the quantitative research, we conducted a survey to investigate training satisfaction through questionnaires, then extracted and analyzed the factors that influence training satisfaction. In the qualitative study, we conducted in-depth, semistructured interviews using qualitative research criteria (COREQ)––a 32-item checklist for interviews. Participants Participants in the quantitative survey included 1172 GPs whose training time wasbetween 2008 and 2017. Afterwards, 100 participants were selected from this sample , filtered by stratified random sampling and by having provided extreme answers on the quantitative survey (less than 5% of the total sample). They were chosen for the qualitative research to conduct a more detailed investigation., This stratified random sampling was based on residents’ grades, regions, and training levels (city level or county level). Extreme answers were identified as answers of “extremely good” or “extremely bad” to questions from the initial comprehensive survey of 1172 participants. Consequently, 30 participants with extreme answers were found, while the remaining 70 participants in the interviews were selected by stratified random sampling. Ultimately, this sample of participants met our information collection and sample estimation requirements. Results The results show that satisfaction with GP theoretical training supervisors, GP hospital-based training supervisors, and GP community-based training supervisors differed. Considering long-term averages, the hierarchy of satisfaction is as follows: GP theoretical training supervisors > GP community-based training supervisors > GP hospital-based training supervisors. GP hospital-based training supervisors need to improve their conception of GPs, teaching methods and conscientiousness. GP community-based training supervisors need to improve their teaching methods, knowledge of clinical theory and practice ability. Conclusions On the one hand, teams of GP supervisors in China have gradually been established over time. On the other hand,the satisfaction tendencies of residents with respect to their GP supervisors are quite different, and teams of GP supervisors must be promoted and improved.

分析医学研究生对新冠肺炎(COVID-19)防治的认知、态度和行为,为重大公共卫生事件和传染病防控采取健康教育措施、提高医学研究生职业素养提供实证参考.

目的 分析获得国家奖学金(以下简称"国奖")医学研究生的创新能力,探讨临床医学研究生创新能力的培养及相关因素.方法 以四川大学华西临床医学院临床医学专业2016、2017级在读研究生为调查对象,以是否获得国奖分为国奖组与对照组,比较两组研究生的创新能力水平和认知差异,并探讨相关因素.结果 共回收有效问卷1 173份,回收率80.23％.两组研究生的性别和专业差异无统计学意义(P＞0.05).对于硕士研究生,国奖组发表国际医学期刊论文(80.95％vs.29.63％)、发表高影响因子期刊论文(影响因子≥6)(7.84％vs.6.16％)、研究申请专利(12.70％vs.3.51％)和创新创业竞赛获奖(20.63％vs.3.93％)的比例高于对照组,差异有统计学意义(P＜0.05).对于博士研究生,国奖组发表国际医学期刊论文(96.00％vs.69.66％)、发表高影响因子期刊论文(22.22％vs.8.89％)、研究申请专利(17.33％vs.8.36％)和创新创业竞赛获奖(17.33％vs.1.86％)的比例高于对照组,差异有统计学意义(P＜0.05).对于创新能力构成的认知,国奖组与对照组的差异无统计学意义(P＞0.05).国奖组与对照组均有超过40％的研究生认为创新能力个人影响因素中最重要的是知识因素,有超过45％的研究生认为创新能力培养影响因素中最重要的是自身因素或导师因素.结论 临床医学研究生创新能力有待提升,导师科研能力水平、导师指导、高质量科研团队、良好学术氛围对于创新能力的培养具有重要作用.优化导师队伍、组建科研指导小组、构建高水平创新平台、瞄准孵化高水平论文、强化国内外交流与合作、激励学生参加创新创业竞赛是培养创新型医学人才的有力举措.

食品新原料赶黄草茎泡饮具有护肝解酒作用,常采用制茶工艺脱苦增香,但其功效及风味成分变化机制不明.文章采用氨基酸分析仪、HS-SPME-GC-MS和HPLC等仪器,分析了赶黄草茎及茎茶中游离氨基酸、没食子酸、挥发性成分、总黄酮、槲皮素、乔松素含量变化,发现赖氨酸和没食子酸为赶黄草茎主要苦味贡献成分,其在茎茶中含量明显降低;茎原料以壬醛、反式-2-壬醛、癸醛、1-辛烯-3-醇、月桂醛为主要挥发性成分,呈现强烈的草青味、药味和橙油味,而茎茶中上述成分显著减少,苯甲醛、6-甲基-3,5-庚二烯-2-酮、 2-戊基呋喃含量增加,故药味、草青味和橙油味变弱,以清香、果香和豆香为主体香气.此外,赶黄草茎茶对槲皮素、乔松素等主要功效成分的溶出无明显影响.

目的 了解临床医学专业学位(传统专硕和双轨制专硕)研究生在读期间论文的发表情况,为医学硕士研究生科研水平的培养评价提供参考依据.方法 以四川大学华西临床医学院2013级和2014级已经毕业的435名专业硕士研究生为调查对象,对其发表的学术论文进行回顾性分析.结果 435名专业学位硕士研究生在读期间共发表840篇学术论文,其中传统专硕247人共发表522篇学术论文(含149篇SCI论文,占28.54％;44篇Medline论文,占8.43％;329篇核心期刊论文,占63.03％),生均发表了2.113篇;双轨制188人共发表318篇学术论文(含84篇SCI论文,占26.42％;24篇Medline论文,占7.55％;210篇核心期刊论文,占66.04％),生均1.691篇.结论 传统型专业学位硕士研究生在发表文章数量和质量上均高于双轨制专业学位硕士;在高水平SCI论文发表上,传统型专业学位硕士也高于双轨制专业学位硕士.

Background: To explore the construction of the trainers' ability system of the community practice base of general practice under the background of hospital / community integrated teaching of general practice. Methods: literature analysis, Delphi discussion and questionnaire survey were used in the study, and exploratory factor analysis was used to extract competency. Results: there are 4 first level indicators and 20 second level indicators in the system, among which the first level indicators are: personal characteristics and professionalism, teaching and research ability, basic level clinical practice ability, and base organization management ability. Conclusion: the index system enriches the theory of teachers' ability in community practice base of general practice medicine, and provides empirical research basis for the selection, ability training and performance evaluation of teachers in community practice base of general practice medicine.