Objective:To assess the concerns about oral anticoagulants (OAC) in patients with nonvalvular atrial fibrillation (NAF) receiving anticoagulant therapy and find the education target in the use of OAC.Methods:It was a cross-sectional study. From December 2018 to October 2019, patients with NAF receiving OAC treatment in Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University were included. The questionnaire survey containing 10 questions was conducted to evaluate each patient's degree of concerns about OAC. A score of 0-10 indicated a level of concern ranging from none to very serious, with 0-3 considered as mild concern, 4-7 considered as moderate concern, and 8-10 considered as serious concern.Results:A total of 115 patients [mean age (65.9±12.5) years and 71 males] were selected in this study. The mean CHA 2DS 2-VASc score was 2.87±1.80. Fifty-six patients (48.7%, 56/115) took warfarin, 36 patients (31.3%, 36/115) took rivaroxaban, and 23 patients (20.0%, 23/115) took dabigatran. There were 89 (77.4%, 89/115) urban residents (urban group) and 26 (22.6%, 26/115) rural residents (rural group) . It had no significant difference in the types of OAC between urban and rural groups ( P=0.828) . Compared to urban patients, rural patients were more concerned about the risk of bleeding (4.1±3.6 vs.6.9±3.0, P=0.003) and the absence of antagonist after OAC overdose (3.6±3.8 vs.5.8±3.7, P=0.039) . There was no significant difference in drug cost between rural and urban population ( P=0.349) . Both of the two groups showed little concern about OAC's interaction with other drugs (66.1%, 76/115) or food (42.6%, 49/115) , while much concern about the potential impairment of liver and kidney functions by OAC (36.5%, 42/115) . Conclusion:Patients with NAF who received OAC treatment had little economic concerns. However, their knowledge of OAC remained lacking. Proper scientific education and optimized out-patient management of OAC should be further strengthened to improve the adherence to OAC.

Background: Anticoagulation clinic (AC) is aimed at improving anticoagulation control and outcomes in patients with atrial fibrillation (AF). There is little published data on the benefits of providing an AC in China even if Asians have a higher risk of hemorrhage and stroke when taking warfarin. This study attempts to assess the impact of the AC on warfarin management in the Chinese population. Subjects and Methods: This prospective observational study was conducted in the First Affiliated Hospital of Nanjing Medical University and consecutively enrolled 42 AF patients from the joint physician-and pharmacist-managed AC from March 2017 to April 2018. The study protocol was approved by the Institutional Review Board of the First Affiliated Hospital of Nanjing Medical University. Patients already on warfarin for at least 6 months before coming to the AC and unwilling to receive AF ablation or switch to non-Vitamin K antagonist oral anticoagulants were included. The anticoagulant activity of warfarin was monitored using the international normalized ratio (INR). The primary outcome of this study was INR control, which was defined by the time-in-therapeutic range (TTR). The TTR before and after visiting the AC was compared. Results: The mean age of the enrolled 42 patients was 68.3 ± 10.6 years and 25 (59.5%) were women. The mean CHA2DS2-VASc score and the mean HAS-BLED score were 3.43 ± 1.29 and 1.86 ± 0.80, respectively, in 28 (66.7%) patients with nonvalvular AF. The median follow-up time after visiting the AC was 298.5 days (interquartile range: 151.8–441.8 days). The TTR (% days) before and after visiting the AC was 44.1% ± 27.5% and 69.7% ± 23.3% (P < 0.001), respectively. Meanwhile, 6 (14.3%) and 25 (59.5%) patients had TTR (% days) >65% before and after visiting the AC (P = 0.001), respectively. Conclusions: TTR values were higher in AF patients taking warfarin after the AC. More patients reached satisfactory warfarin control after visiting the AC.

目的:对单中心33个月所做的直立倾斜试验(HUTT)结果进行分析并探讨健康教育对HUTT阳性患者再发晕厥次数的影响.方法:收集从2015年2月至2017年11月因反复晕厥或反复出现晕厥前兆在南京医科大学第一附属医院就诊并进行HUTT患者294例.根据HUTT中患者心率与血压的变化,196例HUTT呈阳性,其中混合型血管迷走神经性晕厥(Ⅰ型)146例,心脏抑制型血管迷走神经性晕厥(Ⅱ型)14例,血管抑制型迷走神经性晕厥(Ⅲ型)36例.分析各型患者HUTT阳性率并对健康教育前后HUTT阳性结果患者晕厥发生次数的差异进行比较.结果:在294例行HUTT检测的患者中,有196(66.7％)例患者出现血管迷走性晕厥,其中I型、Ⅱ型、Ⅲ型血管迷走性晕厥分别有146例(74.5％)、14例(7.1％)、36例(18.4％).年龄>60岁患者HUTT阳性率明显高于年龄<40岁患者(77.1％vs.57.1％,P<0.01).在196例HUTT阳性患者中,80例(40.8％)患者接受随访,随访患者接受健康教育前后,患者晕厥次数中位数从2(四分位数间距IQR:1～4)次降到0(IQR:0～0)次(P<0.001),差异有统计学意义.结论:HUTT证实,血管迷走性晕厥患者中以混合型血管迷走神经性晕厥为主,年龄较大患者HUTT阳性率较高,随访结果提示健康教育可以减少此类患者再发晕厥风险.

文献报告会(journal club)是一种国际认可的各类高校、科研院所及大学附属医院内常见的学术研讨会.它在传播学科前沿理论,帮助研究生建立批判性思维方式以及提高其口语表达能力等方面,发挥了重要作用.目前,国外已将文献报告会作为医学研究生、住院医生、专科医生培养的重要工具.一些基础医学研究中心也经常举办文献报告会以帮助研究员们了解同一领域其他工作者的科研进展.该研究阐述了开展文献分析会在国内医学教育中的可行性与在心电生理学教学中的必要性,并分享南京医科大学第一附属医院心血管内科心律失常中心文献分析会的开展经验.

Background Recently, flipped classrooms (FCs) have gradually been used in Chinese higher education settings. However, few studies have focused on the effects of FCs on interdisciplinary curricula. The purpose of this study was to examine the impact of an FC on the engagement, performance, and perceptions of students and on teacher-student interaction in a pharmaceutical marketing course. Design A clustered randomized controlled study was conducted, with 137 junior-year pharmacy undergraduates using an FC serving as the intervention group, in contrast to students using lecture-based learning (LBL) as the control group. Flanders’ interaction analysis system (FIAS) was used to measure teacher-student interaction, and questionnaires regarding attitudes toward and satisfaction with the teaching model were administered. Results The students in the FC group scored significantly higher than those in the LBL group (88.21±5.95 vs. 80.05±5.59, t = -8.08, p = 0.000) on pharmaceutical marketing. The multiple linear regression results showed that the FC model had a significant impact on student performance (β = 8.16, p<0.0001). The percentages of teacher talk in the FC and LBL groups were 21% and 96%, respectively (χ2 = 2170.274, p = 0.000); however, the percentages of student talk in the FC and LBL groups were 75% and 2.6%, respectively (χ2 = 2012.483, p = 0.000). Compared with the LBL group, most students in the FC group held more positive attitudes toward the teaching model; the mean scores for the 8 attitude attributes in the FC group were significantly higher than those in the LBL group (p = 0.000). There were significant differences in the ratings of satisfaction with teacher-student interaction (p = 0.000), the students’ learning attitude (p = 0.000), the teacher’s preparatory work (p = 0.000), the teaching objective (p = 0.000), and the teaching effect (p = 0.000) between the two groups. Conclusion Compared with LBL methods, implementing the FC model improved student performance, increased teacher-student interaction and generated positive student attitudes toward the experience. As an effective pedagogical model, it can also stimulate pharmacy students’ learning interest and improve their self-learning abilities.

文章介绍1例因应用华法林抗凝致国际标准化比值严重超标的心房颤动病例.

Objective: Exploring how the theory of planned behavior (TPB), social capital theory (SCT), cervical cancer knowledge (CCK), and demographic variables predict behavioral intentions (BI) related to cervical cancer screening among Chinese women. Methods: Self-administered questionnaires were distributed to 496 women, followed by a path analysis. Results: The three-level model was acceptable, χ2(26, 470) = 26.93, p > 0.05. Subjectively overcoming difficulties, support from significant others, screening necessity, and the objective promotion factor promoted BI, with effect sizes of 0.424, 0.354, 0.199, and 0.124. SCT and CCK promoted BI through TPB, with effect sizes of 0.262 and 0.208. Monthly income, education, age, and childbearing condition affected BI through TPB, SCT, and CCK, with effect sizes of 0.269, 0.105, 0.065, and −0.029. Conclusion: The three-level model systematically predicted behavioral intentions relating to cervical cancer screening.

文章利用PubMed、CNKI等国内外数据库,检索宫颈癌与乳腺癌筛查服务与利用方面的相关文献,整理归纳与比较分析发现,国外研究以社会心理学、行为学等健康信念理论为研究框架,强调社会心理、行为因素、社会资本对供需双方“两癌”筛查服务利用与提供的影响,并以此设计相应的干预策略,但是以供方视角分析筛查服务提供影响因素的研究偏少.国内的研究以需方参与筛查服务的影响因素分析为主,但是大部分研究缺少必要的理论基础,缺少对供方组织和个体层面的系统研究.国内研究者应加强对供方“两癌”筛查服务提供意愿与行为的影响因素分析,建立适合我国城乡妇女“两癌”筛查依从行为解释和干预的理论模型,积极开发提高城乡妇女参与“两癌”筛查依从行为的综合干预方案.

OBJECTIVE:To put forward relevant suggestions for promoting the R&D cooperation in biomedical field in China. METHODS:Information of all invention co-patents in biomedical fields during 2000-2015 in patent database was collected,includ-ing year,patent name,application number,applicant,patent address,etc.,and descriptive statistical analysis was conducted. RE-SULTS:The number of invention co-patents in biomedical fields had been increasing year by year,and the number of invention co-patents in 2015 was about 9 times than that in 2000. Invention co-patents mainly came from Beijing,Shanghai and Guangdong,accounting for 49.1%. The top 15 applicants had 983 invention co-patents in total,accounting for 8.9% of the total number of co-patents,7 of which were enterprises. And in the invention co-patents applied by the top 10 cities for GDP ranking in 2014,inven-tion co-patents applied by enterprises,scientific research institutions(include hospitals)and universities accounted for 56.2% of all patents. CONCLUSIONS:The R&D cooperation in biomedical fields has mainly focused on a few developed provinces and cities, with low concentration of invention co-patents;the R&D cooperation is mainly led by enterprises,and hospitals have low participa-tion. The government should establish national biomedical information sharing platform,raise the R&D cooperation awareness of large-scale pharmaceutical enterprises and encourage hospitals to actively participate in R&D cooperation activities in biomedicine fields.