目的 通过建立急性心力衰竭（AHF）患者服药依从性预测模型,提高AHF患者的服药依从性和临床管理效果。方法 纳入2021年1月—2023年12月在广州市番禺区何贤纪念医院住院治疗的580例AHF患者,通过收集患者的一般人口学资料、疾病相关资料及出院后6个月的服药依从性数据,应用Logistic回归模型分析患者服药依从性的影响因素,并基于影响因素建立预测模型。结果 患者服药依从性总体良好（75%）。依从性良好组与依从性差组的年龄、独居情况、合并基础病、服药种类、疾病了解评分、治疗信心评分和自我控制信心评分比较差异有统计学意义（P<0.05）。Logistic 回归分析显示危险因素包括年龄≥60岁（OR=1.774）、独居（OR=1.871）、合并基础病≥2种（OR=1.719）和服药种类≥7种（OR=1.456）。而疾病了解评分（OR=0.923）、治疗信心评分（OR=0.946）和自我控制信心评分（OR=0.901）是保护因素（P<0.05）。基于上述因素建立的预测模型,通过ROC曲线验证,曲线下面积为0.815（95%CI：0.780~0.850）,提示所构建的模型具有良好的区分度。对该模型的校准度进行评价,P=0.528,提示该预测模型拟合度良好。此外,该预测模型的一致性指数为0.738,说明模型的预测性能良好。绘制的决策曲线中,曲线位于极端线之上,当阈概率取值在9%~59%时,对应的净获益率为0~27%,提示建立的模型具有优秀的临床有效性。结论 AHF患者的服药依从性受到多种因素的影响,包括年龄、居住状态、合并基础病种类及服药种类等。

Objective To establish a predictive model for medication compliance among acute heart failure（AHF）patients in order to enhance their therapeutic compliance and optimize clinical outcomes. Methods A total of 580 AHF inpatients at He Xian Memorial Hospital in Panyu District, Guangzhou between January 2021 and December 2023 were enrolled. Demographic information, disease-specific data,as well as post-discharge medication compliance records within six-month were collected by investigators. Utilizing logistic regression analysis revealed several influential determinants affecting medication compliance which formed the basis for constructing our predictive model. Results Generally,patient compliance was good（75%）. The comparison between the good compliance group and the poor compliance group showed that there were significant differences in age, living alone,combined with underlying diseases, types of medication, disease understanding score, treatment confidence score and self-control confidence score（P<0. 05）. Logistic regression analysis showed that independent risk indicators including individuals aged ≥60 years（odds ratio[OR]=1. 774）, those living alone（OR=1. 871）, presence of two or more underlying diseases（OR=1. 719）, along with consumption of seven or more medications daily（OR=1. 456）. Conversely,disease awareness score（OR=0. 923）, treatment confidence score（OR=0. 946）, and self-control confidence score（OR=0. 901）were identified as independent protective factors. Validation using receiver operating characteristic curves demonstrated robust predictive performance with an area under curve value of 0. 815（95%CI：0. 780-0. 850）, affirming its efficacy. The calibration of the model was evaluated, with a P-value of 0. 528, indicating good fit of the predictive model. Additionally, the concordance index（C-index）of the model was 0. 738, suggesting its excellent predictive performance. The decision curve analysis revealed that the curve was above the extreme lines, with a net benefit rate ranging from 0 to 27% when the threshold probability falls between. Conclusions The medication compliance of AHF patients is influenced by various factors, including age, living arrangement, the number of underlying diseases, and the number of medications taken. Targeted interventions such as enhancing patient education, simplifying treatment regimens, and improving social support can effectively improve the medication compliance of AHF patients. The predictive model established in this study provides a scientific basis for clinicians to develop more precise and effective individualized intervention measures,thereby improving the prognosis and quality of life.

股骨转子间骨折是最常见的髋部骨折,内固定手术为其目前治疗的首选方式。头颈钉位置是评估手术效果和判断治疗预后的重要因素,合适的置钉位置有利于稳定骨折、加速康复以及改善预后。目前头颈钉位置最经典的评估方式为尖顶距（TAD）,但TAD至今仍存在较多争议。近年来提出的轴刀角、尖颈距离比、偏心距（ED）以及标准化TAD（STAD）为临床实践拓展了新视野。文章通过对上述头颈钉位置的评估方法及局限性进行文献综述,旨在为临床手术置钉时提供相应的参考。ED和STAD的提出,为未来人工智能评估头颈钉位置提供了可能。

Femoral intertrochanteric fracture is one of the most common hip fractures, and the internal fixation is the preferred treatment. The position of cephalic fixator is an important factor to evaluate the effect of operation and the prognosis of treatment. Tip-apex-distance（TAD）is the most classical method to evaluate the position of cephalic fixator, but it is still controversial. In recent years, the axis-blade angle,tip-neck distance ratio, eccentric distance（ED）and standardized TAD（STAD）have been proposed,though with limitations, they also provide a new perspective for clinical practice. In this study, we reviewed the literature on the evaluation of the position of cephalic fixator in order to provide the corresponding references and guidance for the clinical operation of internal fixation. Both STAD and ED may be the theoretical possibility of artificial intelligence evaluation of the position of cephalic fixator in the future.

       目的   通过对广东省下的卫生资源配置的公平性进行分析，找出当前卫生资源配置存在的问题并提出优化建议，以进一步减少健康不平等的现象，为实现广东省均衡化配置卫生资源的“十四五”目标提供实践参考依据。方法  收集整理《广东省统计年鉴》中2018—2022年相关数据，采用集聚度法、空间自相关分析，从人口、地理、空间三个纬度对卫生资源分布的公平性进行分析。结果  珠三角、粤东地区的卫生资源配置公平性，在地理维度上较高，人口维度上较低；粤西、粤北地区的卫生资源配置的公平性与之相反。在空间分布上，2018年部分城市的卫生资源分布呈现出一定的空间集聚特征，但到2022年这种空间集聚特征均弱化，空间自相关性消失。结论  广东省卫生资源在地域之间存在分布不均衡情况，其配置公平性有待提升。尽管空间自相关消失可能意味着资源不再集中在某些特定区域，但政策制定者在未来进行卫生资源规划时，要考虑如人口密度、经济发展水平等因素给各地区带来的影响，以进一步促进资源的均等化配置。

       Objective  By analyzing the equity of health resource allocation in Guangdong Province，to identify the current problems in health  resource allocation and put forward optimization suggestions to further  reduce health inequalities and provide practical references for achieving the “14th Five-Year Plan” goal of balanced allocation of health resources in Guangdong Province．Methods  Relevant data from 2018-2022 in the Guangdong Provincial Statistical Yearbook were collected and organized，and the equity of health resource distribution was analyzed in three dimensions：demographic，geographic and spatial，by using the agglomeration method and spatial auto-correlation analysis．Results  The equity of health resource allocation in the Pearl River Delta and Guangdong East regions was higher in geographical dimension and lower in population dimension；the equity of health resource allocation in Guangdong West and Guangdong North regions was the opposite．In terms of spatial distribution，the distribution of health resources in some cities showed some spatial clustering characteristics in 2018，but all such spatial clustering characteristics weakened and spatial auto-correlation disappeared by 2022．Conclusions  Health resources in Guangdong Province were unbalanced in terms of their geographic distribution，and the equity of their allocation needs to be improved．Although the disappearance of spatial auto-correlation may mean that resources are no longer concentrated in certain regions，policymakers should consider the impact of factors such as population density and level of economic development on regions when planning health resources in the future to further promote the equalization of resource allocation．

       目的     探讨内镜下黏膜切除术患者肠道准备教育程序的优化方法及改善效果。方法    选择2022年12月—2023年12月广州市中西医结合医院接收的内镜下黏膜切除术患者180例进行研究，电脑随机编号按奇偶数分为两组各90例，对照组采取常规肠道准备教育工作，观察组实施基于优化的教育程序展开教育工作，比较两组依从性、肠道准备质量、满意度、不适症状发生情况。结果    观察组饮食依从率96.88%、服药依从率98.44%、运动依从率93.75%，均高于对照组的78.13%、79.69%、71.88%（χ ² 分别为6.172、7.745、7.120，P分别为0.012、0.005、0.007）。观察组左侧、横结肠、右侧等评分及肠道准备质量总分高于对照组（t分别为7.175、6.442、5.971、8.234，均P＜0.001）。观察组肠道准备满意度为98.89%，高于对照组的88.89%（χ ² =7.842，P=0.005）。观察组恶心11.11%、呕吐4.44%、腹胀5.56%、腹痛0.00%，低于对照组的22.22%、13.33%、14.44%、6.67%（χ ² 分别为4.000、4.390、3.950、4.310，P分别为0.045、0.036、0.046、0.037）。结论    对内镜下黏膜切除术患者实施基于优化的教育程序展开肠道准备教育工作可提高患者肠道准备依从性，保证良好的肠道准备质量和肠道清洁度，提高患者的满意度，有助减少肠道不适症状。

       Objective  To explore the optimization method and improvement effect of bowel preparation education program in patients undergoing endoscopic mucosal resection．Methods  A total of 180 patients with endoscopic mucosal resection admitted to the hospital from December 2022 to December 2023 were selected for the study．They were randomly divided into two groups with 90 cases in each group．The control group was given routine bowel preparation education，and the observation group was given education based on optimized education procedures．The compliance，quality of bowel preparation，satisfaction and discomfort symptoms were compared between the two groups．Results  The diet compliance rate 96.88%，medication compliance rate 98.44%，exercise compliance rate 93.75% in the observation group were significantly higher than 78.13%，79.69%，71.88% in the control group（χ ² =6.172，7.745，7.120，P=0.012，0.005，0.007）．The scores of left colon，transverse colon and  right colon and the total score of bowel preparation quality in the observation group were significantly higher than those in the control group（t=7.175，6.442，5.971，8.234，all P＜0.001）．The satisfaction of bowel preparation in the observation group（98.89%）was significantly higher than that in the control group（88.89%）（χ ² =7.842，P=0.005）．Nausea 11.11%，vomiting 4.44%，abdominal distension 5.56%，abdominal pain 0.00% in the observation group were significantly lower than 22.22%，13.33%，14.44%，6.67% in the control group（χ ² =4.000，4.390，3.950，4.310，P=0.045，0.036，0.046，0.037）．Conclusions  The implementation of bowel preparation education based on optimized education program in patients undergoing endoscopic mucosal  resection can improve the compliance of bowel preparation，ensure good quality of bowel preparation and bowel cleanliness，improve patient satisfaction，and reduce the occurrence of intestinal discomfort symptoms，which is worthy of promotion．

       目的   对该培训基地师资2021—2023年教学能力进行评价，了解和分析“1+3+n”的院级督导推行前的2021年、“1+3+n”的院级督导推行后的 2022年、2023年师资的教学能力变化。方法   采用问卷调查法收集评价数据，采用SPSS.27.0对教学评价资料进行统计分析，采用净推荐值计算教学口碑，对多年度结果进行纵向比较分析。结果  2021—2023年教学评价次数共5 483次；2021—2023年对师资教学设计能力评价由实施前的8.8提高到9.6、教学实施能力由实施前的9.0提高到9.5、教学热情由实施前的9.0提高到10.0、时间投入由实施前的9.3提高到10.0，不同年份组间比较的差异均有统计学意义（P＜0.001）；课程净推荐值由实施前的60.5%提高到81.3%，师资课程推荐者占比由实施前的65.5%提高到83.2%，贬损者占比由实施前的5.0%降低到1.9%，差异有统计学意义（χ ² =175.4，P＜0.001）。结论   “1+3+n”院级督导模式的相关举措，对师资教学能力的提高具有促进作用，且该促进作用持续存在，师资教学能力逐年递增。

    Objective  To evaluate the teaching ability change of teachers  from 2021 to 2023，including of teachers’ teaching ability in 2021 before the implementation of "1+3+n" college-level supervision，and in  2022  and  2023  after the implementation of "1+3+n" college-level supervision．Methods  Questionnaire survey was used to collect evaluation data，SPSS.27.0 was used to make statistical analysis of teaching evaluation data，and NPS（Net Promoter Score）was used to evaluate teaching quality．Results  From 2021 to 2023，there were 5483 teaching evaluations．From 2021 to 2023，teaching design ability evaluation score increased from 8.8 before the implementation to 9.6，teaching implementation ability evaluation score increased from 9.0 before the implementation to 9.5，teaching enthusiasm evaluation score increased from 9.0 before the implementation to 10.0，time investment evaluation score increased from 9.3 before the implementation to 10.0，and the differences between different years were statistically significant（P＜0.001）．The courses quality increased from 60.5% before the implementation to 81.3%，and the proportion of teachers' course recommenders has increased from 65.5% before the implementation to 83.2%，while the proportion of detractors has decreased from 5.0% before the implementation to 1.9%，with statistical significance（χ ² =175.4，P＜0.001）．Conclusions  The measures of "1+3+n" college-level supervision mode promote the improvement of teachers’ teaching ability，the promotion effect persists，and the teaching ability increases year by year．