Reflection on Community Hospitals Launching Nursing Services, Social Health Centers Enhancing Capacity Series Focus ① A Patient Memoir Community Health | Service Center | Series

Release time:Apr 14, 2024 19:05 PM

[Editor's note]

249 community health service centers in Shanghai have built a grassroots health network. How can doorstep hospitals better care for the health of residents and enhance their medical treatment capabilities in response to an aging society? At the beginning of this year, the Shanghai Municipal Health Commission set a new round of community health service center construction goals: to protect the health of the people, positioning three centers, namely nursing center, rehabilitation center, and health management center. How to better serve community residents in the face of new service attributes? How do residents feel after experiencing it? Recently, reporters from Liberation Daily have continuously visited the Community Health Service Center in Changzheng Town, Putuo District, Dapuqiao Community Health Service Center in Huangpu District, and Tianshan Community Health Service Center in Changning District, recording the process, achievements, and even confusion of community construction as the "three centers".

Reflection on Community Hospitals Launching Nursing Services, Social Health Centers Enhancing Capacity Series Focus ① A Patient Memoir Community Health | Service Center | Series

How to complete the last journey of life is a difficult philosophical question. The Community Health Service Center in Changzheng Town, Putuo District, has a classic case of "Memoirs of Old Wang", which can be regarded as a classic example of hospice care. Old Wang's life endpoint is at the end of the community, and in the final days, medical staff develop a hospice care plan for him, control his illness, provide comfortable care, and recall his life, bringing comfort to his family.

As an important part of the construction of nursing centers in community health service centers, palliative care is increasingly receiving attention. The reporter learned from the Municipal Health Commission that as of the end of last year, there were 261 medical institutions in the city that could provide hospice care services, with 1224 hospice care inpatient beds, 2005 practicing physicians, 1940 registered nurses, and 102 medical social workers. In this aging city, there are 1.09 hospice care service institutions for every 100000 permanent residents, ranking first in the country. Recently, reporters walked into the Community Health Service Center in Changzheng Town to observe the real situation of community hospice care in Shanghai.

How to look back and say goodbye in life

A beautiful "farewell story" has been circulating in the Community Health Service Center of Changzheng Town: in his 60s, Old Wang was diagnosed with advanced cancer during a physical examination and was assessed by doctors as having a "survival period of only 3 months". In the center, his physical symptoms were under control and he revealed a small regret at the last minute: he was unable to complete a life memoir of his own. This has become the starting point for the hospice care team to provide attentive service.

Old Wang lives in bed 10. When he first arrived at the center, his skin turned yellow all over, and his eyes and sclera were particularly stained with yellow. On weekdays, he is humorous and talkative, but when he suddenly says goodbye to life, he is inevitably shocked. Nurse Mao Yiwen told us that physical sensations are only a part, and in exploring peaceful care, humanistic services are the most difficult to quantify and control. This requires medical staff to perceive innovation with care and emotion. After delicate communication with Lao Wang, the team decided to fulfill his small dream. Sincere communication helps establish trust between doctors and patients. Lao Wang opens his heart and recounts his lifelong experiences, setbacks, preferences, and even future arrangements

In the end, all of this turned into a beautiful memoir: from the birth of Lao Wang, going to the countryside, falling in love, to getting married... Life has created his free spirited and resilient personality, and the touching memories of supporting impoverished students are also well-known to family and friends. Old Wang left, and his memoirs became a comfort for his family. His wife held the memoirs and said with relief, "This is the best farewell to life. He left without any regrets. Thank you really!"

What are the coverage of hospice care services

The concept of peaceful care has been around for more than half a century, and Shanghai can be considered a pioneer nationwide. What should hospice care do when facing the final journey of life? Liu Yilei, Director of the Community Health Service Center in Changzheng Town, told reporters that the center has more than 10 years of mature experience in exploration. In 2012, it was determined by the municipal government's practical project as a "pilot institution for end-of-life care services". In 2017, Putuo District was selected as one of the first national pilot projects, and in 2018, a standardized pilot program for hospice care was launched... The hospice care team in Changzheng Town has always explored more connotations and broader scope to care for the body and mind of terminally ill patients. Recently, it has also successfully applied for the Shanghai hospice care qualified nurse training base.

The reporter walked into the central hospice and nursing area, and the warm sunset shone into the ward, creating a peaceful and tranquil atmosphere that made people feel at ease. According to statistics, there are 153700 permanent residents and 42900 elderly people aged 60 and above in Changzheng Town. There are 20 hospice beds and 14 general practitioners in the center. A hospice specialty clinic is opened every Tuesday to connect with home hospice beds.

The most difficult thing is to gain understanding from patients and their families. Wu Jun, Secretary of the Party Branch of the Changzheng Town Community Health Service Center, frankly stated that many patients know what a "end-of-life ward" is, but they do not understand the concept and connotation of hospice care, and some even think it is giving up treatment. Providing technical support and imbuing humanistic significance has become the focus of the hospice care team's work.

When Lao Wang was in the hospital, he saw that medical staff and social workers were busy and asked curiously, "What is social worker for?" Mao Yiwen recalled, "When I saw a beam of sunshine shining into the ward, I told him that social workers are the people who shed sunshine in the hearts of others." Multiple parties participated in providing hospice care services together. The reporter learned that now, relying on universities, social organizations, special committees, etc., Shanghai is establishing a hospice care training base to provide training for different personnel, in order to strengthen the social foundation of hospice care and make services more diverse and effective.

Caring for the dignity of life at the doorstep

The exploration of community health service centers in Changzheng Town is being carried out, from small attempts to gradually becoming a system. Taking Putuo District as an example, the "1+12" hospice care service system has been basically established. 1 hospice care center+12 community health service centers are mutually referred, with the participation of medical institutions and social elderly care institutions, forming a system for promotion throughout the city. Taking care of the last dignity of life, statistics from the Municipal Health Commission show that since 2019, Shanghai has taken the lead in carrying out a pilot program for hospice care nationwide. Up to now, a total of 13 second and third level comprehensive hospitals, 4 specialized hospitals, 12 social medical and public nursing hospitals have provided hospice care services, and 210 community health service centers have established a two-way referral mechanism.

In addition to hospice care, multiple community nursing centers in Shanghai have implemented various forms of exploration in response to the actual needs of residents: the Pingliang Community Health Service Center in Yangpu District has connected with tertiary hospitals such as Xinhua Hospital and established community wound care centers; The Community Health Service Center in Anting Town, Jiading District has built a medical and elderly care support platform, created a community nursing center, and provided chronic disease care services for home-based elderly care; The Community Health Service Center in Taopu Town, Putuo District has opened a PICC nursing clinic, which can ensure community care for residents at their doorstep without the need to travel back and forth to large hospitals; The Dapuqiao Community Health Service Center in Huangpu District has newly established an infusion port port port outpatient service, where residents can enjoy one-stop services for intravenous treatment and nursing at their doorstep

The relevant person in charge of the Municipal Health Commission finally revealed that the next step is for Shanghai to expand the coverage of nursing center services, formulate standards and regulations, improve policy measures, and improve the government led nursing universal benefit system, basic, and bottom-up service system, promote and implement it, so that more residents can feel the care and warmth of hospitals at their doorstep.

Why is "Cancer King" immunotherapy ineffective? Fudan Cancer Hospital Reveals New Mechanisms of Immunosuppressive Environment for pancreatic cancer CRIP1 | Tumor | pancreatic cancer

Immunotherapy has been proven to achieve significant therapeutic effects in various solid tumors. However, for pancreatic cancer, known as the "king of cancer", immunotherapy has been ineffective. On August 4, Professor Yu Xianjun, Dean of the Cancer Hospital Affiliated to Fudan University, and Shi Si, Associate Professor of Pancreatic Surgery released a research achievement, which first found the key role of cysteine rich protein 1 in shaping the immunosuppressive microenvironment of pancreatic cancer, filled the gap in the research field of immunosuppressive microenvironment of pancreatic cancer, and provided a theoretical basis for precise immunotherapy of pancreatic cancer patients. Ductal adenocarcinoma of the pancreas is the main type of pancreatic cancer, accounting for about 90% of all pancreatic cancer. Due to its high malignancy and poor treatment effectiveness, pancreatic ductal adenocarcinoma has always been one of the most malignant tumors. In recent years, the level of surgical techniques and comprehensive treatment has been achieved

A 14-year-old girl suffers from a rare eye disease and receives support from a public welfare fund. Symptoms of "I haven't looked in the mirror for a long time" | Patient | Public welfare

A 14-year-old girl has been experiencing symptoms such as protruding pupils, incomplete eye closure, corneal injury, restricted eye movement, and overall fatigue for several years. The physical discomfort and facial abnormalities caused by eye diseases have made her increasingly reticent, and her temperament is vastly different from before. At the Ophthalmology Department of the Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the pupil has been diagnosed with a rare thyroid ophthalmopathy combined with myasthenia gravis, which requires prompt treatment. However, considering the young age of the pupil, conventional hormone and radiation therapy cannot be used. Therefore, Zhou Huifang, Deputy Director of Ophthalmology and thyroid ophthalmology expert, has developed a targeted drug combined with surgical treatment plan for it, and targeted drug treatment will be performed first. Three months ago, I was hospitalized for one week with mydriasis and received intravenous targeted drug treatment. Afterwards, I went home for observation and followed up on time

The municipal eye disease prevention and treatment center launched the dry eye diagnosis and treatment studio, and the incidence rate of dry eye in China is about 21% to 30% of the meibomian gland | dry eye | eye disease

According to the Statistics of Chinese Dry Eye Expert Consensus, the incidence rate of dry eye in China is about 21%~30%, and it is estimated that there are at least 300 million patients nationwide. The Dry Eye Diagnosis and Treatment Studio of Shanghai Eye Disease Prevention and Treatment Center was officially launched today. In the future, the studio will continuously improve the dry eye diagnosis and treatment standards, and form standardized diagnosis and treatment concepts and service models. Suitable technologies will be promoted to the community, allowing residents to enjoy convenient dry eye diagnosis and treatment services at their doorstep. Executive Dean and Party Secretary Gao Wei stated that this is also one of the livelihood service measures recently launched by the hospital around high-quality development and meeting the needs of the people. It is reported that dry eye syndrome is a chronic ocular surface disease caused by multiple factors. The instability of the tear film or imbalance of the ocular surface microenvironment caused by abnormal quality, quantity, and dynamics of tears can be accompanied by ocular surface inflammatory reactions, tissue damage, and nerve abnormalities, resulting in various discomforts in the eyes

The Ninth Hospital has taken the lead in formulating the world's first consensus on core indicators for clinical evaluation of dental implants, which has been officially published in clinical practice

The International Dental Implant Consensus Report, jointly written by the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine and renowned universities in the field of dentistry such as Harvard University, University of Zurich, University of Gothenburg, Columbia University, and University of Frankfurt, has recently been jointly published in top journals in the field of dentistry, including Clinical Periodontology and Clinical Dental Implant Research. This consensus has for the first time established an internationally unified core set of indicators for evaluating the clinical effectiveness of dental implants, covering the five key areas of the field of dental implants. It is of milestone significance for carrying out standardized clinical diagnosis, treatment, and research on dental implants. The core evaluation indicators determined by this consensus will become an important benchmark for scholars in the field of dental implants worldwide to conduct high-quality research. The consensus is composed of 8 top international experts in the field of oral implantation

Recently, autologous hematopoietic stem cell therapy was completed in Shanghai, and British girls born in the 1990s have suffered from multiple relapses of blood diseases, including stem cells, peripheral blood, and diseases

Recently, Catherine, a British girl born in the 1990s, received autologous peripheral blood hematopoietic stem cell transfusion at the Cancer Center of Shanghai Jiahui International Hospital, and was successfully discharged from the warehouse. She is now on her way back to China after being discharged from the hospital. She is also the first patient at Shanghai Jiahui International Hospital to complete relevant treatments. In 2019, Catherine was diagnosed with Hodgkin's lymphoma in the UK, and after treatment, the disease completely improved. During her work and life in China in 2021, she went to seek medical attention due to multiple enlarged lymph nodes. Pathological biopsy confirmed a recurrence of Hodgkin's lymphoma, and through combined targeted drug treatment, her condition was temporarily under control. Last year in the second half of the year, when the disease recurred, the girl began to use immunotherapy combined with targeted drugs for treatment. Expert evaluation suggests that for young patients with hematological tumors, the risk of recurrence is high and treatment difficulty is increasing in the future. Autologous hematopoietic stem cell therapy is recommended

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