The Development History and Current Situation of General Practice Education in Guangdong Province in the Past 30 Years

With the strong support of national and local policies, the construction of general practice education system and personnel training have been developed in Guangdong Province for nearly 30 years. Since 1996, general practice education in Guangdong Province has gone through four stages, including exploration and start, vigorous growth, development and perfection, comprehensive development. Colleges and universities in Guangdong Province, represented by Guangzhou Medical University, have explored and established a multi-level, multi-path, multi-form and multi-objective general practice education system of treatment-prevention integration, with interconnected academy education, job-transfer training, standardized training, postgraduate education and continuing education, and a standardized training model of general practitioners based on "5+3" has been basically established. The pass rate of the provincial training certificate examination of general practice training students has reached more than 85%. In 2020, there were 4 general practitioners per 10 000 residents, meeting the national requirement of 3 general practitioners per 10 000 residents in 2020. With the purpose to analyze the current situation of the development of general practice education in Guangdong Province, this paper comprehensively summarized the experience and lessons of discipline construction and education training of general practice, broadened the paths and modes of the quality of general practice personnel training, put forward relevant suggestions, to provide policy ideas and reference basis for the rapid development of general practice education in Guangdong Province and even in China in the future

Endovascular therapy in acute ischaemic stroke with large infarction with matched or mismatched clinical-radiological severities: a post-hoc analysis of the ANGEL-ASPECT trialResearch in context

Summary: Background: Endovascular therapy (EVT) was demonstrated effective in acute large vessel occlusion (LVO) with large infarction. Revealing subgroups of patients who would or would not benefit from EVT will further inform patient selection for EVT. Methods: This post-hoc analysis of the ANGEL-ASPECT trial, a randomised controlled trial of 456 adult patients with acute anterior-circulation LVO and large infarction, defined by ASPECTS 3–5 or infarct core volume 70–100 mL, enrolled from 46 centres across China, between October 2, 2020 and May 18, 2022. Patients were randomly assigned (1:1) to receiving EVT and medical management or medical management alone. One patient withdrew consent, 455 patients were included in this post-hoc analysis and categorised into 4 subgroups by lower or higher NIHSS (< or ≥16) and smaller or larger infarct core (< or ≥70 mL). Those with lower NIHSS &amp; smaller core, and higher NIHSS &amp; larger core were considered clinical-radiological matched subgroups; otherwise clinical-radiological mismatched subgroups. Primary outcome was 90-day modified Rankin Scale (mRS). ANGEL-ASPECT is registered with ClinicalTrials.gov, NCT04551664. Findings: Overall, 139 (30.5%) patients had lower NIHSS &amp; smaller core, 106 (23.3%) higher NIHSS &amp; larger core, 130 (28.6%) higher NIHSS &amp; smaller core, and 80 (17.6%) lower NIHSS &amp; larger core. There was significant ordinal shift in the 90-day mRS toward a better outcome with EVT in clinical-radiological matched subgroups: lower NIHSS &amp; smaller core (generalised OR, 1.76; 95% CI, 1.18–2.62; p = 0.01) and higher NIHSS &amp; larger core (1.64; 1.06–2.54; 0.01); but not in the two clinical-radiological mismatched subgroups. Interpretation: Our findings suggested that in patients with anterior-circulation LVO and large infarction, EVT was associated with improved 90-day functional outcomes in those with matched clinical and radiological severities, but not in those with mismatched clinical and radiological severities. Simultaneous consideration of stroke severity and infarct core volume may inform patient selection for EVT. Funding: Unrestricted grants from industry [Covidien Healthcare International Trading (Shanghai), Johnson &amp; Johnson MedTech, Genesis MedTech (Shanghai), and Shanghai HeartCare Medical Technology]