Objective To evaluate the clinical value and safety of adenosine monophosphate( AMP)bronchoprovocation test in patients with asthma. Methods Sixty asthmatics, including 19 cases with uncontrolled asthma, 22 with partially controlled asthma, and 19 with controlled asthma were enrolled. Twenty-four healthy volunteers were enrolled as control and 20 patients with upper respiratory tract infection ( URI) were also included. AMP bronchoprovocation test ( AMP-BPT) was performed. PD20 FEV1-AMP lt;40 mg was set as a cut-off value of positive response to AMP. Positive rate, sensitivity, specificity, accuracy and adverse reactions of AMP-BPT were evaluated. Eleven cases with uncontrolled asthma and 12 cases with partially controlled asthma were followed up with AMP-BPT three months and six months after inhaledcorticosteroids treatment. Asthma symptom scores were recorded a week early before each challenge. The correlation between PD20FEV1 -AMP and asthma symptom score was analyzed. Values of PD20 FEV1 -AMP were represented as median and quartile range [ M( QR) ] . Results No positive responses to AMP were found in both healthy and URI subjects. On the other hand, positive responses to AMP were found in all the uncontrolled asthmatics ( 100% ) with PD20FEV1 -AMP as 0. 6 mg ( 0. 4 mg) , in 19 partially controlled asthmatics ( 86. 4% ) with PD20 FEV1 -AMP as 5. 38 mg ( 32. 67 mg ) , and in 5 controlled asthmatics( 26. 3% ) with PD20FEV1 -AMP as 40 mg ( 29. 3 mg) . There were negative correlations between the logarithms of PD20 FEV1 -AMP and logarithms of asthma symptom scores ( r = - 0. 598, P lt; 0. 01) . The sensitivity, specificity and accuracy was 72% , 100%, and 84% , respectively. Percentage of subjects who experienced wheezing, cough, dyspnea, swallows stimulation, chest tightness, expectoration and cyanosis during AMP-BPT were 37. 5%, 21. 2%, 15. 4%,7. 7%, 7. 7%, 4. 8%, and 1. 0%, respectively. No severe adverse reaction was found. Conclusions AMP-BPT is helpful to the diagnosis and differential diagnosis of bronchial asthma. It also can be used to evaluate the severity and control level, and to monitor the therapeutic efficacy in clinical practice. Moreover, AMP-BPT is well tolerated with little adverse reaction.
Objective To analyze and explore positive emotional experiences of patients, in order to provide reference for improving the medical services. Methods Using NVivo software, praise letters from a tertiary hospital in Guangdong in 2020 and 2021 were used as the research object for three-level coding. The positive emotional experiences of patients were explored through tools such as analytic hierarchy process and node item map. Results A total of 8601 patient praise letters were received, and after screening, a total of 8128 valid texts were obtained. In 2020, there were 2570 patient praise letters, including 69 from the emergency department, 638 from the outpatient department, and 1863 from the inpatient department. In 2021, there were 5558 patient praise letters, including 203 from the emergency department, 2071 from the outpatient department, and 3284 from the inpatient department. The most praise letters were from the inpatient department, with a total of 5147 letters (63.3%). There were 2709 letters (33.3%) from outpatient department, and 272 letters (3.3%) from emergency department. The classification of patient praise letters showed that patient praise for the process and individuals were most common (77.4%). After step-by-step encoding, the valid text formed 36 third level nodes, 8 second level nodes, and 3 first level nodes. Patient praise letters mainly focused on emotional evaluation at the first level node, followed by emotional expression and emotional response. Word frequency analysis showed that in terms of positive emotional experiences, the word “thank you” had the highest frequency among patients. In terms of patient perception of service, the term “patience” had the highest frequency. Conclusions When patients express praise for medical services, they pay more attention to the personal performance of medical staff and the experience of the service process compared to the final result. In the process of hospital management, the emotions of patients should be fully considered.