Objective To enhance medical quality evaluation by conducting a systematic review and evidence-based synthesis of relevant research. Methods Such databases as CBM (1978 to 2009), VIP (1989 to 2009), CNKI (1990 to 2009), WanFang Dissertation database (1997 to 2009), and relevant websites were searched to identify relevant Chinese studies for the synthetical evaluation on methods evaluating medical quality. Results A total of 216 articles including 184 observational studies, 29 traditional reviews, and 3 experts’ opinions were identified. Twenty-one synthetical evaluation methods were used among 216 articles, and the top three methods which had been quoted more than 30 times were: RSR (19.72%), TOPSIS method (19.03%), and comprehensive index (12.80%). Among the 184 observational research papers, the documents using one kind of comprehensive evaluation took up 89.13% (164/184), the ones using two kinds of evaluation methods accounted for 9.78% (18/184), and those using three kinds of methods accounted for 1.09% (2/184). Conclusion a) The joint use of two or more than two methods is not common. The majority of studies using single comprehensive evaluation method focus on RSR, TOPSIS and comprehensive index method; b) The comprehensive evaluation method is considered non-uniform, some not even standardized; c) Most of the medical literatures do not correct the value of quality assessment; and d) Considerably most studies perform retrospective evaluation with historical data.
Heart diseases seriously threaten people's health. More and more functional evaluation of cardiac right ventricle has been considered in the clinical diagnosis in addition to the classical functional evaluation of cardiac left ventricle. It is very important to evaluate the functional parameters of right ventricle in clinical heart disease diagnosis, especially when the ejection fraction of left ventricle is very low. Right ventricular segmentation is needed for the functional evaluation. However, right ventricular segmentation has been difficult due to its thin myocardium, complex structure and significant individual variability. Cine cardiac magnetic resonance image is a golden standard in clinical functional evaluation of cardiac ventricle. In the present paper, we summarize the classic segmentation approaches, evaluation methods and their development, which can help the researchers in the related field have a quick and basic understanding to the right ventricle segmentation.
ObjectiveTo systematically review the comprehensive evaluation methods applied to estimate the medical service performance based on diagnosis-related groups (DRGs) in China and to provide suggestions for the promotion of methods in further studies.MethodsLiterature published before May 2019 were searched in China National Knowledge Infrastructure, WanFang Data, CQVIP and PubMed for studies about DRGs-based comprehensive evaluation. After literature screening and information extracting by two reviewers independently, qualitative approaches were used to describe the application of DRGs-based comprehensive evaluation methods in the performance evaluation of medical services.ResultsA total of 24 articles were included in the systematic review. Different indexes were used to evaluate the medical service performance. Delphi Method, expert discussion, Saaty’s Method and some other means were applied to determine the weights of indexes in 8 articles. Rank-sum ratio method, Technique for Order Preference by Similarity to an Ideal Solution and synthetic index method were proposed for the comprehensive evaluation in 9, 7 and 9 articles, respectively; besides, analytic hierarchy process and combination evaluation were also used.ConclusionsBased on DRGs, the choose of indicators, weighting approaches, and calculation methods of comprehensive values vary richly in different studies. More attention should be paid to weight using and combination of comprehensive evaluation methods in further studies. Meanwhile, the quality of information source used for estimation and the rationality of results application are supposed to be emphasized.
ObjectivesTo investigate residents’ sensitivity towards basic public health services in Sichuan province, so as to provide advice on future improvement.MethodsUsing multistage stratified sampling and through consultation of the Sichuan province's basic public health service regulatory platform to select 40 equidistant samples from the five key population groups. Specifically, 200 individuals from each of the 21 cities were enrolled. Telephone survey was conducted to acquire residents’ awareness rate, satisfaction and compliance. Technique for order preference by similarity to an ideal solution (TOPSIS) was applied to comprehensively evaluate residents’ sensitivity of basic public health services.ResultsA total of 4 200 community residents who have accepted health managements in basic health care institutions were enrolled. The mean Cj value was 0.523 6. The No.4 city had the highest Cj value of 0.751 9, and the No.10 city had the lowest value of 0.276 3.ConclusionsThe residents’ sensitivity to basic public health services varies in 21 cities of Sichuan province. We should improve the quality of medical services in primary health care institutions and provide wide publicity to enhance the well-being and satisfaction of community residents. Government should improve the quality of medical services in primary health care institutions, and narrow the gap between different cities, so as to improve residents’ experience.
Idiopathic thrombocytopenic purpura (ITP) is a common bloody disease with a high incidence in children, but its diagnostic method is exclusive diagnosis, and the existing detection techniques are mostly invasive, which may cause secondary injury to patients and also may increase the risk of disease. In order to make up for the lack of the detection method, this study made a preliminary exploration on the diagnosis of children's ITP from the perspective of infrared thermography. In this study, a total of 11 healthy children and 22 ITP children's frontal infrared thermal images were collected, and the pattern characteristic (PFD), average temperature (Troi) and maximum temperature (MAX) characteristics of 7 target areas were extracted. The weighted PFD parameters were correlated with the platelet count commonly used in clinical diagnosis, and the sensitivity and specificity of the weighted PFD parameters for children's ITP were calculated through the receiver operating characteristic curve (ROC). The final results showed that the difference of the weighted PFD parameters between healthy children and ITP children was statistically significant, and the parameters negatively correlated with platelet count. Under the ROC curve, the area under the curve (AUC) of this parameter is as high as 92.1%. Based on the research results of this paper, infrared thermography can clearly show the difference between ITP children and healthy children. It is hoped that the methods proposed in this paper can non-invasively and objectively describe the characteristics of ITP infrared thermal imaging of children, and provide a new ideas for ITP diagnosis.
Precision medicine is a personalized medical system based on patients' individual biological information, clinical symptoms and signs, forming a new clinical research model and medical practice path. The basic idea of traditional Chinese medicine and the concept of precision medicine share many similarities. The basket trial developed for precision medicine is also suitable for clinical trials and evaluation of the efficacy of traditional Chinese medicine syndrome differentiation and treatment systems. Basket trials are used to evaluate the efficacy of a drug in the treatment of multiple diseases or disease subtypes. It has the advantages of sharing a master protocol, unifying management of subsidiary studies, simplifying the test implementation process, unifying statistical analysis, saving resources, reducing budgets and accelerating the drug evaluation progress. This is similar to the concept of using the "same treatment for different diseases" found in traditional Chinese medicine. This paper introduced the concept and method of basket trials and explored their application and advantages in clinical research into traditional Chinese medicine. This study is expected to provide references for the methodological innovation of clinical research into traditional Chinese medicine.
Objective To construct a quality evaluation index system for healthcare-associated infection (HAI) management, and conduct an empirical evaluation on the quality of HAI management in clinical departments. Methods The literature research method and panel discussion method were adopted to initially form the framework of HAI management quality evaluation index system, and the Delphi method and the analytic hierarchy process were used to establish the index system and determine the weights from January to December 2018. Eight comprehensive evaluation methods, such as osculating value method and technique for order preference by similarity to an ideal solution method, were used to evaluate the quality of HAI management in clinical departments of West China Hospital, Sichuan University in 2018. Kendall’s coefficient of concordance (W) was used to assess the consistency of the results. The clinical departments were ranked by the standardized total scores, which were the means of the normalized scores of the eight methods. Results A quality evaluation index system for HAI management with 3 first-level indicators and 15 second-level indicators was established finally. The results of the eight comprehensive evaluation methods for the quality evaluation of HAI management in 39 clinical departments of West China Hospital, Sichuan University were consistent (W=0.952, χ2=259.800, P<0.001). The standardized total score of Department 18 was 100, which ranked the first place. Conclusion The HAI management quality evaluation index system constructed in this study could be used in clinical departments to evaluate the quality of HAI management in combination with comprehensive evaluation methods.
Objective To summarize the evaluation methods of postoperative healing of supraspinatus tendon tear in recent years, in order to provide reference for clinic. Methods CNKI, Wanfang, PubMed, and Foreign Medical Literature Retrieval Service (FMRS) databases were used to search the literatures between 2005 and 2022. The literature related to the diagnosis and postoperative healing of supraspinatus tendon tear was included. Finally, 50 articles were reviewed. ResultsSupraspinatus tendon tear is a common shoulder disease. Physical examination, clinical score, and imaging examination are used to predict and evaluate the postoperative healing. Among them, physical examination and clinical score are non-invasive and the most economical methods, but their accuracy and sensitivity are lower than imaging examination, so they can only be used as auxiliary methods. The acromio-humeral distance (AHD) and upward migration index (UMI) measured by X-ray films can directly reflect the change of supraspinatus tendon thickness, but they are impossible to distinguish whether there is tear or not. Ultrasound and MRI are the main methods for the clinical diagnosis of supraspinatus tendon tear, but the commonly used MRI sequence can not accurately judge the internal healing of the tendon. Shear wave elastrography (SWE) and ultrashort-echo-time (UTE) techniques are the latest research directions in recent years, but different studies have shown opposite conclusions on the application of SWE technique. This conclusion shows that the principle of SWE technique and its relationship with tendons need to be further studied. UTE technique has good clinical effect, and the T2* value obtained by UTE technique is more accurate than that of traditional Sugaya typing, but there are still few research samples. Conclusion AHD and UMI measured by X-ray film and T2* value measured by UTE technique can be used as effective methods for evaluating the healing of supraspinatus tendon tear after repairing, and can be used as a follow-up evaluation method combined with physical examination and clinical score for patients with supraspinatus tendon tear.
ObjectiveTo understand the prevalence of iliac vein stenosis in crowds without lower extremityvenous disease and symptoms (abbreviated as asymptomatic crowd) and patients with lower extremity varicose vein and analyze relevant to factors of iliac vein stenosis. MethodsAccording to the inclusion and exclusion criteria, the CT imaging data and clinical informations of objects in the department of vascular surgery, the First Affiliated Hospital of Chongqing Medical University from 2020 to 2021 were collected. The objects included the patients with lower extremity varicose vein in the department of vascular surgery of this hospital and asymptomatic crowds in the physical examination center of this hospital. The occurrence of iliac vein stenosis of the objects was compared and the relevant to risk factors affecting the occurrence of iliac vein stenosis were analyzed. ResultsA total of 268 subjects who met the criteria were included in this study, the iliac vein stenosis was occurred in 63 (23.5%) subjects. there were 162 asymptomatic crowds and 106 patients with lower extremity varicose vein. The incidence of iliac vein stenosis was higher in the patients with lower extremity varicose vein than that in the asymptomatic crowds [36.8% (39/106) versus 14.8% (24/162), χ2=17.212, P<0.001]. The results of multivariate logistic regression analysis showed that the female crowds had a higher risk of iliac vein stenosis as compared with the male crowds [OR=3.131, 95%CI (1.188, 8.257), P=0.021] and the crowds with higher body mass index (BMI) had a lower risk of iliac vein stenosis [OR=0.802, 95%CI (0.666, 0.966), P=0.020] in the asymptomatic crowds, as well as the risk of iliac vein stenosis was decreased in the older patients with lower extremity varicose vein [OR=0.946, 95%CI (0.901, 0.993), P=0.026]. ConclusionFrom the results of this study, the incidence of iliac vein stenosis is not low, and the incidence rate of patient with lower extremity varicose vein is higher than that of asymptomatic crowd, and there may be associated with gender, age, or BMI.
Objective To summarize the evaluation methods of return to sports (RTS) after anterior cruciate ligament reconstruction (ACLR) in recent years, in order to provide reference for clinical practice. Methods The literature related to the RTS after ACLR was searched from CNKI, Wanfang, PubMed, and Foreign Medical Information Resources Retrieval Platform (FMRS) databases. The retrieval range was from 2010 to 2023, and 66 papers were finally included for review. The relevant literature was summarized and analyzed from the aspects of RTS time, objective evaluation indicators, and psychological evaluation. Results RTS is the common desire of patients with ACL injury and doctors, as well as the initial intention of selecting surgery. A reasonable and perfect evaluation method of RTS can not only help patients recover to preoperative exercise level, but also protect patients from re-injury. At present, the main criterion for clinical judgement of RTS is time. It is basically agreed that RTS after 9 months can reduce the re-injury. In addition to time, it is also necessary to test the lower limb muscle strength, jumping, balance, and other aspects of the patient, comprehensively assess the degree of functional recovery and determine the different time of RTS according to the type of exercise. Psychological assessment plays an important role in RTS and has a good clinical predictive effect. ConclusionRTS is one of the research hotspots after ACLR. At present, there are many related evaluation methods, which need to be further optimized by more research to build a comprehensive and standardized evaluation system.