Objective To investigate the satisfaction of patients who signed up for chronic disease continuous health management services, so as to provide a theoretical basis for improving service quality. Methods We conducted an online anonymous survey by issuing an electronic questionnaire to all patients who met the inclusion criteria through the short message platform of the hospital from October 8th to 19th, 2021, and used χ2 test and logistic regression to compare the differences in satisfaction among different patients and explore the factors affecting satisfaction. Results A total of 3311 short messages were send out, and 816 valid copies of questionnaire were recalled. The total satisfaction was 77.3%, and the satisfaction before, during and after service were 86.0%, 75.2% and 73.7%, respectively. The items with low satisfaction included service pricing (58.9%), online follow-up (57.5%) and overall cost reduction (43.9%). There were significant differences in satisfaction among patients of different permanent addresses and health status (P<0.05). The multiple binary logistic regression analysis showed that the respondents in Chengdu city had lower satisfaction than those outside Sichuan province [odds ratio (OR)=0.377, 95% confidence interval (CI) (0.156, 0.908), P=0.030], and the respondents with poor, general, and good self-reported health status had lower satisfaction than those with very good self-reported health status [OR=0.196, 95%CI (0.067, 0.577), P=0.003; OR=0.165, 95%CI (0.058, 0.468), P=0.001; OR=0.317, 95%CI (0.108, 0.927), P=0.036]. Conclusions The patients’ satisfaction with chronic disease continuous health management services is at a high level. The next step should focus on service pricing and online follow-up, and strive to improve the service experience of people with low satisfaction.
Objective To compare the clinical characteristics of chronic cough, and to establish the Modified Cough Assessment Test and the simple decision tree to improve the efficacy of etiologic diagnosis. Methods Patients with chronic cough consulted in Tongji Hospital between October 2021 and August 2023 were enrolled in our study. The patients with identified single cause were divided into 3 groups accordingly: corticosteroid-responsive cough (CRC), upper airway cough syndrome (UACS) and gastroesophageal reflux-related cough (GERC). And the characteristics of chronic cough in different causes were assessed and compared by cough questionnaires. Independent predictors of various causes were identified by multivariate logistic regression analysis and used to establish the Modified Cough Assessment Test (MCET) and to construct the simple decision tree. Results A total of 358 patients were enrolled, including 201 with CRC (56.1%), 125 with UACS (34.9%) and 32 with GERC (8.94%). "Cough with wheezing or chest tightness" (OR=3.222, 95%CI 2.144 - 4.843, P<0.001), "Cough with daytime heaviness and nighttime lightness" (OR=1.755, 95%CI 1.264 - 2.435, P<0.001), and "Cough with acid reflux, heartburn or indigestion" (OR=15.580, 95%CI 5.894 - 41.184, P<0.001) were independent factors for each group, respectively. The area under ROC curve for classification of CRC, UACS and GERC were 0.871, 0.840 and 0.988 for MCET, which were better than those of Leicester Cough Questionnaire (LCQ) (0.792, 0.766 and 0.913) and Cough Evaluation Test (CET) (0.649, 0.691 and 0.580). The accuracy of the simple decision tree for the differential diagnosis of chronic cough was 77.4%. Conclusion The simple decision tree based on the Modified Cough Evaluation Test is a simple and effective method of etiologic diagnosis of chronic cough, which can be used as a tool to improve the efficacy of clinical diagnosis in outpatient settings.
To help better understanding on evidence-based medicine, five frequently asked questions relevant to evidence-based clinical practice were commented on. The questions included: 1. Dose evidence-based medicine only emphasize evidence and ignore clinical experiences? 2. Dose evidence only include randomized controlled trials and systematic reviews? 3. How to face the quality of evidence? 4. Is randomized evidence suitable for treating individual patient? 5. Is evidence-based medicine useless since there is no adequate evidence for many clinical questions?
Objective To analyze the nurses' current view and perceptions of enhanced recovery after surgery (ERAS) by a questionnaire and to promote the clinical application of ERAS. Methods We conducted a questionnaire study for nurses who attended the First West China Forum on Chest ERAS in Chengdu during September 26-27, 2016 and 259 questionnaires were collected for descriptive analysis. Results (1) The application status of ERAS: There were 13.5% responders whose hospital took a wait-an-see attitude, while the others' hospital took different actions for ERAS; 85.7% of nurses believed that ERAS in all surgeries should be used; 58.7% of nurses believed that the concept of ERAS was more in theory than in the practice; 40.2% of nurses thought that all patients were suitable for the application of ERAS; (2) 81.9% of nurses believed that the evaluation criteria of ERAS should be a combination of the average hospital stay, patients’ comprehensive feelings and social satisfaction; (3) 70.7% of nurses thought that the combination of subjects integration, surgery orientation and surgeon-nurse teamwork was the best model of ERAS; 44.8% of nurses thought the hospital administration was the best way to promote ERAS applications; (4) 69.1% of responders believed that immature plan, no consensus and norms and insecurity for doctors were the reasons for poor compliance of ERAS; 79.5% of nurses thought that the ERAS meeting should include the publicity of norms and consensus, analysis and implementation of projects and the status and progress of ERAS. Conclusion ERAS concept has been recognized by most nurses. Multidisciplinary collaboration and hospital promotion is the best way to achieve clinical applications.
Objective To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention. Methods One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis. Results The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy. Conclusions Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.
Recent studies have introduced attention models for medical visual question answering (MVQA). In medical research, not only is the modeling of “visual attention” crucial, but the modeling of “question attention” is equally significant. To facilitate bidirectional reasoning in the attention processes involving medical images and questions, a new MVQA architecture, named MCAN, has been proposed. This architecture incorporated a cross-modal co-attention network, FCAF, which identifies key words in questions and principal parts in images. Through a meta-learning channel attention module (MLCA), weights were adaptively assigned to each word and region, reflecting the model’s focus on specific words and regions during reasoning. Additionally, this study specially designed and developed a medical domain-specific word embedding model, Med-GloVe, to further enhance the model’s accuracy and practical value. Experimental results indicated that MCAN proposed in this study improved the accuracy by 7.7% on free-form questions in the Path-VQA dataset, and by 4.4% on closed-form questions in the VQA-RAD dataset, which effectively improves the accuracy of the medical vision question answer.
Objective To investigate the free influenza vaccination of health care workers in major departments and explore the possible influencing factors of influenza vaccination of staff. Methods In November 2021, a questionnaire survey was conducted among health care workers who received free influenza vaccination in 19 major departments of West China Hospital of Sichuan University, and the un-vaccinated workers’ information was obtained from the registration system of staff information. Multiple logistic regression model was used to analyze the possible influencing factors of free influenza vaccination. Results The coverage rate of centralized free influenza vaccination of staff in major departments was 32.7% (1101/3369). Multiple logistic regression analysis showed that workers who were female [odds ratio (OR)=1.853, 95% confidence interval (CI) (1.481, 2.318), P<0.001], with an educational background of high school or below [OR=4.304, 95%CI (2.484, 7.455), P<0.001], engaged in nursing work [OR=2.341, 95%CI (1.701, 3.221), P<0.001], and with 11 or more years of working experience [OR=2.410, 95%CI (1.657, 3.505), P<0.001] were more likely to inject influenza vaccine, and workers who had a bachelor’s degree were less likely to inject influenza vaccine. Conclusions The rate of free influenza vaccination among medical staff is low. In order to mobilize the enthusiasm of influenza vaccination among medical staff, it is necessary to analyze the characteristics of the population and take targeted measures to improve the level of vaccination among medical staff.
In the formulation of the clinical question of traditional Chinese medicine clinical practice guidelines, even if the intervention elements (intervention or control) have an appropriate scope, guideline developers are still faced with a variety of interventions. By analyzing the difficulty and necessity of priority selection of intervention interventions, we propose the approach of extending expert evidence to the process of priority selection of intervention interventions, and further provide the methodology of expert evidence data collection table design, application, data presentation and expert decision-making method to provide references and guidance for guideline developers.
ObjectiveTo investigate the feasibility and effect of early pulmonary rehabilitation (PR) in patients after acute exacerbation of chronic obstructive pulmonary disease (COPD) in a district hospital. MethodsA single-centre prospective study was conducted. The COPD patients after an episode of acute exacerbation and referred to the outpatient department were recruited from January 2013 to December 2014. They were randomized to a group with PR (PR group) and a group without PR (wPR group). The following data were recorded and evaluated including age, gender, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1 as a percentage of the predicted value (FEV1% pred).The baseline and the post-PR medical research council scale (MRC), St. George's respiratory questionnaire (SGRQ), and six-minute walk distance (6MWD) were also compared. ResultsA total of 91 cases were enrolled with 46 cases in the PR group and 45 cases in the wPR group. The age, gender, the severity of COPD were similar in two groups (P > 0.05). The MRC score and SGRQ score of the PR group were significantly improved 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 26 patients whose SGRQ scores decreased > 4 in the PR group (26/46, 56.5%), which was significantly higher than the wPR group (7/45, 15.6%) (P < 0.05). The 6MWD of the PR group was significantly increased 3 months later compare with the baseline (P < 0.05), and did not changed significantly in the wPR group (P > 0.05). There were 22 patients whose 6MWD increased > 54 meters in the PR group (22/46, 47.8%), which was significantly higher than the wPR group (9/45, 20.0%) (P < 0.05). ConclusionsIt is feasible and safety to perform early PR in patients after acute exacerbation of COPD in the district hospital. The early PR can improve the MRC score, SGQR score, and 6MWD in COPD patients.
ObjectiveThe application of the coefficient of variation (CV) in the development of clinical practice guidelines is limited to evaluating the consistency of the consensus panel in clinical questions rating, and the application of variability was limited. This study presents the application and results of variability evaluation in the development of guidelines. MethodsWe conducted a large-scale clinical survey through questionnaire survey, and conducted two rounds of questionnaire survey and face-to-face consensus meeting for the consensus group. Means and CV were calculated for clinical questions and outcome importance ratings. We performed the summary and analysis by SPSS and Microsoft Excel. ResultsA total of 356 clinical survey questionnaires and two rounds survey in consensus panel were collected. We found that in the clinical survey and the first-round of the consensus panel, the CV was greater than 25% for all clinical questions regardless of the overall importance score. In the consensus panel, the results of the second-round were greatly changed. On the one hand, compared with the first-round, the CV of almost all clinical questions was smaller in the second-round, and the CV of high-priority clinical questions was less than 25%, while the clinical questions with a CV greater than 25% were of low-priority. In view of the CV of outcome importance, the clinical survey was similar to the results of the first-round of consensus panel. The CV of very important outcomes was less than 30%. In the second-round of consensus panel, the variability of very important outcomes was less than 20%. The higher the importance level of the outcome was, the smaller the CV was. ConclusionThe study of variability evaluation has practical methodological value, which can assist clinical questions and outcomes priority selection, and help to fully consider the influence of different factors and values, and develop high-quality guidelines.