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.
Objective To investigate problems in applying clinical epidemiology and evidence-based medicine in the field of dentistry in China. Method In early April of 2001, about 200 copies of a questionnaire were sent to chief editors of dental journals, directors and famous experts of the university dental schools and/or dental departments of the provincial/metropolitan hospitals located in the mainland of China. The sent back questionnaires were summarized and analysized. Results At the end of June, 2001, 40 replies from the experts of 12 universities and one metropolitan dental hospital were received. The main points are summarized as following: EBM in China is at starting stage of "anti-illiteracy" campaign. There are 6 out of 12 universities having delivered clinical epidemiology courses to postgraduates (2 to undergraduates), only 3 added lectures on evidence-based medicine to dental students and/or professionals, only one university held intensive training courses on EBM to clinicians. In dental practice there are still scram dentists making decisions simply by experiences. In the research practice some dentists are eager for quick success, and instant benefits, ignoring, scientific design aid quality control of the studies. Randomized controlled clinical trials are seldom appeared in Chinese dental journals. To popularize EBM in all dental clinicians is important for them to use and produce the best evidences. Conclusions EBM in dental field of China is at starling stage. Collection and dissemination of best dental evidences in dental professionals is a key to raise the dental care levels in China.
ObjectiveTo compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.MethodsA retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.ResultsBaseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).ConclusionsRFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.
Objective To investigate the current development status of chest wall surgery at all levels of hospitals in Sichuan Province, as well as to provide evidence for the promotion of chest wall surgery. Methods We conducted a questionnaire study to investigate chest wall surgery at all levels of hospitals in Sichuan Province and to collect suggestions for chest wall surgery development from thoracic surgeons attending the meeting of the Sichuan International Medical Exchange & Promotion Association from September 2021 to January 2022. Results A total of 128 questionnaires were issued, with 97 (75.8%) of them being valid. According to the survey results, hospitals with grade A secondary or higher in Sichuan Province performed chest wall surgery. Chest wall surgery accounted for 14.3% of thoracic surgery, with 70.4% being chest wall trauma surgeries, 11.6% being chest wall tumor surgeries, 10.5% being chest wall infection surgeries, and 7.5% being chest wall deformity surgeries. Chest wall surgery accounted for 9.3% of thoracic surgery in the grade A tertiary hospitals, primarily for chest wall trauma and tumor; 23.1% in grade B tertiary hospitals, primarily for chest wall trauma and tumor; and 50.7% in grade A secondary hospitals, primarily for chest wall trauma and infection. Totally 96.9% of hospitals supported the establishment of a subspecialty in chest wall surgery. Suggestions for advancing chest wall surgery included: enhancing communication and cooperation (e.g. holding academic conferences, training courses), the establishment of the chest wall surgery association or consortium, and the formulation of regulations and guidelines or consensus, etc. Conclusion Chest wall surgery has been performed at all levels of hospitals in Sichuan Province. The relevant guidelines can be made based on the related academic associations, thus boosting the development of chest wall surgery in the future.
Objective To investigate the validity of estimating American Spinal Injury Association Impairment Scale (AIS) grade with a bowel-routine based self-administered questionnaire for assessment of sacral sparing after spinal cord injury (SCI).Methods The 5-item SCI sacral sparing self-report questionnaire was administrated to SCI inpatients from August 2014 to July 2016, followed by an standardized digital rectal examination. Question 1 (perceiving the tissue), Question 2 (identifying the water temperature as warm or cold), Question 3 (perceiving the inserted finger), and Question 4 (perceiving the inserted enema tube) tested the sensory sacral sparing, and Question 5 (holding the enema for more than 1 min) evaluated the voluntary anal sphincter contraction. Based on the answers from each participant, the sensory and motor sacral sparing was implied, and an estimated AIS grade (AIS A, AIS B, or AIS C/D) was recorded. Agreement of the estimated AIS grade and the actual AIS grade according to the physical examination was analyzed. Sensitivity, specificity, and Youden’s index of the questionnaire for estimating completeness of injury were calculated.ResultsA total of 102 SCI patients were enrolled. The general agreement of estimated and actual AIS grades was good (κ=0.681, P<0.001). For the estimation of a complete injury, both the sensitivity (87.10%) and the specificity (100.00%) of this questionnaire were high, with a Youden’s index of 0.87. For the estimation of a motor complete injury, the sensitivity increased (92.00%) while the specificity decreased slightly (75.00%), with a Youden’s index of 0.67.ConclusionsThe validity of this self-report questionnaire for estimation of AIS grade is good. In some situations, it could be considered as an alternative tool for the estimation of sacral sparing as well as the AIS grades within SCI individuals, especially when repeated anorectal examinations are not feasible.
Objective To verify the reliability and validity of a self-developed satisfaction evaluation questionnaire for outpatient department employees in public hospitals, and to provide suitable tools for conducting such surveys. Methods Two anonymous surveys were conducted on all employees of the Outpatient Department of West China Hospital of Sichuan University in July 2019 and November 2021, respectively. Questionnaire items were screened using methods such as item distribution, coefficient of variation, and decision value, and the reliability and validity of the questionnaire were evaluated using Spearman-Brown coefficient and Cronbach’s α coefficient, exploratory factor analysis, and confirmatory factor analysis. Results The final questionnaire retained 14 items, which could be divided into two dimensions: work conditions and interpersonal environment, and the overall fit index of structural equation model were as follows: χ2/ν=6.957, the standardized root mean square residual was 0.061, the root mean square error of approximation was 0.147, the goodness-of-fit index was 0.796, the adjusted goodness-of-fit index was 0.719, the normed fit index was 0.849, the relative fit index was 0.819, the incremental fit index was 0.868, the Tucker-Lewis Index was 0.841, and the comparative fit index was 0.867. The combined reliability of the two factors in the questionnaire was 0.94 and 0.91, respectively. The average variance extraction was 0.67 and 0.76, respectively, and the square root of the average variance extraction was 0.82 and 0.87, respectively, both of which were greater than the correlation coefficient of 0.71 between the two factors. The Spearman-Brown coefficient of the final questionnaire was 0.913, and the Cronbach’s α coefficients for the overall and two dimensions were 0.953, 0.937, and 0.910, respectively. Conclusion The reliability and validity of the satisfaction evaluation questionnaire for outpatient department employees in public hospitals are good and the questionnaire can be applied to practical surveys.
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.
ObjectiveThe current medical questionnaire resources are mainly processed and organized at the document level, which hampers user access and reuse at the questionnaire item level. This study aims to propose a multi-class classification of items in medical questionnaires in low-resource scenarios, and to support fine-grained organization and provision of medical questionnaires resources. MethodsWe introduced a novel, BERT-based, prompt learning approach for multi-class classification of items in medical questionnaires. First, we curated a small corpus of lung cancer medical assessment items by collecting relevant clinical assessment questionnaires, extracting function and domain classifications, and manually annotating the items with "function-domain" combination labels. We then employed prompt learning by feeding the customized template into BERT. The masked positions were predicted and filled, followed by mapping the populated text to labels. This process enables the multi-class classification of item texts in medical questionnaires. ResultsThe constructed corpus comprised 347 clinical assessment items for lung cancer, across nine "function-domain" labels. The experimental results indicated that the proposed method achieved an average accuracy of 93% on our self-constructed dataset, outperforming the runner-up GAN-BERT by approximately 6%. ConclusionThe proposed method can maintain robust performance while minimizing the cost of building medical questionnaire item corpora, illustrating its promotion value of research and practice in medical questionnaire classification.
ObjectiveTo investigate the therapeutic effect of glucosamine hydrochloride on chronic lumbago and backache. MethodsWe selected 328 outpatients with chronic lumbago and backache diagnosed between May 2014 and May 2015, and randomly (with single blind method) divided them into study group (n=172) and control group (n=156). Patients in the control group were treated with ibuprofen and placebo, while those in the study group were treated with ibuprofen and glucosamine hydrochloride. The short-form McGill pain questionnaire (SF-MPQ) was used for investigation at three time points (before the treatment, one month and two months after the treatment). ResultsThe score of SF-MPQ in the study group was 64.34±23.35 before the treatment, 44.04±13.22 one month after the treatment, and 19.87±8.11 two months after the treatment. While in the control group, the results at those three time points were 65.19±24.12, 47.04±11.36, and 54.44±21.39, respectively. There was no obvious difference between the two groups one month after the treatment (P>0.05). The pain was alleviated in both of the two groups one month after the treatment, while the therapeutic effect in the study group was significantly better than that in the control group two months after the treatment (P<0.05). Archenteric complications were found in 3 patients (1.74%) in the study group and 2 (1.28%) in the control group without a significant difference (P>0.05). ConclusionGlucosamine hydrochloride may effectively alleviate the lumbago and backache without any obvious adverse reactions.
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.