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.
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.
ObjectiveTo observe the effect of kinesio tape (KT) combined with progressive resistance training (PRT) in patients with subacromial impingement syndrome (SIS), and to explore whether the direction of KT affects the therapeutic effect of SIS.MethodsBetween May 2017 and March 2019, 90 participants with SIS in West China Hospital, Sichuan University were randomly divided into three groups, with 30 participants in each group. Participants were treated with KT combined with PRT, and the direction of the KT is from the proximal end of the rotator cuff muscles to the distal end in group A. Participants were treated with KT combined with PRT, and the direction of the KT is from the distal end of the rotator cuff muscles to the proximal end in group B. Participants were treated with PRT alone in group C. Visual Analog Scale (VAS) was used to evaluate the pain in patients at rest, during movement and at night; range of motion (ROM) of shoulder and the disabilities of the arm, shoulder and hand (DASH) outcome questionnaire were used to measure the physical function before treatment and after 1 week and 2 weeks.ResultsAfter 1 week of treatment, ROM of shoulder abduction, internal rotation and DASH scores in group A were significantly improved compared with those in group B and C (P<0.05). After 2 weeks of treatment, the nighttime VAS score, ROM of shoulder abduction, internal rotation and DASH score scores in group A were significantly improved compared with those in group B and C (P<0.05). The VAS score during movement, nighttime VAS score, ROM of shoulder (except external rotation) and DASH score in group A were significantly improved after 1 week and 2 weeks of treatment (P<0.05); and after 2 weeks of treatment, the nighttime VAS score, ROM of shoulder flexion and internal rotation in group B were significantly improved compared with those before treatment (P<0.05). After 2 weeks of treatment, the VAS score during movement, nighttime VAS score, ROM of shoulder (except external rotation) in group C were significantly improved compared with those before treatment (P<0.05).ConclusionKT combined with PRT is more effective than PRT alone in the treatment of SIS, and the therapeutic effect is related to the direction of the tape.
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 compare BODE index with GOLD staging for the severity evaluation in patients with chronic obstructive pulmonary disease ( COPD) . To investigate the relationship between BODE index and quality of life. Methods A total of 100 patients with stable COPD were enrolled. All participants were examined with lung function test and St George’s Respiratory Questionnaire ( SGRQ) for evaluation of quality of life. BODE index and it’s four components including body mass index( BMI) , airflow obstruction ( FEV1%pred) , dyspnea( MMRC) , and exercise capacity( 6MWD) were calculated. The participants were divided into four groups of severity using GOLD guidelines and BODE index quartiles. Results The associations between SGRQ total score and SGRQ subscales, and BODE index were significant( P lt;0. 01) .BODE index was a significant predictor of the quality of life, explaining 41. 3% of the total score of the SGRQ ( P lt;0. 01) . However, GOLD classification showed a correlation only with SGRQ activity score ( P lt;0. 05) but not with other SGRQ scores. There were significant differences in SGRQ total score and SGRQsubscales between different severity groups of BODE index( P lt;0. 01) . But there was no difference in SGRQ score between different severity groups of GOLD classification, except SGRQ activity score. Conclusion BODE scoring system is better correlated with the quality of life as assessed by the disease severity inpatients with COPD than the GOLD staging criteria.
ObjectiveTo investigate the preoperative psychological state of patients with pulmonary nodules in order to make the content of the education more "individualized and humanized".MethodsWe conducted a consecutive questionnaire study for 107 patients who were planning to undergo pulmonary resection surgery from May 2018 to July 2018 in our department. There were 54 males and 53 females with an average age of 56.8±11.2 years. The questionnaire content included two parts: personal basic information and 20 questions about surgery, complications, follow-up and hospitalization expense.ResultsThere were 60.7% of the patients diagnosed with pulmonary nodules by CT scan during physical examination, and 52.3% of the patients had strong will to undergo pulmonary surgery to resect nodules; 64.5% of patients wanted doctors to tell them the extent of the disease and whether the tumor could be cured by surgery, and 30.0% of patients concerned whether chief surgeon would complete the whole surgery. The surgery risk and postoperative complications were ignored by patients easily (5.6% and 14.9% respectively). The hospital expenses were not the primary concern of patients. Only 1.9% of patients believed that doctors used nonessentials which deliberately led to increased costs. Network follow-up was accepted by most patients (94.4%).ConclusionIt will contribute to improve preoperative education rationality and effectiveness by understanding true psychological state of patients.
Objective To understand the current status of the preferences and opinions on the investigator-initiated trails (IIT) of the neurosurgeons participating in INTERACT3 in China, as well as the design preference for IIT projects, and to provide a basis for the design and organization of multi-center clinical studies in the future. Methods Neurosurgeons with different seniority and professional titles from 89 domestic research institutions participating in the INTERACT3 project were collected from September to October 2023. The questionnaires were collected by questionnaire star. Results A total of 56 valid questionnaires were collected from 29 units. Among the 56 respondents, 52 neurosurgeons (92.86%) were from teaching hospitals and 45 (80.36%) were from grade A tertiary hospitals. 30 neurosurgeons (53.57%) had experience in conducting various clinical studies, and 55 neurosurgeons (98.21%) had experience in participating in various clinical studies. The main purposes of presiding over or participating in clinical research focused on “accumulating relevant experience and preparing for future projects” and “standardizing clinical diagnosis and treatment”, which were 89.29% and 83.93%. Respectively, regarding the way the case report form completing, respondents preferred to use electronic data collection systems (83.93%). Conclusions The purpose of the neurosurgeons interviewed to host or participate in clinical research is mainly to assist clinical and scientific research. Economic reasons have little impact on whether to participate in clinical research. The rationality and ease of operation of the trail design are the keys to attracting respondents to participate in clinical researches, and the level of remuneration has little impact on the decision-making of the respondents. The safety of clinical studies and the difficulty of enrolling subjects are the key factors that hinder respondents’ participation in clinical studies.
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.
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.
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.