OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China...OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.展开更多
OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure ...OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.展开更多
Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we ...Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.展开更多
This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descript...This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.展开更多
目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗...目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗程住院治疗策略的新疆其他地州肺结核报告发病数据。利用Joinpoint回归模型分析肺结核报告发病率的时间趋势。以2018年7月作为“肺结核主动筛查+全疗程住院治疗”模式干预时间点,根据是否设置对照地区,分别构建单组中断时间序列(interrupted time series, ITS)模型和设置对照的ITS模型(controlled interrupted time series, CITS)分析政策干预效果。结果:2012—2021年新疆和田地区肺结核报告发病率最高为2018年的465.10/10万(10 278例),最低为2021年的129.40/10万(3241例),总体呈现下降趋势(AAPC=-4.5%,P<0.05);2012—2018年肺结核报告发病率呈现上升趋势(APC=10.8%,P<0.05),2018—2021年肺结核报告发病率呈快速下降趋势(APC=-29.0%,P<0.05)。ITS模型分析显示,和田地区实施“肺结核主动筛查+全疗程住院治疗”模式后1个月(2018年7月),报告发病率增加16.859/10万(P=0.001),新型模式实施后的长期效果为肺结核报告发病率呈下降趋势(β3=-1.098,P<0.001)。CITS模型分析显示,和田地区在新型模式实施后1个月(2018年7月),肺结核报告发病率明显增加,增加量比对照地区高14.751/10万(P<0.001),新型模式实施后长期效果为肺结核报告发病率呈下降趋势,平均每月下降0.815/10万(β5+β7=-0.815,P<0.001),下降速度大于对照地区(β7=-0.931,P<0.001)。结论:新疆和田地区实施“肺结核主动筛查+全疗程住院治疗”模式与肺结核报告发病率之间存在动态因果关系,该模式促使肺结核报告发病率在短暂地上升后呈现下降的长期趋势。实施该模式对控制结核病高负担地区肺结核疫情具有明显优势。展开更多
The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial in...The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial infections. Verify the compliance of health professionals to the practices of contact precautions in patients colonized by microorganisms in a teaching hospital. This was a prospective observational cohort study in a special-sized hospital located in southeastern Brazil. The observation of health professionals in delivery of health care to patients with contact precaution was performed regarding hand hygiene, use of overcoat, glove, and mask. We carried out 1502 observations involving the following professional categories: nursing technicians and/or nursing assistants (n = 1028;68.4%), nurses (n = 200;13.3%), physical therapists (n = 185;12.3%), and physicians (n = 89;5.9%), totaling 971.8 hours. Regarding the level of compliance of professionals to contact precaution practices with hand hygiene after the procedures, the use of overcoats, gloves, and masks, all were statistically significant (p Klebsiella pneumoniae was the most positive pathogen identified in laboratory tests. This study provided the mapping of the compliance of health professionals to the practices of contact precautions in order to support a safer management of patient care reducing the risks of Healthcare-Associated Infections (HAI). This study also showed that health professionals are using practice management to deal with their behavior to protect their health.展开更多
The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by deter...The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by determining not only biological, but also psychological and social. The aims of the study are research and evaluation tools to determine the biopsychosocial vulnerability and the creation of a flow-chart for the establishment of health and socio-personalized care programs, but based on scientific evidence. In our study we have built an original scale of assessment for the general medicine, which could simultaneously analyze the Bio-Psycho-Social aspect of patients. A group of GPs （general practitioners） have tested this tool on a group of complex patients. The results of the study show that a high score on our scale of assessment is not correlated with the age of a patient （R = 0.454）; instead there is a straight correlation between the high score and the number of GPs and patient contacts （R = 0.790） and a border-line significant correlation （R = 0.590） between high scores and hospital admissions and resources utilization. In conclusion, with our assessment scale we built a general medicine instrument, simple, integrated with primary care setting and tools, fast in use. In the research and validation phase we showed how this scale would be able to identify patients in need of more attention where there is a necessity to go from a Guideline and EBM-Based approach to a Personalized approach.展开更多
BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vit...BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.展开更多
基金supported by the National Natural Science Foundation of China(No.81073163)
文摘OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.
基金supported by the National Natural Science Foundation of China (Project Grant No. 81073163)
文摘OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.
文摘Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel<sup>®</sup> program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old;60.8% Female, BMI: 26 ± 4.4 Kg/m<sup>2</sup>, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
文摘This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.
文摘目的:定量评价“肺结核主动筛查+全疗程住院治疗”模式在新疆维吾尔自治区(简称“新疆”)和田地区肺结核患者发现中的实施效果,为新疆肺结核防治工作的稳步推进提供科学依据。方法:收集2012年1月至2021年12月新疆和田地区及未实施全疗程住院治疗策略的新疆其他地州肺结核报告发病数据。利用Joinpoint回归模型分析肺结核报告发病率的时间趋势。以2018年7月作为“肺结核主动筛查+全疗程住院治疗”模式干预时间点,根据是否设置对照地区,分别构建单组中断时间序列(interrupted time series, ITS)模型和设置对照的ITS模型(controlled interrupted time series, CITS)分析政策干预效果。结果:2012—2021年新疆和田地区肺结核报告发病率最高为2018年的465.10/10万(10 278例),最低为2021年的129.40/10万(3241例),总体呈现下降趋势(AAPC=-4.5%,P<0.05);2012—2018年肺结核报告发病率呈现上升趋势(APC=10.8%,P<0.05),2018—2021年肺结核报告发病率呈快速下降趋势(APC=-29.0%,P<0.05)。ITS模型分析显示,和田地区实施“肺结核主动筛查+全疗程住院治疗”模式后1个月(2018年7月),报告发病率增加16.859/10万(P=0.001),新型模式实施后的长期效果为肺结核报告发病率呈下降趋势(β3=-1.098,P<0.001)。CITS模型分析显示,和田地区在新型模式实施后1个月(2018年7月),肺结核报告发病率明显增加,增加量比对照地区高14.751/10万(P<0.001),新型模式实施后长期效果为肺结核报告发病率呈下降趋势,平均每月下降0.815/10万(β5+β7=-0.815,P<0.001),下降速度大于对照地区(β7=-0.931,P<0.001)。结论:新疆和田地区实施“肺结核主动筛查+全疗程住院治疗”模式与肺结核报告发病率之间存在动态因果关系,该模式促使肺结核报告发病率在短暂地上升后呈现下降的长期趋势。实施该模式对控制结核病高负担地区肺结核疫情具有明显优势。
文摘The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial infections. Verify the compliance of health professionals to the practices of contact precautions in patients colonized by microorganisms in a teaching hospital. This was a prospective observational cohort study in a special-sized hospital located in southeastern Brazil. The observation of health professionals in delivery of health care to patients with contact precaution was performed regarding hand hygiene, use of overcoat, glove, and mask. We carried out 1502 observations involving the following professional categories: nursing technicians and/or nursing assistants (n = 1028;68.4%), nurses (n = 200;13.3%), physical therapists (n = 185;12.3%), and physicians (n = 89;5.9%), totaling 971.8 hours. Regarding the level of compliance of professionals to contact precaution practices with hand hygiene after the procedures, the use of overcoats, gloves, and masks, all were statistically significant (p Klebsiella pneumoniae was the most positive pathogen identified in laboratory tests. This study provided the mapping of the compliance of health professionals to the practices of contact precautions in order to support a safer management of patient care reducing the risks of Healthcare-Associated Infections (HAI). This study also showed that health professionals are using practice management to deal with their behavior to protect their health.
文摘The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by determining not only biological, but also psychological and social. The aims of the study are research and evaluation tools to determine the biopsychosocial vulnerability and the creation of a flow-chart for the establishment of health and socio-personalized care programs, but based on scientific evidence. In our study we have built an original scale of assessment for the general medicine, which could simultaneously analyze the Bio-Psycho-Social aspect of patients. A group of GPs （general practitioners） have tested this tool on a group of complex patients. The results of the study show that a high score on our scale of assessment is not correlated with the age of a patient （R = 0.454）; instead there is a straight correlation between the high score and the number of GPs and patient contacts （R = 0.790） and a border-line significant correlation （R = 0.590） between high scores and hospital admissions and resources utilization. In conclusion, with our assessment scale we built a general medicine instrument, simple, integrated with primary care setting and tools, fast in use. In the research and validation phase we showed how this scale would be able to identify patients in need of more attention where there is a necessity to go from a Guideline and EBM-Based approach to a Personalized approach.
文摘BACKGROUND Intensive care unit(ICU)patients demand continuous monitoring of several clinical and laboratory parameters that directly influence their medical progress and the staff’s decision-making.Those data are vital in the assistance of these patients,being already used by several scoring systems.In this context,machine learning approaches have been used for medical predictions based on clinical data,which includes patient outcomes.AIM To develop a binary classifier for the outcome of death in ICU patients based on clinical and laboratory parameters,a set formed by 1087 instances and 50 variables from ICU patients admitted to the emergency department was obtained in the“WiDS(Women in Data Science)Datathon 2020:ICU Mortality Prediction”dataset.METHODS For categorical variables,frequencies and risk ratios were calculated.Numerical variables were computed as means and standard deviations and Mann-Whitney U tests were performed.We then divided the data into a training(80%)and test(20%)set.The training set was used to train a predictive model based on the Random Forest algorithm and the test set was used to evaluate the predictive effectiveness of the model.RESULTS A statistically significant association was identified between need for intubation,as well predominant systemic cardiovascular involvement,and hospital death.A number of the numerical variables analyzed(for instance Glasgow Coma Score punctuations,mean arterial pressure,temperature,pH,and lactate,creatinine,albumin and bilirubin values)were also significantly associated with death outcome.The proposed binary Random Forest classifier obtained on the test set(n=218)had an accuracy of 80.28%,sensitivity of 81.82%,specificity of 79.43%,positive predictive value of 73.26%,negative predictive value of 84.85%,F1 score of 0.74,and area under the curve score of 0.85.The predictive variables of the greatest importance were the maximum and minimum lactate values,adding up to a predictive importance of 15.54%.CONCLUSION We demonstrated the efficacy of a Random Forest machine learning algorithm for handling clinical and laboratory data from patients under intensive monitoring.Therefore,we endorse the emerging notion that machine learning has great potential to provide us support to critically question existing methodologies,allowing improvements that reduce mortality.
