Patient-centric periodontal research:A pioneering application of patient-reported outcome measures

Conventional dentistry or periodontal research often ignores the human component in favor of clinical outcomes and biological causes.Clinical research is driven by the statistical significance of outcome parameters rather than the satisfaction level of the patient.In this context,patient-centric periodontal research(PCPR)is an approach that considers the patient´s feedback concerning their functional status,experience,clinical outcomes,and accessibility to their treatments.It is argued that data self-reported by the patient might have low reliability owing to the confounding effect of their personal belief,cultural background,and social and economic factors.However,literature has shown that the incorporation of“patient-centric outcome”components considerably enhances the validity and applicability of research findings.Variations in the results of different studies might be due to the use of different and non-standardized assessment tools.To overcome this problem,this editorial enlists various reliable tools available in the literature.In conclusion,we advocate that the focus of researchers should shift from mere periodontal research to PCPR so that the results can be effectively applied in clinical settings and the therapeutic strategy can also change from mere periodontal therapy to patient-centric periodontal therapy.

In-Hospital Outcomes in Minimally Invasive Mitral Valve Surgery: First Results in a Brazilian Single Center

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® 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/m2, 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.

Impact of Relaxation and Group Psycho-Education on Health Outcomes Using Integrated Care Models and Quality Improvement

The purpose of this Integrated Care Practice Change and Quality Improvement (ICPCQI) initiative was to evaluate the impact of wellness and relaxation and group psycho-education on health out-comes in an integrated care setting. Individuals diagnosed with mental illness and a co-occurring chronic medical condition participated in the ICPCQI initiatives which were run by peer support and wellness experts in an integrated care setting over the one-year project implementation period. Evaluation of outcome measures revealed an overall decline of 8.3% (p < 0.0001) and 7.3% (p < 0.0001) in the average systolic and diastolic blood pressure respectively. There was a 12.3% (p = 0.02) reduction on the average PHQ-9 scores. GAD-7 (p = 0.9) scores had a mean reduction of 1.5%. These preliminary results suggest that the evidence-based ICPCQI initiatives positively impact health outcomes among individuals with mental illness and chronic medical conditions.

Literature review and analysis of the application of health outcome assessment instruments in Chinese medicine

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.

Literature review and analysis of the development of health outcomes assessment instruments in Chinese medicine

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.

Extension for Community Health Outcomes-hepatitis C:Small steps carve big footprints in the allocation of scarce resources for hepatitis C virus treatment to remote developing areas

Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.

Pattern of Stroke Admissions, Radiodiagnostic Compliance, and Outcomes in the Intensive Care Unit of a Tertiary Hospital, South-South, Nigeria

Background: Stroke patients form an integral part of patients admitted into the intensive care unit (ICU);and may need airway maintenance, supplemental oxygen and even endotracheal intubation for mechanical ventilation. Method: In this retrospective study, the medical records and radiological investigations of the patients were assessed. Also, their socio-demographics, and clinical diagnosis and background co-morbidities were noted. The radiological diagnosis post CT was used to determine the type of stroke for those compliant;while clinical assessment alone was used to determine the diagnosis in those who did not do CT. They were also classified into 2 groups: those requiring mechanical ventilation (for ICU care) and those without the need for mechanical ventilation (for high dependency Unit (HDU) care). The eventual clinical outcome was noted. Result: A total of eighty-eight cases, 67% (n = 59) were males and 33% (n = 29) females. 89.8% (n = 79) had hypertension, 3.4% (n = 3) had diabetes while 6.8% (n = 6) had both hypertension and diabetes. Of the hypertensives, 36.7% (n = 29) had hemorrhagic stroke and 66.3% (n = 50) had ischaemic stroke. 53.3% (n = 46) patients had High dependency Unit (HDU care while 47.7% (n = 42) were mechanically ventilated. Of the number in HDU, 51.5% (n = 17) were haemorrhagic, while 52.7% (n = 29) were ischaemic. Clinical diagnosis of ischemic stroke was done in 55 (62.5%) and hemorrhagic stroke in 37.5% (n = 33). Of the lot, only 19.3% (n = 17) of them did CT and 80.7% (n = 71) did not have CT done. None did MRI. Late presentation (beyond 24 hrs) was a common feature for most of the patients, for whom immediate cardio-respiratory support became necessary. Overall mortality rate was 62.5% (n = 55). 39.1% (n = 18) of the HDU (46) patients died, while 88.1% (n = 37) of the ventilated (42) patients died. 56.6% (n = 26) were discharged from the HDU and 4.3% (n = 2) referred to another facility. Of the 42 patients on mechanical ventilation 88.1% (37) died, 9.5% (n = 4) discharged, and 2.4% (n = 1) referred to another health facility. Summary: Low neuroimaging compliance by Stroke patients in our environment and late presentation to hospital, impacts negatively on good outcome of the disease. This, coupled with the high cost of these facilities, makes their use unaffordable, suggesting a strong indication for comprehensive quality and affordable health care and health insurance in the country.

Association of types of diabetes and insulin dependency on birth outcomes

BACKGROUND Diabetes rates among pregnant women in the United States have been increasing and are associated with adverse pregnancy outcomes.AIM To investigate differences in birth outcomes(preterm birth,macrosomia,and neonatal death)by diabetes status.METHODS Cross-sectional design,using linked Missouri birth and death certificates(singleton births only),2010 to 2012(n=204057).Exposure was diabetes non-diabetic,pre-pregnancy diabetes-insulin dependent(PD-I),pre-pregnancy diabetes-non-insulin dependent(PD-NI),gestational diabetes-insulin dependent(GD-I),and gestational diabetes-non-insulin dependent(GD-NI).Outcomes included preterm birth,macrosomia,and infant mortality.Confounders included demographic characteristics,adequacy of prenatal care,body mass index,smoking,hypertension,and previous preterm birth.Bivariate and multivariate logistic regression assessed differences in outcomes by diabetes status.RESULTS Women with PD-I,PD-NI,and GD-I remained at a significantly increased odds for preterm birth(aOR 2.87,aOR 1.77,and aOR 1.73,respectively)and having a very large baby[macrosomia](aOR 3.01,aOR 2.12,and aOR 1.96,respectively);in reference to non-diabetic women.Women with GDNI were at a significantly increased risk for macrosomia(aOR1.53),decreased risk for their baby to die before their first birthday(aOR 0.41)and no difference in risk for preterm birth in reference to non-diabetic women.CONCLUSION Diabetes is associated with the poor birth outcomes.Clinical management of diabetes during pregnancy and healthy lifestyle behaviors before pregnancy can reduce the risk for diabetes and poor birth outcomes.

Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review

BACKGROUND Pediatric functional gastrointestinal disorders(FGIDs)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom presentations.Nonetheless,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIDs remains rare.The current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom improvement.AIM To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIDs and identify patient characteristics that predicted clinical outcomes.METHODS Participants were 392 children,ages 8-18[M=13.8;standard deviation(SD)=2.7],seen between August 1,2013 and June 15,2016 in an interdisciplinary APC housed within the Division of Gastroenterology in a medium-sized Midwestern children's hospital.To be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial evaluation.Medical and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational study.Logistic regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower improvers.RESULTS Nearly 70%of patients followed during the study period achieved resolution on at least one of the employed outcome indices.Among those who achieved resolution during follow up,43%to 49%did so by the first follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of resolution.More specifically,the odds of clinical resolution were 14%to 16%lower per additional year of patient age(P<0.001 to P=0.016).The odds of resolution were 28%to 42%lower per 1-standard deviation(SD)increase on a pediatric sleep measure(P=0.006 to P<0.040).Additionally,odds of clinical resolution were 58%lower per 1-SD increase on parent-reported measure of depression(P=0.006),and doubled in cases where parents agreed that their children found it easy to relax(P=0.045).Furthermore,sleep predicted the rapidity of clinical resolution;that is,the odds of achieving resolution by the first follow up visit were 47%to 60%lower per 1-SD increase on the pediatric sleep measure(P=0.002).CONCLUSION Outcomes for youth with FGIDs may be significantly improved by paying specific attention to sleep,ensuring adequate skills for relaxation,and screening of and referral for treatment of comorbid depression.

Contributions of Primary Health Care and Next Step Considerations: A Systematic Review

The essential consideration is the cornerstone of a solid medical care system that provides outstanding health outcomes at a low cost. Medical therapy has evolved over the previous century from concentrating on random etiologies to lifestyle, race, and environmental factors. The aim behind these changes is to serve the public health requirements by delivering frequent and easy services based on the individual, couple, or family. Accurate evaluation of the magnitude by which primary health care contributes to the health care system is essential to the improvement of these contributions and determining next step considerations. The number one factor has been associated with greater access to medical care, better health outcomes, and reduced hospitalization and ER (emergency room) visits. The number one consideration may also help balance the adverse effects of poor financial situations on well-being. Therefore, we need more primary care doctors in the US. Research is also necessary to understand which essential consideration models provide acceptable health results.

Barriers and Facilitators of Adherence to Anti-Diabetic Therapy in Pregnant Women with Diabetes: Health Care Workers’ Perspectives

Global prevalence of hyperglycaemia in pregnancy in women of 20 - 49 years was estimated to be 16.9% and affecting 21.4 million live births, in 2013, 90% of which occurred in developing countries. The cornerstone of anti-diabetic therapy is diet, physical activity and medications. The study utilized a qualitative descriptive design using key informant interviews from August 2016 to November 2016 to explore challenges of adherence to anti-diabetic therapy in pregnant women with diabetes at a central hospital in Harare, Zimbabwe. Permission to conduct the study was obtained from the respective local and national ethical review boards. All participants gave verbal and written informed consent. A sample of eight key informants directly involved in the care of pregnant women with diabetes was purposively selected for key informant interviews. Key informants should have worked with diabetic pregnant women for at least one year. Sample size was determined by data saturation. Interviews followed a semi structured questionnaire that had sections on the burden of diabetes in pregnancy, challenges of adherence, challenges in management and possible solutions to challenges faced. All interviews were conducted in a private room. Detailed notes were taken during the interviews which were also being audiotaped. Trustworthiness was achieved by observing credibility, dependability, transferability and confirmability. Thematic analysis was done. Thematic analysis was done manually. The stages of data analysis followed were data organization, familiarization, transcription, coding, developing a thematic framework, indexing, displaying and reporting. Major themes identified were barriers and facilitators of adherence to anti-diabetic therapy. Categories under barriers were financial barriers, lack of health education, lack of trained personnel, shortage of staff and lack of collaboration among practitioners. Categories under facilitators of adherence were subsidization of care, formal training of professionals, promoting collaboration and establishment of a unit dedicated to the care of pregnant women with diabetes. Barriers and solutions identified should be utilized to develop frameworks to promote adherence to anti-diabetic therapy incidence of adverse perinatal outcomes.

Exploring Factors in the Systematic Use of Outcome Measures: A Multi-Disciplinary Rehabilitation Team Perspective

Purpose: The implementation of routine outcome measurement was initiated as a quality improvement initiative in a unit delivering intensive functional rehabilitation for people with lower limb amputation. Two years post-implementation, completion rates remained low which raised the need to gain an indepth understanding of the factors that might impact the systematic use of Outcome Measures (OMs). Method: A qualitative exploratory study embedded in the ongoing quality improvement initiative was designed. Data were gathered through a focus group with members of a multidisciplinary rehabilitation team. A deductive content analysis was performed using Consolidated Framework for Implementation Research (CFIR) as a guide to explore factors that impact routine outcome measurement. Results: Respondents perceived OMs as valid and offering clear advantages in clinical practice. At the organizational level, lack of fit with clinical practice, loss of project leaders and lack of clear management directives had negative repercussions on the use of OMs. Conclusion: Our results suggest that a dedicated project leader throughout the implementation process and effective communication may contribute to bypassing barriers associated to practice changes leading to a more systematic use of OMs among clinicians.

新疆维吾尔自治区和田地区“肺结核主动筛查+全疗程住院治疗”模式对患者发现的效果

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。

机构养老模式的医疗费用和健康结果评估研究——基于价值医疗视角

随着老龄化程度的加深和家庭养老能力的降低,机构养老的需求量不断攀升。本文基于价值医疗视角,采用中国老年健康影响因素跟踪调查(CLHLS)数据,运用固定效应模型对机构养老模式的医疗费用和健康结果进行评估。研究发现:机构养老模式有利于降低医疗费用;机构养老模式通过减少问诊就医和住院治疗进而降低老年人的医疗费用,通过规范老年人生活方式、提高医疗效率进而提升老年人健康水平,但机构养老模式缺乏对心理健康的关注,不利于提升老年人健康水平。机构养老模式的医疗控费效果在轻度失能和中度失能老年人中更为明显,且机构养老模式明显降低了失智老年人的健康水平。本文的研究对于实现价值医疗目标的同时提升机构养老服务质量具有一定的参考价值。

“十三五”期间广州市不同结核病防治管理模式实施效果评价

目的:评价广州市现存结核病管理模式的实施效果,为不断完善结核病防治服务体系提供依据和实例。方法:从广州市结核病监测信息报告管理系统和广州市“十三五”结核病防治规划终期评估报告中搜集2016-2020年广州市4种结核病防治管理模式(慢病管理模式、“三位一体”模式、综合医院管理模式和委托服务模式)下的结核病疫情资料,计算不同模式下的肺结核患者登记率、病原学阳性率、治疗成功率、管理率和规范管理率等,并进行实施效果的成本-效用分析。结果:2016-2020年,广州市肺结核年均总登记率为51.78/10万(46 228/89 280 200),4种模式年均登记率由高及低依次为委托服务模式[74.37/10万(10 522/14 148 900)]、“三位一体”模式[50.17/10万(11 349/22 619 500)]、慢病管理模式[47.37/10万(14 588/30 793 700)]和综合医院管理模式[44.98/10万(9769/21 718 100)],差异有统计学意义(χ^(2)=222.422,P<0.001)。总病原学阳性率为49.33%(22 806/46 228),以慢病管理模式为最高[50.98%(7437/14 588)],委托服务模式为最低[48.07%(5058/10 522)];总治疗成功率为93.26%(43 113/46 228),以综合医院管理模式为最高[95.73%(9352/9769)],“三位一体”模式为最低[90.30%(10 248/11 349)];总规范管理率为89.08%(13 254/14 879),以委托服务模式为最高[95.40%(2573/2697)],“三位一体”模式为最低[82.69%(3100/3749)];差异均有统计学意义(χ^(2)=27.302,P<0.001;χ^(2)=306.666,P<0.001;χ^(2)=294.272,P<0.001)。总人均投入0.86元(76 477 200/89 280 200),挽回1个伤残调整生命年(DALY)损失需要投入的费用以“三位一体”模式为最高[188.20元(20 326 600/108 003.67)],综合医院管理模式为最低[153.77元(15 155 800/98 560.73)]。结论:“十三五”期间广州市4种结核病防治管理模式各有其优势及不足,未来仍需结合各区需求导向,从政府部门、系统到人才建设,积极采取措施,完善其现存结核病防治服务体系中的不足,以进一步提升患者登记率、病原学阳性率和总规范管理率。

新疆维吾尔自治区南疆地区结核病防治工作实施现状的定性评价——基于扎根理论的质性访谈

目的:通过深度访谈,调查和分析新疆维吾尔自治区(简称“新疆”)南疆地区结核病防治工作的实施现状、存在的问题及合理化建议,为促进新疆结核病防治工作的完善和可持续发展提供决策依据。方法:采用系统随机抽样的方式,在南疆四地州(阿克苏地区、和田地区、喀什地区、克孜勒苏柯尔克孜自治州)对从事结核病防治工作的相关工作人员27名进行半结构式访谈,基于扎根理论框架凝练资料信息,对访谈文本进行梳理、编码与提炼。结果:对访谈文本提取南疆地区结核病防治工作的成效、问题及建议三个主题,深度了解与定性分析南疆地区结核病防控工作的实施的成效、不足与问题,以及提出的合理性建议。结论:南疆地区实施新型肺结核防治工作后,患者发现的方式、数量和患者治疗管理情况均有大幅改观,目前仍存在一些不足,还需不断完善和充实南疆地区结核病防治工作,为新疆结核病防治提出科学有效的策略和路径,切实控制结核病的发生与传播,在新疆早日实现“终止结核病流行策略”的目标。

干预图式健康教育联合运动管理在妊娠期糖尿病患者中的应用价值

目的探讨干预图式健康教育联合运动管理在妊娠期糖尿病患者中的应用价值。方法纳入我院2020年5月至2022年5月收治的妊娠期糖尿病患者120例为研究对象,随机分为对照组和观察组,每组60例。对照组采用常规护理干预措施,观察组采用干预图式健康教育联合运动管理,比较2组的血糖指标水平、自我护理能力、妊娠结局、新生儿结局和依从性。结果2组干预后的空腹血糖、餐后2 h血糖和糖化血红蛋白的水平均低于干预前,观察组低于对照组(P<0.05)。2组干预后的自我护理能力评定量表(ESCA)评分高于干预前,观察组高于对照组(P<0.05)。观察组的早产、胎儿窘迫、羊水过多、巨大儿发生率,低于对照组(P<0.05)。观察组的遵医饮食、康复锻炼、遵医治疗、血糖监测及定期复查依从率高于对照组(P<0.05)。结论在妊娠期糖尿病患者中,应用干预图式健康教育联合运动管理进行护理干预,可改善患者的血糖指标水平、妊娠结局、新生儿结局,提高患者自我护理能力和依从性,干预效果显著。

数字化治疗依从性技术在肺结核患者服药管理中的应用效果评价

目的:评价数字化治疗依从性技术(digital treatment adherence technologies, DAT)的实施效果,以进一步提高新疆维吾尔自治区(以下简称“新疆”)昌吉州结核病患者治疗及服务管理质量。方法:采取回顾性研究方法,从中国疾病预防控制中心“结核病管理信息系统”和“易督导”网站中导出2021年1月1日至2023年3月31日登记现住址为“新疆维吾尔自治区昌吉州5县2市”且完成治疗疗程的活动性肺结核患者相关临床资料。根据患者管理方式,将2021年1月1日至12月31日登记为肺结核但未使用“易督导”管理系统的403例患者纳入传统方式管理组(传统组),将2022年1月1日至2023年3月31日登记为肺结核且使用“易督导”管理系统的313例患者纳入DAT管理组(DAT组),DAT使用率为89.68%(313/349),再根据使用电子工具的不同将DAT组分为电子药盒管理组[药盒组;81例(25.88%)]和微信公众号管理组[微信组;232例(74.12%)]。分析传统组和DAT组患者人口学特征、服药依从性及治疗效果,以及DAT组使用DAT的情况及不同地区的管理情况。结果:微信组在≥60岁年龄组[30.60%(71/232)]和农牧民[40.95%(95/232)]的占比均明显低于药盒组[77.78%(63/81)和76.54%(62/81)],差异均有统计学意义(χ2=54.780,P=0.000;χ2=32.666,P=0.000)。传统组总体服药率[97.78%(99 053/101 299)]和规则服药率[96.03%(387/403)]均优于DAT组[分别为93.23%(62 601/67 146)和85.62%(268/313)],药盒组总体服药率[95.89%(15 808/16 486)]优于微信组[92.37%(46 793/50 660)],差异均有统计学意义(χ2=2162.210、24.481、244.306,P值均=0.000),但微信组规则服药率[84.48%(196/232)]与药盒组[88.89%(72/81)]差异无统计学意义(χ2=0.947,P=0.331)。DAT组的治疗成功率[95.85%(300/313)]、第2/3个月末查痰率[99.36%(311/313)]和痰菌阴转率[98.76%(159/161)]与传统组[分别为94.29%(380/403)、98.26%(396/403)和97.83%(271/277)]的差异均无统计学意义(χ2=0.891,P=0.345;χ2=0.941,P=0.332;χ2=0.106,P=0.744),但微信组治疗成功率[98.28%(228/232)]高于药盒组[88.89%(72/81)],差异有统计学意义(χ2=11.036,P=0.001)。DAT组不同地区规则服药率介于61.22%(30/49)~97.30%(36/37),差异有统计学意义(χ2=39.320,P=0.000)。结论:新疆昌吉州各县(市)接受使用DAT管理的肺结核患者比例较高,且以接受微信公众号管理为主,可更准确地反映患者服药情况,管理效果也与传统管理方式一致。应针对不同县市、不同管理方式、不同年龄、不同职业人群制定不同的DAT管理措施,以提高规则服药率,并逐步在新疆地区推广应用。

中心群组化孕期保健模式对高龄初产妇分娩不良情绪和妊娠结局的影响

目的探讨中心群组化孕期保健模式对高龄初产妇分娩不良情绪与妊娠结局的影响。方法选取2022年1月-6月北京市某三级综合医院妇产科门诊建档并定期参加产检的60例高龄初产妇,采用随机数字表法将其分为对照组和干预组,各30例。对照组实施常规孕期护理,干预组在对照组基础上实施中心群组化孕期保健干预。分别于干预前和分娩后采用焦虑自评量表(self-rating anxiety scale,SAS),抑郁自评量表(self-rating depression scale,SDS)评价2组焦虑、抑郁情况,并统计不良妊娠结局和顺产率。结果干预后,干预组SAS、SDS评分均低于对照组(t=2.830,P=0.006;t=5.315,P<0.001),顺产率高于对照组(χ^(2)=5.711,P=0.017),2组胎儿窘迫、新生儿窒息、产后出血发生率比较,差异均无统计学意义(χ^(2)=5.868,P=0.167;χ^(2)=3.086,P=0.283;χ^(2)=2.576,P=0.152)。结论中心群组化孕期保健模式能有效提高高龄初产妇顺产率,缓解其孕期焦虑、抑郁情绪,值得临床推广。

过敏性皮肤病患者就医延迟的影响因素及健康结局分析

目的探讨过敏性皮肤病(ASD)患者就医延迟的影响因素及其与健康结局的关系。方法采用一般资料调查表、ASD患者就医延迟评估问卷、感知压力视觉模拟评分法(VAS)、疾病症状严重程度VAS、皮肤病生活质量指数(DLQI),于2022年4月至5月对中南大学湘雅医院皮肤性病科门诊ASD患者进行网络问卷调查,分析其就医延迟的影响因素及与健康结局的关系(就诊时间≥3个月定义为就医延迟)。采用logistic回归模型分析就医延迟的影响因素,采用两独立样本t检验分析就医延迟与健康结局的关联。结果单因素分析结果提示,就医延迟者和未就医延迟者的显著感知压力、对医疗系统的不信任、有过皮肤问题治疗的不良经历比较,差异有统计学意义(P<0.05)。多因素分析结果提示,感知压力越大(β=0.966,OR=2.63,95%CI=1.22~5.64)、有过皮肤问题治疗不良经历(β=0.622,OR=1.86,95%CI=1.18~2.94)是ASD患者就医延迟的危险因素(P<0.05)。就医延迟组的治疗满意度低于未就医延迟组,就医延迟组的疾病症状严重程度高于未就医延迟组,差异有统计学意义(P<0.05)。结论ASD患者感知压力越大和有过皮肤问题治疗的不良经历是就医延迟的重要影响因素,就医延迟与多种不良皮肤健康结局相关。