AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a tota...AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.展开更多
Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor pa...Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.展开更多
Consciousness is controlled by ular activating system (ARAS). lower and upper parts between activation of the ascending retic- The ARAS consists mainly of the the thalamus and cerebral cortex (Edlow et al., 2012; Y...Consciousness is controlled by ular activating system (ARAS). lower and upper parts between activation of the ascending retic- The ARAS consists mainly of the the thalamus and cerebral cortex (Edlow et al., 2012; Yeo et al., 2013; Jang et al., 2014). Because the ARAS is composed of several neuronal circuits connecting the brainstem to the cortex. These neuronal connections begin from the reticular formation (RF) of the brainstem and the intralaminar nucleus of thalamus to the cerebral cortex (Gosseroes et al., 2011). In addition, the ARAS system also includes several brainstem nuclei (such as dorsal raphe, locus coeruleus, pedun-culopontine nucleus, median raphe and parabrachial nucleus), non-specific thalamic nuclei, hypothalamus, and basal forebrain (Fuller et al., 2011).展开更多
Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as ...Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .展开更多
This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive (ss+ and/or c+) two years after they were declared cured, and to explore causes of recurrence ...This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive (ss+ and/or c+) two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.展开更多
Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive u...Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.展开更多
AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecuti...AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecutive group of 588patients, who had undergone total joint arthroplasty(TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding variables.RESULTS: Complete follow-up data was collected on 554 of the 588 total patients(93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age(P = 0.026) and a greater proportion of females(P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo postoperative.CONCLUSION: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.展开更多
AIM To evaluate the effect of introducing a structured online follow-up system on the response rate.METHODS Since June 2015 we have set up an electronic followup system for prosthesis in orthopedic patients. This syst...AIM To evaluate the effect of introducing a structured online follow-up system on the response rate.METHODS Since June 2015 we have set up an electronic followup system for prosthesis in orthopedic patients. This system allows prospective data gathering using both online and paper questionnaires. In the past all patients received questionnaires on paper. This study includes only patients who received elbow arthroplasty. Response rates before and after introduction of the online database were compared. After the implementation,completeness of the questionnaires was compared between paper and digital versions. For both comparisons Fisher's Exact tests were used.RESULTS A total of 233 patients were included in the study. With the introduction of this online follow-up system,the overall response rate increased from 49.8% to 91.6%(P < 0.01). The response rate of 92.0% in the paper group was comparable to 90.7% in the online group(P > 0.05).Paper questionnaires had a completeness of 54.4%,which was lower compared to the online questionnaires where we reached full completeness(P < 0.01). Furthermore,non-responders proved to be younger with a mean age of 52 years compared to a mean age 62 years of responders(P < 0.05).CONCLUSION The use of a structured online follow-up system increased the response rate. Moreover,online questionnaires are more complete than paper questionnaires.展开更多
Purpose: To determine if nurses are able to identify medication errors that have the potential to bypass computer physician order entry (CPOE) and smart ordering systems. Background: Medical care systems employ comput...Purpose: To determine if nurses are able to identify medication errors that have the potential to bypass computer physician order entry (CPOE) and smart ordering systems. Background: Medical care systems employ computer “smart” systems to reduce medication errors by using artificial intelligence (preprogrammed methods of decision support and error reduction). However, these systems are not perfect and they can be bypassed. Nurses who carry out the order represent the last check point in error prevention prior to the administration of medication orders. Methods: A paper exercise was created with 513 physician orders. Nurses were asked to indicate whether they would carry out the order, refuse to carry out the order, consult a pharmacist for clarification, or carry out the order with special precautions. Nurses were given the option of using any nursing or medical reference. Results: The rate of correctly identifying 23 of the contraindicated orders was low. Both experienced and inexperienced nurses had high rates of not identifying the errors despite similar use of references and requests for assistance from pharmacists. Conclusions: This study demonstrates that if an error escapes a smart system, nurses were able to identify most of these errors, but not all of these. The current system features high stress, self-esteem issues, time pressure, high volume, and high risk. The system must change radically to meet the public’s expectations of being nearly error free which can only be achieved with smarter systems that are more resistant to human errors.展开更多
I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a pati...I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a patient with bilateral retinoblastoma 72mo after the initial successful globe-preserving therapies, which included chemotherapy, laser photocoagulation, and cryotherapy.展开更多
The human brain is known to contain a maximum of eight cholinergic nuclei: the basal forebrain region: the medial septal nucleus (Ch 1), the vertical nucleus of the diagonal band (Ch 2), the horizontal limb of t...The human brain is known to contain a maximum of eight cholinergic nuclei: the basal forebrain region: the medial septal nucleus (Ch 1), the vertical nucleus of the diagonal band (Ch 2), the horizontal limb of the diago- nal band (Ch 3), and the nucleus basalis of Meynert (Ch 4); the brainstem: the pedunculopontine nucleus (Ch 5), the laterodorsal tegmental nucleus (Ch 6), and the para- bigeminal nucleus (Ch 8); and the thalamus: the medial habenular nucleus (Ch 7) (Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009). The cingulum is the neu- ral tract extending from the orbitofrontal cortex to the medial temporal lobe (Mufson and Pandya, 1984). The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which pro- vides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 (mainly) (Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and lang, 2010).展开更多
Objective:To study the effect of family follow-up nursing in rehabilitation of elderly autistic patients in community institutions.Methods:120 elderly autistic patients from February 2021 to July 2022 were randomly di...Objective:To study the effect of family follow-up nursing in rehabilitation of elderly autistic patients in community institutions.Methods:120 elderly autistic patients from February 2021 to July 2022 were randomly divided into a control group and a test group with 60 cases each.The patients in the control group were cared for at home by their family members,while the patients in the test group were given family follow-up rehabilitation care on the basis of the control group.The compliance of patients in the rehabilitation process,the UCLA loneliness score,the autism treatment assessment scale(ATEC)score of patients after this nursing care,and the quality-of-life scores of patients of the two groups before and after nursing care were compared.Results:The compliance of patients in the process of rehabilitation treatment was better in the experimental group than in the experimental group.The physical function score of patients after nursing was better in the experimental group than in the experimental group.The UCLA loneliness score and ATEC score of patients in the experimental group after nursing were lower than those of the control group(P<0.05);the quality-of-life score was higher in the experimental group(P<0.05).Conclusion:The application of family follow-up nursing in the rehabilitation of elderly autistic patients in community institutions can significantly improve patients’compliance and improve their prognosis,thus having high clinical value.展开更多
Introduction: The ring system is one of the devices that are necessary for patients in hospital. Patients can use it in emergencies and call nurses for help. Patients who have a tracheal tube cannot make the simplest ...Introduction: The ring system is one of the devices that are necessary for patients in hospital. Patients can use it in emergencies and call nurses for help. Patients who have a tracheal tube cannot make the simplest requests, and they do not have verbal communication due to tracheal tube or tracheostomy tube. According to surveys, patients’ survival is 55.5% in intensive care unit (ICU). They experience severe stressful conditions. This project is designed to solve communicational problems for ICU patients. We have developed and successfully tested a new moveable “nurse call system” for ICU patient. Material Methods: this is an interventional study. Regarding the main goal of this project, it seems that the best design for “nurse call system” is horizontal panels. The Panel of device contains a touchable board, which consists of symbols that allow patients to select them despite of their physical limitation. When patient touches any symbol, the message will be sent and heard by the nurse and the patient as well, so the patient will be sure that the massages is received properly. A notepad device will be used on which patients are able to write too. It is finger touch, and has virtual keywords in both Persian and English alphabets. The voice messages and other data will be transmitted to the computer in central nurse station by a wireless accesses point. In this study, we evaluated the viewpoint of nurses and patients who have used this device. Results: 40 questionnaires were distributed, but 30 cases were collected. Results showed that 26.7% (8 cases) were men, 73.3% (22 cases) women. 26.7% (23 cases) were nurses, 6.7% (2 cases) doctor, 6.7% (2 cases) nurse assistant. 33.3% (9 cases) were in the morning shift, 66.7% (21 cases) worked in other shifts. About patient 60% (6 cases) were men, 40% (4 cases) women and in 98% comments were completely compliant and device was full consent. Conclusion: The Nurse Call system caused patients’ satisfaction. In addition, this device resolved many problems of patients and made it possible to have active communication with them.展开更多
Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the stren...Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.展开更多
The aim of this study was to investigate changes in the Autonomic Nervous System (ANS) and moods before and after participation in a Mindfulness Art Therapy Short version (MATS). The study design was non-randomized co...The aim of this study was to investigate changes in the Autonomic Nervous System (ANS) and moods before and after participation in a Mindfulness Art Therapy Short version (MATS). The study design was non-randomized controlled trial in intervention study. Participants were 10 Japanese patients with advanced cancer. They received the MATS in one session, which consisted of mindfulness practices and making arts. Their Autonomic Nervous System (sympathetic nervous, parasympathetic nervous) physiologically and mood (Tense Arousal: TA, Energetic Arousal: EA) psychologically were measured before and after the MATS. The results showed that the level of parasympathetic nervous system decreased and that the sympathetic nervous system increased in small effect size. The TA decreased in a large effect size and EA increased in a middle effect size. These results suggested that the MATS might activate physiologically, alleviate tension and increase energy psychologically.展开更多
To explore changes of toll-like receptor (TLR) 2,4 in peripheral blood mononuclear cells (PBMC) in acute abdomen patients with systemic inflammatory response syndrome (SIRS) and their significance.Methods A clinical s...To explore changes of toll-like receptor (TLR) 2,4 in peripheral blood mononuclear cells (PBMC) in acute abdomen patients with systemic inflammatory response syndrome (SIRS) and their significance.Methods A clinical study was done on 103 patients of which 65 were with SIRS.The mRNA expression of TLR2,4 were detected by RT-PCR;the expression of TNF-α and IL-6 were observed by ELISA;the correlation between TLR2,4 mRNA,the level of TNF-α and IL-6,and the clinical course was evaluated.Results TLR2 mRNA ,TNF-α and IL-6 were upregulated markedly on the first day of hospitalization,then decreased gradually;TLR2 mRNA maintained on high level till the 5th day.The expression of TLR2,4 mRNA was positive correlated with the level of TNF-α and IL-6,and the length of stay.TLR2,4 mRNA expression increased in patients with multiple organ failure.Conclusion In actue abdomen patients with SIRS,the expression of TLR2,4 of PBMC increased markedly,indicating its improtant role in the pathogenesis of SIRS.4 refs,2 figs,2 tabs.展开更多
Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow ang...Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.展开更多
AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint condition...AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.展开更多
基金Supported by the Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.YNZD2201903)the Scientific Research Foundation of the Eye Hospital,School of Ophthalmology&Optometry,Wenzhou Medical University(No.KYQD20180306)the Nursing Project of the Eye Hospital of Wenzhou Medical University(No.YNHL2201908).
文摘AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.
文摘Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.
基金supported by the National Research Foundation (NRF) of Korea Grant funded by the Korean Government (MSIP) No. 2015R1A2A2A01004073
文摘Consciousness is controlled by ular activating system (ARAS). lower and upper parts between activation of the ascending retic- The ARAS consists mainly of the the thalamus and cerebral cortex (Edlow et al., 2012; Yeo et al., 2013; Jang et al., 2014). Because the ARAS is composed of several neuronal circuits connecting the brainstem to the cortex. These neuronal connections begin from the reticular formation (RF) of the brainstem and the intralaminar nucleus of thalamus to the cerebral cortex (Gosseroes et al., 2011). In addition, the ARAS system also includes several brainstem nuclei (such as dorsal raphe, locus coeruleus, pedun-culopontine nucleus, median raphe and parabrachial nucleus), non-specific thalamic nuclei, hypothalamus, and basal forebrain (Fuller et al., 2011).
文摘Objectives: To assess the factors influencing the ophthalmological follow-up of sickle cell patients in Togo. Materials and Methods: The national center of research and care for sickle cell patients (CNRSD) served as study setting. It was a descriptive and analytical study by interview over a three-month period from December 01, 2020 to March 02, 2021. Was included in the study, any patient with sickle cell disease genotype SS or SC, age ≥ 17 years, regularly followed at the CNRSD and having accepted the interview by a survey sheet. Excluded were patients with sickle cell trait genotype AS or AC or with a disability that prevented them from being interviewed. Results: Two hundred and fifty (250) patients with sickle cell disease were interviewed. The mean age was 29.1 years ± 11.12 years [17 years;67 years] and the sex ratio = 0.52. Nine patients over ten (9/10) attended at least secondary school. The jobless represented 25.60% of the total population followed respectively by students and laborers in 20.40% and 16% of cases. Twenty-four percent (24%) of patients were followed up in ophthalmology department. Statistically, there was no significant relationship between level of education (p = 0.4083), occupation (p = 0.6441) and knowledge of the ocular complications of sickle cell disease. Statistically, there was a significant relationship between knowledge of the ocular complications of sickle cell disease and compliance with ophthalmological follow-up (p = 0.0009). Conclusion: The knowledge of eye disorders related to sickle cell disease by patients with sickle cell disease improves their ophthalmological follow-up. Greater awareness on eye disorders related to sickle cell disease by medical staff towards patients with sickle cell disease would improve ophthalmological follow-up. .
基金supported by ‘Follow-up Study of Retreatment TB Patients with Sputum Smear Positive Two Years after Declared Cured’(TB10-002)
文摘This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive (ss+ and/or c+) two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.
文摘Objective The trial was designed to evaluate the safety and performance of the ev3 Protégé TM stent in the treatment of de novo or re-stenotic common and/or internal carotid artery stenoses with adjunctive use of a CE-marked filter embolic protection device.Methods This study was a prospective multi-center, single-arm trial. Between June and October 2003, 77 patients were enrolled in 8 investigational centers throughout Europe. The primary endpoint was the incidence of Major Neurological Events (MANE) through one month. Other endpoints were the ability to properly place the stent, and primary patency and MANE after six months. Eligible for the study were patients with a de novo or restenotic target lesion located in the common and/or internal carotid artery (>70% stenosis for asymptomatic and >50% stenosis for symptomatic patients). The ev3 Spider (Embolic Protection Filter was used in 75 of 77 cases. Results In 76 out of the 77 patients (99%), the stent could be successfully implanted with a residual stenosis ≤30% as criterion. Of the 74 patients that had a carotid ultrasound at one month follow-up, none had a re-stenosis of the target lesion. There were three MANEs during or immediately after the procedure (3.9%), two were major and one was a minor stroke. There were eight severe complications (9.1%); six of these happened during or immediately after the procedure and were related to the procedure, none was related to the device. They are resolved without sequelae. No deaths have occurred.Conclusions The Protégé stent is safe and performs well in the treatment of carotid artery stenosis. The technical success rate for placement of the Protégé stent as assessed by the residual stenosis post implant was very high and all stents were successfully deployed. The incidence of MANE was comparable with that in other recent carotid stent studies and still lower than standard CEA.
文摘AIM: To determine whether there is a functional difference between patients who actively follow-up in the office(OFU) and those who are non-compliant with office follow-up visits(NFU). METHODS: We reviewed a consecutive group of 588patients, who had undergone total joint arthroplasty(TJA), for compliance and functional outcomes at one to two years post-operatively. All patients were given verbal instructions by the primary surgeon to return at one year for routine follow-up visits. Patients that were compliant with the instructions at one year were placed in the OFU cohort, while those who were non-compliant were placed in the NFU cohort. Survey mailings and telephone interviews were utilized to obtain complete follow-up for the cohort. A χ2 test and an unpaired t test were used for comparison of baseline characteristics. Analysis of covariance was used to compare the mean clinical outcomes after controlling for confounding variables.RESULTS: Complete follow-up data was collected on 554 of the 588 total patients(93%), with 75.5% of patients assigned to the OFU cohort and 24.5% assigned to the NFU cohort. We found significant differences between the cohorts with the OFU group having a higher mean age(P = 0.026) and a greater proportion of females(P = 0.041). No significant differences were found in either the SF12 or WOMAC scores at baseline or at 12 mo postoperative.CONCLUSION: Patients who are compliant to routine follow-up visits at one to two years post-operation do not experience better patient reported outcomes than those that are non-compliant. Additionally, after TJA, older women are more likely to be compliant in following surgeon instructions with regard to follow-up office care.
文摘AIM To evaluate the effect of introducing a structured online follow-up system on the response rate.METHODS Since June 2015 we have set up an electronic followup system for prosthesis in orthopedic patients. This system allows prospective data gathering using both online and paper questionnaires. In the past all patients received questionnaires on paper. This study includes only patients who received elbow arthroplasty. Response rates before and after introduction of the online database were compared. After the implementation,completeness of the questionnaires was compared between paper and digital versions. For both comparisons Fisher's Exact tests were used.RESULTS A total of 233 patients were included in the study. With the introduction of this online follow-up system,the overall response rate increased from 49.8% to 91.6%(P < 0.01). The response rate of 92.0% in the paper group was comparable to 90.7% in the online group(P > 0.05).Paper questionnaires had a completeness of 54.4%,which was lower compared to the online questionnaires where we reached full completeness(P < 0.01). Furthermore,non-responders proved to be younger with a mean age of 52 years compared to a mean age 62 years of responders(P < 0.05).CONCLUSION The use of a structured online follow-up system increased the response rate. Moreover,online questionnaires are more complete than paper questionnaires.
文摘Purpose: To determine if nurses are able to identify medication errors that have the potential to bypass computer physician order entry (CPOE) and smart ordering systems. Background: Medical care systems employ computer “smart” systems to reduce medication errors by using artificial intelligence (preprogrammed methods of decision support and error reduction). However, these systems are not perfect and they can be bypassed. Nurses who carry out the order represent the last check point in error prevention prior to the administration of medication orders. Methods: A paper exercise was created with 513 physician orders. Nurses were asked to indicate whether they would carry out the order, refuse to carry out the order, consult a pharmacist for clarification, or carry out the order with special precautions. Nurses were given the option of using any nursing or medical reference. Results: The rate of correctly identifying 23 of the contraindicated orders was low. Both experienced and inexperienced nurses had high rates of not identifying the errors despite similar use of references and requests for assistance from pharmacists. Conclusions: This study demonstrates that if an error escapes a smart system, nurses were able to identify most of these errors, but not all of these. The current system features high stress, self-esteem issues, time pressure, high volume, and high risk. The system must change radically to meet the public’s expectations of being nearly error free which can only be achieved with smarter systems that are more resistant to human errors.
基金Supported by Beijing "215" High-Level Medical Talent Development Program(No.2015-3-018)
文摘I am Dr. Yi Zhang, from the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University,Beijing, China. I would like to describe the metastasis in the left parotid and cervical lymph nodes of a patient with bilateral retinoblastoma 72mo after the initial successful globe-preserving therapies, which included chemotherapy, laser photocoagulation, and cryotherapy.
基金supported by Basic Science Research Program through the National Research Foundation of Korea(NRF)funded by the Ministry of Education,Science and Technology,No.2012R1A1A4A01001873
文摘The human brain is known to contain a maximum of eight cholinergic nuclei: the basal forebrain region: the medial septal nucleus (Ch 1), the vertical nucleus of the diagonal band (Ch 2), the horizontal limb of the diago- nal band (Ch 3), and the nucleus basalis of Meynert (Ch 4); the brainstem: the pedunculopontine nucleus (Ch 5), the laterodorsal tegmental nucleus (Ch 6), and the para- bigeminal nucleus (Ch 8); and the thalamus: the medial habenular nucleus (Ch 7) (Nieuwenhuys et al., 2008; Naidich and Duvernoy, 2009). The cingulum is the neu- ral tract extending from the orbitofrontal cortex to the medial temporal lobe (Mufson and Pandya, 1984). The cingulum plays an important role in memory because it is a passage of the medial cholinergic pathway, which pro- vides cholinergic innervations to the cerebral cortex after originating from Ch 1 and Ch 2 as well as Ch 4 (mainly) (Selden et al., 1998; Nieuwenhuys et al., 2008; Hong and lang, 2010).
文摘Objective:To study the effect of family follow-up nursing in rehabilitation of elderly autistic patients in community institutions.Methods:120 elderly autistic patients from February 2021 to July 2022 were randomly divided into a control group and a test group with 60 cases each.The patients in the control group were cared for at home by their family members,while the patients in the test group were given family follow-up rehabilitation care on the basis of the control group.The compliance of patients in the rehabilitation process,the UCLA loneliness score,the autism treatment assessment scale(ATEC)score of patients after this nursing care,and the quality-of-life scores of patients of the two groups before and after nursing care were compared.Results:The compliance of patients in the process of rehabilitation treatment was better in the experimental group than in the experimental group.The physical function score of patients after nursing was better in the experimental group than in the experimental group.The UCLA loneliness score and ATEC score of patients in the experimental group after nursing were lower than those of the control group(P<0.05);the quality-of-life score was higher in the experimental group(P<0.05).Conclusion:The application of family follow-up nursing in the rehabilitation of elderly autistic patients in community institutions can significantly improve patients’compliance and improve their prognosis,thus having high clinical value.
文摘Introduction: The ring system is one of the devices that are necessary for patients in hospital. Patients can use it in emergencies and call nurses for help. Patients who have a tracheal tube cannot make the simplest requests, and they do not have verbal communication due to tracheal tube or tracheostomy tube. According to surveys, patients’ survival is 55.5% in intensive care unit (ICU). They experience severe stressful conditions. This project is designed to solve communicational problems for ICU patients. We have developed and successfully tested a new moveable “nurse call system” for ICU patient. Material Methods: this is an interventional study. Regarding the main goal of this project, it seems that the best design for “nurse call system” is horizontal panels. The Panel of device contains a touchable board, which consists of symbols that allow patients to select them despite of their physical limitation. When patient touches any symbol, the message will be sent and heard by the nurse and the patient as well, so the patient will be sure that the massages is received properly. A notepad device will be used on which patients are able to write too. It is finger touch, and has virtual keywords in both Persian and English alphabets. The voice messages and other data will be transmitted to the computer in central nurse station by a wireless accesses point. In this study, we evaluated the viewpoint of nurses and patients who have used this device. Results: 40 questionnaires were distributed, but 30 cases were collected. Results showed that 26.7% (8 cases) were men, 73.3% (22 cases) women. 26.7% (23 cases) were nurses, 6.7% (2 cases) doctor, 6.7% (2 cases) nurse assistant. 33.3% (9 cases) were in the morning shift, 66.7% (21 cases) worked in other shifts. About patient 60% (6 cases) were men, 40% (4 cases) women and in 98% comments were completely compliant and device was full consent. Conclusion: The Nurse Call system caused patients’ satisfaction. In addition, this device resolved many problems of patients and made it possible to have active communication with them.
文摘Background: The prevalence and incidence rate of tuberculosis remains high although the disease is known to be almost always curable provided the patient adheres to the treatment regimen. This study assessed the strength of association between known patient and health system factors associated with first line tuberculosis treatment adherence. Methods: A quantitative cross sectional study. Retrospective chart reviews were conducted among 570 persons who had primary tuberculosis and received first line treatment at a health facility within the Nkangala district, Mpumalanga province and who had a treatment outcome recorded between 1st January 2009 and 31st December 2014. Adherence to first line tuberculosis treatment was defined as taking ≥80% of tuberculosis prescribed drugs within a period of 6 to 8 months. Stata software (logistic regressions model) was used to analyze results and find the strength of association between known factors and treatment adherence. Results: Out of the 570 study participants, 473 were adherent and 96 were not adherent. There was a statistically significant association between age 18 years and above (OR: 1.02, P-value: 0.027), sex (lower in males OR: 0.44, P-value: 0.001) and support (OR: 3.04, P-value: 0.05) and HIV (OR: 1, P-value: 0.634) and first line TB treatment adherence. Conclusion and Recommendation: >80% adherence to first line tuberculosis outcome is possible. The support given to people with tuberculosis will further enhance adherence to first line tuberculosis treatment.
文摘The aim of this study was to investigate changes in the Autonomic Nervous System (ANS) and moods before and after participation in a Mindfulness Art Therapy Short version (MATS). The study design was non-randomized controlled trial in intervention study. Participants were 10 Japanese patients with advanced cancer. They received the MATS in one session, which consisted of mindfulness practices and making arts. Their Autonomic Nervous System (sympathetic nervous, parasympathetic nervous) physiologically and mood (Tense Arousal: TA, Energetic Arousal: EA) psychologically were measured before and after the MATS. The results showed that the level of parasympathetic nervous system decreased and that the sympathetic nervous system increased in small effect size. The TA decreased in a large effect size and EA increased in a middle effect size. These results suggested that the MATS might activate physiologically, alleviate tension and increase energy psychologically.
文摘To explore changes of toll-like receptor (TLR) 2,4 in peripheral blood mononuclear cells (PBMC) in acute abdomen patients with systemic inflammatory response syndrome (SIRS) and their significance.Methods A clinical study was done on 103 patients of which 65 were with SIRS.The mRNA expression of TLR2,4 were detected by RT-PCR;the expression of TNF-α and IL-6 were observed by ELISA;the correlation between TLR2,4 mRNA,the level of TNF-α and IL-6,and the clinical course was evaluated.Results TLR2 mRNA ,TNF-α and IL-6 were upregulated markedly on the first day of hospitalization,then decreased gradually;TLR2 mRNA maintained on high level till the 5th day.The expression of TLR2,4 mRNA was positive correlated with the level of TNF-α and IL-6,and the length of stay.TLR2,4 mRNA expression increased in patients with multiple organ failure.Conclusion In actue abdomen patients with SIRS,the expression of TLR2,4 of PBMC increased markedly,indicating its improtant role in the pathogenesis of SIRS.4 refs,2 figs,2 tabs.
文摘Aim: In prone breast treatments, a carbon fiber support device resides under the contralateral breast. Tangent beams are designed to encompass the treated breast and these often pass through the board at a shallow angle, resulting in significant attenuation. Our planners account for this attenuation by adding field-in-field dose to the deep part of the breast, through the board. Concern was raised about how accurate the treatment delivery is when the inherent uncertainties of patients’ positions are accounted for. Furthermore, transmission measurements are usually carried out perpendicular to the board, a non-clinical situation. The goal of this study is to evaluate the dosimetric effect of the board and the robustness of the plan to positional uncertainty. Materials and Methods: Twenty-two breast patients treated on a commercial prone breast board between 2017 and 2020 were selected for this retrospective study. To evaluate the board’s attenuation, we compared the plans with the board removed from the dose calculation. To quantify the robustness of this technique, we moved the beam isocenter with respect to the patient and board. Results: Our results showed that when the breast board is removed from a plan which was designed to account for the board attenuation, the average point dose increases by 7.48%, with a maximum of 22%. Comparing results with a mixed Analysis of Variance (ANOVA) and a least-square means analysis, our robustness evaluation indicates that anterior shifts at every magnitude (1 mm through 5 mm) make a significant difference in all dose statistics (D95, max, 95% prescription coverage and homogeneity index) investigated. In/out and right/left shifts resulted in an insignificant change in dose statistics. Conclusion: Prone breast boards can add significant dosimetric uncertainty into the treatment delivery process. Accounting for plan robustness in the design of the plan is highly recommended. A prone breast board design with support moved away from the beam path is warranted.
基金National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health,No.U01AR067138.
文摘AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.