An Evaluation Scale of Medical Services Quality Based on “Patients' Experience”

An evaluation scale of medical services quality was developed on the basis of ＂patients＇ experience＂. The questionnaires were developed by, among others, searching relevant literature, col- lecting well-established assessment scales, measuring patients＇ experience and satisfaction, brain-storming, literature analysis. Delphi method was adopted for expert consultation. Scale items were screened and revised. The key indexes were converted. Field surveys were conducted for testing the reliability and validity of the scale. Our modified evaluation scale for measuring medical services quality based on ＂patients＇ experience＂ included 6 dimensions （tangibility, reliability, responsiveness, assurance, empathy and continuity）, and 50 items. The novel scale based on ＂patients＇ experience＂ may better serve the purpose of assessin~ medical services quality.

Development of a Scale to Evaluate the Depressive State among Elderly Patients in General Wards

This study aims to develop a scale to evaluate depressive states among elderly patients in general wards, and verify the reliability and validity of the scale. Based on the results of interviews with nurses, we developed a draft of a scale comprised of 48 questions (NDE48). The Geriatric Depression Scale short version (GDS15), and the Zung Self-rating Depression Scale (SDS) were administered to 54 elderly patients. Two groups of nurses completed the NDE48 on different days. After performing an explanatory factor analysis, the NDE48 was simplified to a 16 question item scale (NDE16), comprising three factors. The correlation coefficient between GDS15 and NDE16 was 0.41 (p = 0.00191), and between SDS and NDE16 was 0.30 (p = 0.02633). Alpha coefficient of the total score of NDE16 was 0.88. For inter-rater reliability, the correlation coefficient was 0.57 (p = 0.00005). The findings suggest that the NDE16 will be highly useful when nurses evaluate depressive states among elderly inpatients.

Ocular manifestations and quality of life in patients after hematopoietic stem cell transplantation

AIM:To explore the relationship between ocular and systemic conditions and the impact of ocular complications on the quality of life(QOL)in patients after allogeneic hematopoietic stem cell transplantation(ALLO-HSCT).METHODS:Forty-four patients with severe hematopoietic disease were enrolled after ALLO-HSCT at our center from July 2018 to October 2020.They completed two questionnaires:the Ocular Surface Disease Index(OSDI)and the quality-of-life scale for Chinese patients with visual impairment(SQOL-DV1).Ocular conditions and systemic conditions were also assessed.RESULTS:Eye damage was correlated with total bilirubin(P=0.005),and gamma-glutamyl transferase(GGT)(P=0.021).There was no significant correlation between the overall QOL score and OSDI(P=0.8226)or SQOLDV1(P=0.9526)scores.The OSDI and the overall QOL score were not correlated with ocular conditions,including best-corrected visual acuity(BCVA),intraocular pressure,Schirmer tear test II,sodium fluorescein staining,tear film breakup time,and tear meniscus height.SQOLDV1 was correlated with BCVA(P=0.0007),sodium fluorescein staining(P=0.007),and tear film breakup time(P=0.0146).CONCLUSION:In some patients,early ocular symptoms are not evident after ALLO-HSCT,while ocular surface complications can be observed after a comprehensive ophthalmological examination.Especially for those with elevated total bilirubin or GGT,regular ophthalmic follow-up visits are essential to diagnose and treat ocular graft versus host disease(o GVHD),especially for patients with elevated total bilirubin or GGT.

Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients

Background: Hyperglycemia in hospitalized patients is managed through one of the following approaches: sliding scale insulin (SSI) alone;SSI plus long-acting insulin and basal-bolus insulin (BBI). The optimal insulin treatment regimen is still debated. Objectives: To evaluate the clinical outcomes associated with the use of SSI compared to other regimens. Setting: The general medical wards in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: Medical charts for adult patients admitted between October 2014-December 2015 with type 2 diabetes or uncontrolled hyperglycemia with insulin treatment were reviewed. Data from capillary blood glucose were measured daily for the first 5 days of hospitalization and recorded. Demographics and blood glucose levels were compared by group using one-way ANOVA or Chi-square test. The number of hyperglycemic/hypoglycemic episodes was analyzed using the Kruskal-Wallis test. Results: A total of 240 patients were included. The three insulin regimen groups were not statistically different in terms of the number of days with episodes of hyper- or hypoglycemia (p > 0.05). However, a significantly bigger change from baseline (improvement) in random blood glucose (RBG) levels was observed in BBI and SSI plus glargine patients compared to SSI (p = 0.014). Conclusion: Our study showed no significant difference in the number of days with episodes of hyper- or hypoglycemia for SSI vs. other insulin regimens. However, SSI patients had less improvement in their RBG levels compared to other insulin regimen groups. Further studies with a larger sample size are needed to confirm these findings.

Development of ethical dilemma scale Japanese nurse faced physical restraints to elderly patients with dementia

Purpose: This study aimed to develop an ethical dilemma scale for nurses faced with the use of physical restraint when caring for elderly patients with dementia. Methods: We used a previously established 20-item dilemma scale. The objective and method of the study were explained to the head of nursing at 17 selected hospitals, and 121 nurses working in the general wards of 14 hospitals (excluding emergency department wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms and intensive care units) who agreed to participate were enrolled in 2000. Seventy-six nurses from one of the hospitals were selected after eight years (2008) to provide a comparison. Ethical considerations: The study was conducted with the approval of the ethics committee at Meiji University of Integrative Medicine. Results and discussion: Four factors were compared between 2000 and 2008: “execution of treatment and security”, “characteristic features in nursing of elderly patients with dementia”, “cooperative relationship in nursing”, and “priorities in nursing”. The cumulative contribution ratio was 65.3% (KMO = 0.77, p = 0.000) in 2000 and 72.5% (KMO = 0.78, p = 0.000) in 2008. Therefore, the scale dilemma nurse faced physical restraints to elderly patients with dementia in Japan was developed 4 facoters from 17-delremmas items of 20 items.

Development of a Scale to Evaluate Depressive States among Elderly Patients in General Wards —Verification of the Contents to Improve the Accuracy of the Scale

Purpose: This study aims to verify the validity of the contents of the Nurse Administered Depression Scale for Elderly Inpatients16 (NDE16) using the Delphi approach in order to further improve the accuracy of the NDE16, a scale for rating potential depressive states in elderly inpatients through the observations reported by nurses. Methods: Participants were nurses working in general wards for longer than 3 years and who expressed consent to the study participation. Data were collected using the Delphi method (3 times). Responses are scored from 1 to 5 (3 - 5 points as positive) using the Likert method. The standard criteria for inclusion in the further evaluation are “mean ≥ 3.0”, “standard deviation < 1.0”, “median ≥ 3.0”, and “IQR ≤ 1.0”. Items that meet all the criteria at the third survey are employed as question items in the final questionnaire. Results: The respondents were 139 females, 10 males, and 1 unknown, aged 25 to 65. The collection rates of the three surveys were 75% to 82%. Based on the results of the first survey, wordings of 9 questions were modified. Since Question 13 “Queries are not really responded to.” did not meet the criteria (IQR = 2) at the third survey, we excluded this question and named the revised scale NDE15. Discussion: The reason why Question 13 did not meet the criteria could be due to the difficulty in distinguishing “Expressing thought suppression” from the state of cognitive decline in dementia. Further studies are needed to determine cutoff points.

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke （59.6%） was the primary stroke type found in the young group, while ischemic stroke （60.0%） was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction （such as friendship） improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: A randomized clinical trial

BACKGROUND Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients.Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry,many studies have compared its efficacy and safety to conventional anesthesia.However,very few studies have compared single tooth anesthesia(STA)and traditional local anesthesia.AIM To compare pain rating,changes in blood pressure,and heart rate during the local anesthetic injection.The secondary objectives were to measure the patients’level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.METHODS A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study.The patients were evaluated for their general physical status and oral clinical findings before enrollment.Information regarding perceived pain,changes in heart rate and blood pressure,and patients’satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.RESULTS No significant difference was noted in perceived pain(P=0.59)and systolic blood pressure(P=0.09)during anesthetic injection using both traditional and STA techniques.STA patients had a significantly higher heart rate during anesthesia,although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia.During the restorative procedure,less pain was perceived by STA patients on the Wong-Baker FACES pain scale,which was statistically significant(P<0.001).Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future(P=0.04).CONCLUSION STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.

Development of an instrument to measure patients' attitudes towards involuntary hospitalization

AIM To construct and assess the psychometric properties of an instrument to measure patients' attitudes towards involuntary hospitalization. METHODS This is a two phase study. In the first phase, based on comprehensive literature review, a twenty one item scale to measure patients' attitudes to involuntary admission was constructed. Forensic and inpatient Psychiatrists, patients' advocates and legal experts(n = 15) were invited to participate in the validation process of the written instrument, by formally rating each item of the instrument for its relevancy in measuring patients' attitudes to involuntary admission. In the second phase of the project, the instrument was administered to a sample of eighty consecutive patients, who were admitted involuntarily to an acute psychiatric unit of a teaching hospital. All patients completed the constructed attitudes towards involuntary admission scale, and the client satisfaction questionnaire. RESULTS Responses from psychiatry and advocacy experts provided evidence for face and content validity for the constructed instrument. The internal consistency reliability of the instrument is 0.84(Chronbach' alpha), factor analysis resulted in three correlated, and theoretically meaningful factors. There was evidence for content, convergent, and concurrent validity.CONCLUSION A reliable twenty one item instrument scale to measure patients' attitudes to involuntary admission was developed. The developed instrument has high reliability, there is strong evidence for validity, and it takes ten minutes to complete.

Selecting the Optimal Morse Falls Scale Cut-Off Point for Patient Fall Risk

Patient falls have long been a difficult problem and topic of research in the inpatient hospital environment. Hospitals experience heavy financial burden due to patient falls. Preventing falls can improve patient outcomes as well as reduce financial burden on both the patient as well as the healthcare organization. In this study, we determine the optimal cut-off value for patients at risk for falls using a Falls Screening Tool, the Morse Falls Scale. This study was conducted at a community-owned hospital with 256 acute care private rooms and 36 critical care rooms. This study used only the admission Morse Falls Scale (MFS) score in its analysis.

A comparison of a patient-rated visual analogue scale with the Liebowitz Social Anxiety Scale for social anxiety disorder: A cross-sectional study

Introduction: The Liebowitz Social Anxiety Scale (LSAS), used to assess the severity of social anxiety disorder (SAD), requires considerable effort and time to complete. The aims of this study were: 1) to investigate whether a visual analogue scale (VAS) could be linear with the LSAS and substitute for the LSAS, 2) to relate such a VAS instrument to patient demographics. Methods: Fifty SAD patients were assessed using the LSAS and VAS instruments completed by both patients and doctors at the same session. We then drew distributions and calculated the Spearman’s ρ and κ coefficient values (divided at the median for each scale) between patient and doctor assessments. Next, each pair among the scores for the LSAS, the patient VAS and the doctor VAS was compared using Wilcoxon rank sum tests according to patient life profile data. Results: Scatter plots of pairs of scores were obtained. Spearman’s ρ was 0.661 between the LSAS and the patient VAS, 0.461 between the LSAS and the doctor VAS, and 0.494 between VAS scores of patients and doctors. The κ coefficients were 0.501 between the LSAS and patient VAS, 0.251 between the LSAS and doctor VAS, and 0.425 between patient VAS and doctor VAS (for all six, p < 0.001). The Wilcoxon rank sum tests indicated a significant difference between the groups with/ without “employment” (LSAS, patient/doctor VAS), with/without “graduation from junior college/university” (doctor VAS) (p < 0.05) and with/without marital history (the age of first consultation) (p < 0.01). Conclusions: A patient VAS may substitute for the LSAS and offer the versatility necessary to capture patient states and life profiles.

Effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and quality of life

Objective:To investigate the clinical effect of ultra-low frequency repetitive transcranial magnetic stimulation on dysphagia in elderly patients with acute cerebral infarction and its impact on quality of life.Methods:60 elderly patients with dysphagia caused by acute cerebral infarction were randomly divided into rTMS group and control group,30 cases in each group.Both groups received routine drug therapy and swallowing function training.rTMS group was additionally treated by ultra-low frequency(10mHZ)repetitive transcranial magnetic stimulation for 14 days.The changes of NIHSS score andADL score and NSE serum level and Wa Tian drinking water experiment and Fujishima Ichiro dysphagia scale score and SWAL-QOL score and SF-36 score were observed between the two groups before and after treatment.The clinical effect was evaluated by Wa Tian drinking water experiment.Results:After treatment,The clinical effective rate in rTMS group was significantly higher compared with that in the control group(P<0.05),NIHSS score and serum NSE level were significantly lower compared with the control group(P<0.05),ADL score and Fujishima Ichiro dysphagia score and SWAL-QOL score and SF-36 scores were significantly higher compared with the control group(P<0.05).After treatment,SF-36 total score(or SWAL-QOL Score)was negatively correlated with NSE serum level and NIHSS score,which was positively correlated with ADL score and Fujishima Ichiro dysphagia scale score score.Conclusion:Ultra-low frequency rTMS therapy can reduce NSE level,effectively improve dysphagia in elderly patients with acute cerebral infarction and significantly improve the elderly patients'life quality.

Research on the Transformation of Mapping Method for Cancer Patients’ Health Utility in the Asia-Pacific Region

Objective To systematically collect the mapping functions of health utility values of various cancer patients in the Asia-Pacific region to provide scientific reference for domestic research in the field of cancer patients’health utility values.Methods A systematic literature search was conducted by using PubMed,ScienceDirect,Web of Science,CNKI,VIP Database and Wanfang Database to collect studies on the application of mapping method for health utility value measurement from 2008 to 2019.The key words included cancer,scale,mapping,and health utility.The inclusion criteria for the studies were:(1)The research papers came from countries in Asia Pacific region;(2)Original research articles;(3)Written/published in Chinese and English.Results and Conclusion A total of 137 Chinese and English articles were retrieved,and 9 articles met the requirements in the screening.The literature was classified by the following types:(1)It had a clear functional relationship;(2)It had no clear functional relationship.Due to the small numbers of samples,the reliability of the research results is not high.The construction of mapping model should build multiple regression models to test the performance of the model combined with different index variables.In addition,due to the limitations of the research objects selected in the literature,more attention should be paid to the mapping function of other types of cancers.At the same time,the research and development of the original data should be focused on as well.

儿科手术患者术中获得性压力性损伤风险评估量表的构建及应用研究

目的 构建儿科手术患者术中获得性压力性损伤(IAPI)风险评估量表并探讨其应用效果。方法 选取2022年8月至2023年5月湖南省儿童医院106例儿科手术患者为研究对象,通过文献回顾和德尔菲专家函询,生成IAPI风险评估量表,将函询后生成的量表应用到临床,开展信效度检验及预测IAPI发生的效能。结果 两轮函询结果显示,专家积极性较高、权威程度较高、意见比较集中、一致性较高。最终量表包括手术时间、体位、美国麻醉医师协会分级、营养状态、体重指数、术中受压处皮肤情况、术前肢体活动、组织灌注8个条目,量表Cronbach’s α系数为0.705,分半信度为0.725,问卷水平内容效度指数为0.832,条目水平内容效度指数为0.805~1.000。使用Munro量表作为效标,术前、术中、术后评分的相关系数分别为0.377、0.415、0.513。量表预测IAPI发生的曲线下面积为0.810,灵敏度为70.8%、特异度为81.5%、临界值为13.5分。结论 构建的量表具有较高的权威性和科学性,可作为儿科手术患者IAPI风险的评估工具。

老年期精神分裂症社会支持度及其影响因素:基于144名连续抽样住院患者的横断面研究

目的:探讨老年期精神分裂住院患者社会支持度及影响因素。方法:采用连续抽样的方法招募了2021年3月至2023年12月广州医科大学附属脑科医院老年精神科的144例精神分裂症住院患者作为研究对象,使用社会支持度量表(SSRS)调查患者社会支持情况,收集数据包括基本资料、精神症状情况等。结果:144例老年精神分裂症患者的SSRS总分为28.29±5.67,单因素分析结果显示,老年期精神分裂症患者社会支持的影响因素为病程,婚姻状况与照顾者(P<0.05)。多元线性回归结果显示,老年期精神分裂症患者的社会支持主要与主要照顾者(他人照顾)(β=2.836,95%CI:0.515~5.158,P=0.017),婚姻状况(无伴侣)(β=-2.725,95%CI:-4.627~-0.824,P=0.005),简明精神病量表(BPRS)中的敌对猜疑因素(β=-0.488,95%CI:-0.739~-0.250,P<0.001)有关。结论:受他人照顾、有伴侣与精神行为症状中的敌对猜疑是老年期精神分裂住院患者社会支持度的主要影响因素。

住院患者护理存在量表的汉化及信度效度检验

目的:对英文版住院患者护理存在量表进行汉化,并进行信度、效度检验,为调查患者对护理存在的感受提供可靠有效的测评工具。方法:对英文版住院患者护理存在量表进行翻译及回译,并进行文化调试,采用便利抽样法对武汉市某三级甲等医院530例住院患者进行正式问卷调查。结果:中文版住院患者护理存在量表共33个条目,分为4个维度,量表总体Cronbach’sα系数为0.931,各维度Cronbach’sα系数在0.738~0.852之间,量表水平内容效度指数为0.98。验证性因子分析显示卡方/自由度(χ2/df)为1.897,拟合优度指数(GFI)为0.812、比较拟合指数(CFI)为0.869、增值拟合指数(IFI)为0.871、Tucker-Lewis指数(TLI)为0.859、均方根残差(RMR)为0.024、近似误差均方根(RMSEA)为0.062,均达到拟合标准。结论:中文版住院患者护理存在量表有较好的信度、效度,适合用于评价我国住院患者对护理存在的感受与体验。

PBL教学法联合情景模拟在医患沟通教学中的应用

目的 研究以问题为基础的教学法(problem-based learning,PBL)联合情景模拟在培养住院医师医患沟通能力中的作用。方法 将2022年9—12月在中山大学孙逸仙纪念医院进行规范化培训的40名二年级住院医师随机分为试验组20名、对照组20名,试验组采取PBL教学法联合情景模拟教学,对照组采用PBL教学法,共4学时。教学过程中进行课堂教学效果评价。教学前和教学结束后,分别应用医患沟通技能评价量表(doctor-patient communication skills evaluation scale,SEGUE)对2组学员进行医患沟通能力评价,对2组得分进行统计学分析。2组均发放教学满意度调查问卷。结果 试验组课堂效果优于对照组,试验组住培学员在课堂气氛、师生互动、讨论活跃度、课堂注意力和学习积极性方面的评分高于对照组,差异有统计学意义(P <0.05)。试验组在教学完成后的SEGUE量表评分高于对照组,差异有统计学意义(P <0.001)。试验组满意度高于对照组,但差异无统计学意义(P> 0.05)。结论PBL教学法联合情景模拟能够活跃课堂气氛、增加住培学员的学习积极性,有效提高住院医师的医患沟通能力,优于单纯PBL教学法。

炎症性肠病残疾视觉模拟评估量表的汉化及信效度检验

目的对炎症性肠病残疾视觉模拟评估量表(IBD Disk)进行汉化和跨文化调适,并在炎症性肠病(IBD)患者中检验其信效度。方法基于改良版Brislin翻译模型,通过正译、回译、小组讨论和跨文化调适对IBD Disk进行汉化和跨文化调适。2022年1—12月,采用便利抽样法抽取299例IBD患者进行调查,验证量表的信效度。结果中文版IBD Disk共包括10个条目,各条目决断值为4.79~15.68(均>3.00),且P<0.05,说明各条目鉴别度较高;量表总Cronbach′s α系数为0.88,重测信度为0.87,说明该量表可重复性良好;验证性因子分析结果显示,该量表拟合程度理想;Pearson相关分析结果显示,IBD Disk总分与炎症性肠病残疾指数量表(IBD-DI)总分呈显著正相关(r=0.81,P<0.001),提示IBD Disk与IBD-DI存在良好相关性。结论中文版IBD Disk具有良好的信效度,适合用作中国文化背景下的IBD患者残疾评估工具。

基于“四象限模型”的医患信任测量量表构建及初步研究

目的 通过构建适宜我国应用的“四象限模型”医患信任测量量表,评价分析其效度及信度,为改善医患关系提供一定的帮助。方法 本文以国外学者研究的“四象限模型”为理论框架,通过文献回顾、访谈法、德尔菲专家咨询法等多种方式构建“四象限模型”医患信任测量量表,将某院作为实际研究的案例,对“四象限模型”医患信任测量量表的信度、效度进行检验。结果 “四象限模型”医患信任测量量表的总Cronbach’s α信度系数为0.912;分半信度R为0.863和0.932;内容效度Pearson相关系数0.38~0.81,均具有统计学意义;结构效度RMR为0.065,RMSEA为0.073,χ~2/df为2.236,GFI为0.791。结论 经过某医院的实证检验,“四象限模型”医患信任测量量表具有较高的信度和较好的效度,可为我国医患信任方面研究提供一个科学的、合理的、有效的并且符合我国国情的医患信任测量量表,在重构医患信任、改善医患关系方面有着广阔的应用前景。

分析步行运动联合正念干预对卵巢癌患者睡眠质量的影响

目的:分析步行运动联合正念干预对卵巢癌患者睡眠质量的影响,寻求能够提升化疗期卵巢癌患者生命质量的护理措施。方法:选取2022年6月至2023年6月厦门大学附属第一医院妇产科收治的确诊为卵巢癌患者68例作为研究对象,按照随机数字表法分为对照组和观察组,每组34例。对照组给予常规护理干预,观察组给予步行运动联合正念干预。采用匹兹堡睡眠质量指数(PSQI)比较2组患者干预前后睡眠质量的变化,采用中文版Piper疲乏修订量表(PFS-R)比较2组患者干预前后的疲乏状态,采用生命质量测定量表(EORTC QLQC30)比较2组患者干预前后生命质量的变化。结果:干预后,观察组PSQI评分显著低于对照组,观察组癌因性疲乏Piper量表评分显著低于对照组,患者生命质量测定量表QLQC30评分显著高于对照组,差异均有统计学意义(均P<0.05)。结论:卵巢癌患者在化疗期间展开步行运动联合正念干预,与治疗措施之间可产生良好的辅助配合效果,能够有效提高患者的睡眠质量和生命质量,增加对抗癌症、化疗的信念,值得临床推广应用。