基于扎根理论的用户生成在线医评信息的影响因素研究

[目的/意义]在线医评信息对构建互联网医疗信任十分重要,但目前医评网站中医生人均评论十分有限。因此,探索用户生成在线医评信息的影响因素有利于促进互联网医疗的发展。[方法/过程]对34位健康信息用户进行半结构化访谈,基于扎根理论对资料进行开放性编码、主轴编码和选择性编码。[结果/结论]通过分析得到45个初始概念、15个范畴及对应的用户认知、用户个体特征、医疗环境和医生特征4个主范畴,在此基础上构建了用户生成在线医评信息的影响因素模型,并从医疗政策、医疗服务提供者、网络医疗平台和网络用户4个方面提出相应的激励对策。研究结果对在线医评信息生成的影响因素提供了理论支持,对促进在线医评信息的生成提供了对策和思路。

在线医评信息研究述评与未来展望

[目的/意义]在线医评信息作为健康信息的一种,在“互联网+医疗健康”时代,对健康消费者、医疗服务提供者和在线医评网站均有重要影响。[方法/过程]通过系统检索国外在线医评信息领域的研究,围绕已发表文献的计量分析、在线医评信息的内容分析、在线医评信息特征的相关因素、用户和医生对在线医评信息的认知和利用、在线医评信息与医疗服务质量关系等5个方面,对目前在线医评信息的研究成果进行梳理和评述。[结果/结论]在线医评信息研究得到国外不同领域学者的重视,用户生成的在线医评信息逐渐增多,与在线医评信息特征相关的因素有待进一步检验,健康消费者及医生对医评信息的认知和利用程度不断提高,在线医评信息与医疗服务质量的关系尚未得到一致结论。最后,针对现有研究的不足提出未来展望,以期对在线医评信息开展更深入地研究。

网络用户对在线医评信息查寻过程的实验研究

[目的/意义]作为健康信息的一种,在线医评信息对用户医疗决策十分重要。研究用户查寻在线医评信息的过程,挖掘存在的障碍,有助于优化医评网站设计、促进医生在线服务和满足用户健康信息查寻需求。[方法/过程]采用检索实验、内容分析、发声思考和问卷调查等方法,从查寻表现、查寻阶段和查寻障碍3个方面分析在线医评信息这一特定情景下用户的查寻行为及存在问题。[结果/结论]结果显示教育水平和健康信息检索技能与在线医评信息查寻表现正向相关。在线医评信息查寻过程模型包括医生初筛、医评信息检索、浏览、对比、验证和利用6个阶段。健康信息检索技能和甄别能力弱、医评网站评论数量少、医院官网和医评网站可用性差以及医评网站与线下医疗服务融合程度低是影响用户查寻在线医评信息的主要障碍。

自评式中文版耳鸣残疾量表的临床实用性研究

目的探讨以自评方式填写中文版耳鸣残疾量表(the Chinese version of the tinnitus handicap inventory,THI-C)的可靠性及临床实用性。方法对以耳鸣为第一主诉的180例患者分别采用患者自评及医评两种方式收集初诊THIC资料,并以自评方式收集复诊患者的THI-C资料,统计自评及医评THI-C完成率,比较两者得分差异,计算自评与医评的符合率及耗时差异。结果初诊THI-C医评完成率为98.33%,自评完成率为43.89%,自评与医评符合率为16.38%,自评分(48.71±26.75)显著高于医评分(41.11±21.69,P<0.01),自评耗时(3.93±2.44分钟)明显低于医评耗时(7.67±1.81分钟,P<0.01)。复诊中,2诊至5诊THI-C完成率分别为49.4%、51.2%、43.5%、46.7%,平均耗时分别为3.44±1.76、2.97±1.62、2.88±1.48、2.42±1.44分钟。结论以自评方式填写THI-C评估耳鸣严重程度可靠性较低,临床实用性有限。

股评家 战评家 医评家

华尔街有句名言，叫作：“知者不言，言者不知”。用来评说股评家比较恰当，用来评说战评家也同样适用。

六味地黄丸在《评校柳选四家医案》中的临床应用分析

目的:总结尤在泾使用六味地黄丸的用药特点与临床应用经验。方法:以《评校柳选四家医案(柳宝诒)》为底本,选取尤在泾使用六味丸及六味丸加减的19则验案进行整理统计,分析六味丸使用的门类、六味丸药物及药对使用情况。结果:尤在泾运用六味丸多用于咳喘、遗精以及内伤杂病,常在临证中加五味子、牛膝、肉桂、天冬等药物,常以五味子和肉桂、枸杞子和天冬作为加减药对。结论:尤在泾以治病必求于本为旨,应用六味丸时重视先天之肾,以求水火共济,阴阳协调。

The effect of digital health technologies on managing symptoms across pediatric cancer continuum:A systematic review

Objective:Pediatric cancer patients endure multiple symptoms during treatment and also in survivorship.Digital health technologies provide an innovative way to support their symptom management.This review aimed to examine the effect of digital health technologies on managing symptoms among across pediatric cancer continuum.Methods:A systematic literature search of six English and three Chinese electronic databases was combined with hand searching,to identify eligible research studies from database establishment to November 30,2019.Two reviewers carried out data selection,data extraction,and quality appraisal independently.A narrative approach was taken to summarize data.Results:Four randomized control trials,two quasi-experiments,and five one group pre-posttest designed studies,were included in the review with a total of 425 participants.The methodological quality of the studies was generally fair.Seven symptoms(anxiety,depression,pain,anger,fatigue,fear,distress)and seven digital health technologies(visual reality,website,humanoid robot,app,wearable devices,short messages and videoconference)were reported in the included studies.Conclusions:Current evidence supports the effect of digital health technologies is generally mixed and inconclusive.There is a trend of positive effects found in the interventions that feature digital health technologies’interactive function.This review highlights the need for further investigation with rigorous research designs and the consideration of influencing factors from the symptoms,participants,and context levels to inform a better digital health implementation.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

AIM： To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma. METHODS： From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS： The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage （P 〈 0.05）. The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly （P 〈 0.001）. Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection （28 mo vs 18 mo; P 〈 0.05）. The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy （91.4% vs 68%; P 〈 0.05 ）. And it was also higher in detecting port vein involvement （90% vs 54.5%; P 〈 0.05）.CONCLUSION： The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler UItrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.（OR = 2.46, 95% CI = 0.98-6.14）, and a significantly elevated risk of developing esophageal cancer among alcohol drinkers among alcohol drinkers （OR = 9.86, 95% CI = 3.10-31.38）. CONCLUSION： ADH2 and ALDH2 genotypes areassociated with esophageal cancer risk. ADH2＊1 allele and ALDH2＊2 allele carriers have a much higher risk of developing esophageal cancer, especially among alcohol drinkers.

Data Envelopment Analysis on Evaluating the Efficiency of Public Hospitals in Tianjin,China

Public hospitals are the most important components of health systems and account for a large proportion of health resources in China. However, few researches on the efficiency assessment of public hospitals have been conducted in Tianjin, China. On the basis of the data of annual health service report in 2013 from the Ministry of Health, we measured the relative efficiency of the tertiary general public hospitals in Tianjin and estimated the magnitudes of output increase and/or input reduction by using data envelopment analysis to improve hospital efficiency. The main findings of this study indicate that more than half of the sample hospitals operate at a technical and scale efficiency, and the prevalent scale inefficiency is increasing returns to scale. Moreover, it is a prominent issue that health resource constraint and resource waste coexist. Health policy-makers and hospital administrators would need to address these problems by taking comprehensive measures such as optimizing the allocation of health resources, implementing hierarchical diagnosis and treatment, as well as innovating medical-service operating mechanism of public hospital to improve the people's wellbeing.

Correlation Between Helicobacter pylori Infection and Tongue Manifestations:A Meta-analysis

Objective To analyze the relationship between Helicobacter pylori(H.pylori)infection and the manifestations of the tongue.Methods Without language restrictions,we searched databases including CAJD,CBMdisc,CDFD,CMFD,PubMed,Cochrane,and EMBASE and made meta-analysis for all literature we have collected.Results Six studies with 975 patients and 50 healthy people in total were included in the analytic pool.There were significant differences in the numbers of H.pylori infections between patients with thin and thick tongue coatings(OR=2.02,95%CI 1.32–3.07,P=0.001).In yellow tongue subgroup,there was a significant difference between patients with thick and thin coatings(OR=2.09,95%CI 1.16–3.77,P=0.01).There was a significant difference in the prevalence of H.pylori infection between patients with yellow and white coatings(OR=2.86,95%CI 2.10–3.90,P<0.001).The frequency of H.pylori infection was significantly increased in patients with red and purple tongues compared with those with pale red tongues(OR=3.42,95%CI 2.40–4.88,P<0.001;OR=7.51,95%CI 3.57–15.79,P<0.001).Conclusion Red or purple tongues and yellow tongues with thick coatings are indicators of a risk of H.pylori infection in patients with GI symptoms.Our study shows that tongue manifestations could serve as a feasible predictor of H.pylori infection in patients with GI symptoms,and determination of the exact association between tongue manifestations and H.pylori infection could enable an understanding of the objectivity of TCM.Long-term and rigorous controlled trials are needed in the future to evaluate the correlating factors.

Accounting Harmonization for the Assessment of the Public Expenditure in Healthcare Service： Evidence From the Italian Experience

The introduction of the New Public Management （NPM） has not bridged the differences among the various European accounting traditions. In Italy, in particular, there are still different accounting methods in all public sectors. In the healthcare system, these differences have emerged more strongly. The recent Italian reform on accounting harmonization seems to be the answer to this accounting disharmony and represents a means of controlling public expenditure. This study aims to analyze the consolidated financial statement and the consolidated cash flow statement of the regional healthcare system as a new tool for the accounting harmonization. This paper is divided into two logical parts： In the first part, the authors analyze how the new accounting model is evolving under the current reform; in the second part, the authors analyze the consolidated financial statement and the consolidated cash flow statement that has been applied experimentally over the last two years in the Umbria Region.

Adapting the Servqual Scale to a Private Hospital Emergency Services： An Empirical Investigation

Most of the time, clients only have one opportunity to evaluate a service received in terms of quality and satisfaction; under this premise organizations have been concerned with developing, in a permanent manner, a quality evaluation culture in the services offered to their clients. To do this, procedures and methods that let them achieve it, have been implemented. That is the case of the model that concedes to measure and evaluate service quality, which is redefined and named Servqual, considering a multidimensional theoretical construct that explains the client＇s perception of quality service considering the differences between what is expected and what is received. Therefore, the goal of this study is to identify the factors that define the quality of emergency services provided by a private hospital in Hermosillo, Sonora, Mtxico, a sample of 384 patients, with a confidence level of 95% and a margin of permissible error of 5%. A questionnaire with 22 items was applied to measure the perceptions and expectations of users in terms of the quality of the service, which was subjected to an extensive evaluation of reliability and construct validity, with an estimate Cronbach＇s alpha of 95.6% and 97.9% respectively. The results showed that Servqual is a valid, reliable, and dependable instrument to monitor and measure the quality of the services offered in private hospitals in Hermosillo, and permit hospital administrators to identify opportunities or improvement areas, from the patients＇ perspective.

Geriatric assessment for oncologists

The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

An epidemic of violence on medical personnel:are we prepared

The incidence of violence against doctors has been increasing, both in China and worldwide. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial medical malpractice or even no fault of theirs. The once glittering halo of medical workers is being shredded thanks to the stressed health system and a lack of evaluation for risk of violence of the patients. Modem China sees a wide disparity between industry standards in rural and urban areas. People seeking health care service are often scared, can＇t get timely service and turn their anger towards those around them. To change a whole system in this giant nation is too hard a rock. Therefore, our focus is on the prompt awareness and preparation of a possible patient violence. The simplest approaches seem to be the most effective. Medical staffs should re-leam empathy on patients and be better trained on recognizing and reducing conflicts

Assessment of community health needs of Chongqing residents: a qualitative study

Objective: The aim of this preliminary qualitative study was to gain insight into community health needs in order to develop health program for community in Chongqing. Methods: Totally 40 participants were assigned into 6 focus group discussions. All groups were led by local language speakers, and their talking was recorded after gaining informed consent. Transcribed data were coded and subjected to thematic analysis. Results: The main obtained themes were that community health problems were chronic noncommunicable disease, main health service needs included regularly free check-up and health education, and perceived health risk factors were unhealthy lifestyle and behavior as well as environment problems. Conclusion: Our community health needs assessment (CHNA) with FGDs indicate that residents realize the importance of prevention of disease. Our study identifies that primarily community health promotion is one of the priorities of community health service needs, including reorienting health service, health education, guiding behavior or lifestyle, and creating healthy environments. The findings of this study can provide guidance to the development of more effective and pertinent health program in this community.

Systematic evaluation and Meta-analysis of acupuncture and collaterals cupping therapy for Knee Osteoarthritis

Objective:In order to obtain the best treatment program for Knee Osteoarthritis(KOA),to alleviate the pain of patients with KOA,and to systematically evaluate the efficacy of acupuncture cupping therapy for KOA.Methods:we used computer to search the databases of CNKI(1989-2018.10),Wanfang(1989-2018.10),VIP(1989-2018.10),PubMed(1966-2018.10),EMbase(1986-2018.10)and Cochrane Library(the 3rd issue of 2018).And the literature quality was evaluated by Jadad scale.Results:A total of 19 eligible RCT studies were included,and a total of 2,088 patients participated in the eligible clinical study.Meta-analysis results showed that the total effective rate OR combination=2.85[OR=3.98,95%CI(2.98,5.32),P<0.00001].The results showed that the curative effect of acupuncture and collaterals cupping in the treatment of KOA was superior to other therapies.Conclusion:Acupuncture and cupping therapy of traditional Chinese medicine is effective and safe in treating KOA.Due to the impact of the original study on Meta-analysis results,more large samples and high-quality clinical trials are still needed to verify.

Requirements for Evaluation on Drug-medical Device

The administration of combination products in U.S.Food and Drug Administration(FDA)are analyzed and summarized in this paper.Furthermore,the technical evaluation on drug-medical device in the State Food and Drug Administration of China(SFDA)is also illustrated.Meanwhile,this paper discusses how to promote the development of drug-medical device in the administration and technical evaluation.