Objective To understand the incidence of frailty in maintenance hemodialysis (MHD) patients, and to explore the correlation and influencing factors of frailty in MHD patients, so as to provide some basis for the intervention of frailty in MHD patients. Methods Patients who underwent MHD in the Department of Nephrology of West China Hospital of Sichuan University from January to March 2021 were selected. Frail scale and Pittsburgh Sleep Quality Index (PSQI) were used for evaluation, and the influencing factors of frail in patients with MHD and its correlation with frail were analyzed. Results A total of 141 patients with MHD were included, including 57 cases without frailty (40.43%), 71 cases in early frailty (50.35%), and 13 cases in frailty (9.22%). 54 cases (38.30%) had very good sleep quality, 56 cases (39.72%) had good sleep quality, 24 cases (17.02%) had average sleep quality, and 7 cases (4.96%) had very poor sleep quality. The frailty of MHD patients was positively correlated with age (rs=0.265, P=0.002), PSQI (rs=0.235, P=0.005) and magnesium (rs=0.280, P=0.001). Logistic regression analysis showed that the influencing factors of MHD patients’ frailty were gender [odds ratio (OR) =4.321, 95%confidence interval (CI) (1.525, 12.243), P=0.006], PSQI [OR=1.110, 95%CI (1.009, 1.222), P=0.032], magnesium [OR=122.072, 95%CI (4.752, 3 135.528), P=0.004], hypertension [OR=0.112, 95%CI (0.023, 0.545), P=0.007] and other diseases [OR=0.102, 95%CI (0.019, 0.552), P=0.008]. Conclusions The incidence of frailty in MHD patients is high. Gender, PSQI, magnesium, hypertension and other diseases are the influencing factors of frailty in MHD patients, and there is a correlation between frailty and sleep. It is suggested that renal medical staff should pay more attention to the assessment of MHD frailty and sleep, and carry out multi-disciplinary personalized intervention to improve the quality of life of MHD patients.
Objective To investigate patients in gynecological endocrinology clinic with the following three pieces of information: how did they provide their symptom information, how did they understand diagnostic and therapeutic information, and what was their attitude towards the visit, and to get to know about the situation and problems in doctor-patient communication, so as to aim directly at improving the efficiency of diagnosis and treatment. Methods A total of 403 patients, who visited Prof. HAN Zi-yan’s clinic in the hospital from April to August 2010, were evaluated using self-edited Assessment on Doctor-patient Communication in Gynecological Endocrinology Outpatient Clinic. Results a) As to the situation of patients providing symptom information as well as understanding diagnostic and therapeutic information, when doctor asked, only 29% (118/403) of patients could narrate their treatment history clearly, and 38% (152/403) could tell their examination history exactly. After doctors’ explanation, only 21% (86/403) understood their examination results correctly, and 27% (108/403) understood management and therapeutic advice. The result of correlation analysis showed the accuracy of patients in providing disease information and accepting diagnostic and therapeutic information was higher in patients aged from 21 to 40 rather than those younger than 20, in patients well- educated rather than those with little education at the primary school, and in patients who were also engaged in medical work, All differences were significant (all Plt;0.05); and b) As to patients’ attitude towards visit, 55% (222/403) of patients hoped to get more attention from doctor, and 37.5% (151/403) overly expected the visit. Conclusion In the professor’s gynecological endocrinology outpatient clinic, many patients can’t clearly provide their treatment and examination history, neither understand exam situation and therapeutic advice at that visit, which are influenced by their age, education and occupation. In addition, psychological needs of patients should be concerned, too
Objective To evaluate the quality of controlled trials on 131I therapy for thyroglobulin positive and radioactive iodine negative metastases（131I WBS-/Tg+）. Methods We electronically searched MEDLINE (1966 to Mar. 2004), EMBASE (1984 to 2003), The Cochrane Central Register of Controlled Trial, CENTRAL (Issue 2, 2004), CBMdisc (1978 to 2004) and CNKI (1994 to 2004), and handsearched 5 radiotherapy and endocrinology journals (Jan. 1980 to Apr. 2003). The methodological quality of included studies was assessed by using quality assessment criteria of the Cochrane systematic review guideline. Results Three non-randomized controlled trials were included. One was historical controlled trial, and two prospective trials. The sample sizes of three trials were 26, 60 and 70 respectively without mentioning the calculation base. The comparability of baseline was mentioned but not comparable across the trials. No double blind studies were used in the assessment of 131I efficacy. The time of follow-up varied from 2 to 15 years. None studies mentioned the side effects of 131I therapy for 131I WBS-/Tg+ metastases. Only two studies applied statistical methods properly. Conclusions Problems about allocation of groups, double blind, sample size, and follow-up period continue to exist in published controlled trials. RCT or prospective controlled trials of high quality are urgently needed in order to define the efficacy and safety of 131I therapy for 131I WBS-/Tg+ metastases.
ObjectiveTo describe the status of epilepsy inpatients healthcare service in tertiary public hospitals in China by the data collected from the Hospital Quality Monitoring System.MethodsA population-based study was conducted with data of hospitalized patients collected from the Hospital Quality Monitoring System between 2015 and 2017. Diagnoses were identified by International Statistical Classification of Diseases and Related Health Problems 10th Revision codes for epilepsy (G40). The information of demographic characteristics, costs, payment methods, and discharge status were extracted and analyzed annually to make cross-sectional studies.ResultsA total of 329 241 hospitalized epilepsy patients from 585 tertiary public hospitals were identified. The average age of the patients was 31.74 and male patients accounted for 60.00% of the total. The proportion of patients covered by the national basic medical insurance in the three years was 50.15%, and that in the year 2015, 2016, and 2017 was 49.03%, 49.79%, and 51.80%, respectively; the proportion of patients with full self-payment was 30.40%. The average length of hospital stay was 6.65 d, the average cost for each stay was 7 985.53 yuan, the average self-payed cost for each stay was 3 979.62 yuan. In terms of the discharge way of the patients, 88.02% discharged following doctors’ advice, 0.40% were transferred to another hospital with doctors’ advice, and 6.59% discharged against doctors’ advice. The in-hospital mortality in the three years was 0.16%, and that in the year 2015, 2016, and 2017 was 0.19%, 0.16%, and 0.12%, respectively.ConclusionThe study shows that the in-hospital mortality rate of epilepsy inpatients in the tertiary public hospitals in China decreased gradually from 2015 to 2017, the coverage rate of national basic medical insurance increased year by year, and there is still room for further improvement.
The quality of clinical trials is key to determine the value of a clinical research and whether it can transform achievements. In this paper, the characteristics and direction of the implementation of quality control in clinical trials in China, and the characteristics of quality control in clinical trials of Chinese medicine are discussed, and the development direction of quality control in clinical trials in China is explored in order to improve the overall level of clinical trials in China.
Objective To investigate the quality of life (QOL) of Beichuan cadres 1 year after Wenchuan earthquake, so as to provide references for promoting psychological intervention and improving QOL. Methods With the adoption of WHOQOL-BREF, questionnaire survey on basic conditions of cadre victims, and PCL-C scale, cross-section survey was conducted for 2 055 cadres of Beichuan public institutions in aspects of their QOL, social demographic characteristics and psychological trauma. Results a) Compared with domestic norm, although the Beichuan cadres had higher score in social relation domain (14.31 ± 2.59, Plt;0.01), their QOL scores in each dimensions (physical domain score: 14.16 ± 2.43; psychological domain score: 13.79 ± 2.59, environmental domain score: 11.20 ± 2.74) were lower with significant difference (Plt;0.01); b) The group with population under the age of 30 scored higher than other age groups in the psychological and environmental domains; men scored higher than women in the psychological domain; the widowed group scored lower than other groups in all domains; the Han nationality group scored higher than the Qiang nationality group in all domains; the primary education group scored lower than other groups in the social relation domain; the group with relatives, houses and physical loss or damage scored lower than the non-loss group in all domains; and the higher the score in PCL-C, the lower the scores in all domains (all Plt;0.05). Conclusion Beichuan cadres are severely affected in their physical, psychological and environmental domains even one year after Wenchuan earthquake, especially the female, the Qiang nationality, the old, the lost, and the psychological injured cadres are more badly affected with worse QOL, so those population should be concerned in particular with sustainable psychological service and other measures. The finding of social relation domain score being higher than general population suggests that it is important to promote the satisfaction with social relation through the timely effective support from both government and civil society, and the resettlement of sample housing area as well.
ObjectivesTo evaluate the quality of health information on diabetes in Chinese internet, so as to understand the current status of diabetes network health information, and provide reference for improving and enriching the three-level prevention of diabetes.MethodsThe three most common Chinese search engines: Baidu, Sogou and Haosou Search were searched with the keywords " diabetes” and " diabetes treatment”, using the health information evaluation tool DISCERN score to evaluate the quality of the information, and the integrity and accuracy of information content were evaluated with reference to the " Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)” issued by the Chinese Diabetes Society of Chinese Medical Association.ResultsA total of 300 links were accessed and included in 17 websites. The DISCERN review showed that only 1 item's average score exceeded 3 points. According to website content score, the excellent part accounted for 11.7%, the good part accounted for 35.2%, the fair part accounted for 47.1%, and the poor part accounted for 5.8%. 50% of websites contained error messages, and the subject of the most error-prone information was diagnosis and treatment. There was a positive correlation between the content score and the DSCERN score in the credibility score and the verbosity score (r=0.71, 0.73, P<0.001). The websites were evaluated by attributes, and the quality evaluation of diabetes-related information in some general-purpose websites was higher than that of diabetes specialist websites.ConclusionsThe quality of diabetes health information on Chinese websites is insufficient. It is necessary for China to establish a web-based information platform for diabetes. China has not yet formed a unified network health information evaluation standard in line with its national conditions. The key to solving the problem lies in the collaboration between professional health personnel and website developers.
Objective To evaluate the methodological quality of clinical trials on traditional Chinese medicine (TCM) nursing in recent six years.Methods Such databases as CNKI, VIP, WanFang Data and CBM were searched for collecting clinical trials on TCM nursing published from January 2006 to September 2011, and domestic primary nursing journals were also searched from January 2010 and September 2011. Methodological quality of included studies was assessed using quality assessment criteria of the Cochrane systematic review guideline. Results A total of 854 clinical trials were retrieved, including 706 (82.7%) randomized controlled trials (RCTs), 108 (12.6%) quasi-randomized controlled trials and 40 (4.7%) non-randomized controlled trials. In the methodological quality analysis, the comparability of baseline was mentioned in 784 trials (91.8%), a total of 498 (58.3%) reported definite diagnosis criteria. 178 (20.8%) reported exclusive criteria. 831 studies (97.3%) applied relevant statistical methods properly. However, only 55 trials (6.4%) mentioned the method of randomization sequence. 10 studies (1.2%) described the method of randomiztion assignment. Blinding was mentioned in 22 studies (2.6%). 98 trials (11.5%) did prospective follow-up. 93 trials (10.9%) had safety description. 20 trials (2.3%) reported lost and with drawl cases, but only 2 conducted intention-to-treat analysis. It was hard to determine whether there was selective reporting bias or not because all the studies did not have protocols. Only 21 studies (2.5%) mentioned the lack of outcome indicators which could be the evidence for existing of bias. By annual analysis, there were 81 trials which conformed to at least 2 low risk criteria. 10 trials (12.3%) was published in 2009, 26 trials (32.1%) published in 2010, and 27 trials published by September 2011, indicated an uptrend. Conclusions According to the Cochrane Collaboration’s tool for assessing risk of bias, the overall quality of clinical trials on TCM nursing is low with defects in different degrees, but it rises gradually over years.
ObjectiveTo comprehensively collect quality assessment tools of systematic review/meta-analysis (SR/MA) of randomized controlled trials (RCTs), and compare the differences of numbers and contents of items, in order to provide references for optimizing and using these quality assessment tools. MethodsWe searched PubMed and EMbase databases up to December 31th, 2013 for quality assessment tools of SR/MA of RCTs. EndNote X3 software was used for screening literature and Excel 2010 software was used for data extraction. A descriptive analysis was performed. ResultsA total of 61 studies including 32 quality assessment tools were included. Among them, 30 tools were for methodological quality and 2 tools for reporting quality. These tools were developed by different medical universities or colleges, research institutes, national health institutes, and some famous epidemiologists and methodologists from 1984 to 2007. Among the 32 tools, 4 tools were scales, while 28 were checklists. The numbers of items of these tools ranged from 5 to 101, among them, 9 tools had more than 20 items. ConclusionThere are many quality assessment tools for SR/MA, but none of them is generally acknowledged. The quality, contents of items, and applicability of these tools are different, and some of them are too long to use. In practice and decision-making, most of the tools have the problems of low relevance and applicability. How to regularly use these tools to guide the research, practice and decision-making of SR/MA is still needed to be further researched.
Objective To prospectively evaluate the health-related quality of life (HRQOL) outcomes in patients undergoing laparoscopic total mesorectal excision (LTME) with anal sphincter preservation (ASP) for low rectal cancers. Methods From June 2001 to March 2004, 125 patients undergoing LTME and 103 patients undergoing OTME were included in this study. The international standard questionnaires (QLQ-C30 and QLQ-CR38) were used to evaluate the conditions of patients at 3 periods after surgery respetively: 3-6 months, 12-18 months, gt;24 months. Results In contrast to OTME patients, the LTME ones showed significantly better physical function during 3-6 months after surgery, less micturition problems within 12-18 months, less male sexual problems and better sexual function during 12-18 months after surgery, with better sexual enjoyment after postoperative 24 months. Both groups showed significant improvement in most subscales from the first to the second assessment, and improvement in sexual enjoyment from the second to the third assessment. The sexual function, micturition problems and male sexual problems in LTME group significantly improved from the first to the second assessment, whereas the sexual function in OTME group improved from the second to the third assessment.Conclusion Patients undergoing LTME for low rectal cancers have bette postoperative HRQOL than patients undergoing OTME, with better physical function, micturition function, overall sexual and male sexual functions in short term, and better sexual enjoyment in the long term. The HRQOL of both LTME and OTME patients may be expected to improve over time, particularly in the first postoperative year.