Rare diseases have problems with low number of cases, low social awareness, and long time of diagnosis. “Targeted doctor” is the first step to help rare disease patients start the correct path of diagnosis and treatment. This article introduces the design of a decision-making engine for patients with rare diseases by constructing a knowledge graph of rare diseases and experts, using an intelligent question-and-answer system, and combining big data and artificial intelligence methods. This engine can perform rare disease pre-screening based on patient portraits and other information, and recommend the best visiting route to patients, thereby improving the efficiency of rare disease patients’ medical service system and enhancing the decision-making ability of rare diseases.
ObjectiveTo observe the effect of kinesio tape (KT) combined with progressive resistance training (PRT) in patients with subacromial impingement syndrome (SIS), and to explore whether the direction of KT affects the therapeutic effect of SIS.MethodsBetween May 2017 and March 2019, 90 participants with SIS in West China Hospital, Sichuan University were randomly divided into three groups, with 30 participants in each group. Participants were treated with KT combined with PRT, and the direction of the KT is from the proximal end of the rotator cuff muscles to the distal end in group A. Participants were treated with KT combined with PRT, and the direction of the KT is from the distal end of the rotator cuff muscles to the proximal end in group B. Participants were treated with PRT alone in group C. Visual Analog Scale (VAS) was used to evaluate the pain in patients at rest, during movement and at night; range of motion (ROM) of shoulder and the disabilities of the arm, shoulder and hand (DASH) outcome questionnaire were used to measure the physical function before treatment and after 1 week and 2 weeks.ResultsAfter 1 week of treatment, ROM of shoulder abduction, internal rotation and DASH scores in group A were significantly improved compared with those in group B and C (P<0.05). After 2 weeks of treatment, the nighttime VAS score, ROM of shoulder abduction, internal rotation and DASH score scores in group A were significantly improved compared with those in group B and C (P<0.05). The VAS score during movement, nighttime VAS score, ROM of shoulder (except external rotation) and DASH score in group A were significantly improved after 1 week and 2 weeks of treatment (P<0.05); and after 2 weeks of treatment, the nighttime VAS score, ROM of shoulder flexion and internal rotation in group B were significantly improved compared with those before treatment (P<0.05). After 2 weeks of treatment, the VAS score during movement, nighttime VAS score, ROM of shoulder (except external rotation) in group C were significantly improved compared with those before treatment (P<0.05).ConclusionKT combined with PRT is more effective than PRT alone in the treatment of SIS, and the therapeutic effect is related to the direction of the tape.
In the process of guideline development and construction of clinical questions, it is necessary to guide clinicians to propose clinical problems into PICO (population, intervention, control, outcome) structured clinical questions. However, there are still unclear criteria to define and judge the appropriateness of the width of the PICO elements of a clinical question. Either too wide or too narrow can make the PICO question unsuitable to be a question for clinical practice guidelines to answer. We graded the clinical questions to be eight grades (3, 2, 1, 0, ?1, ?2, ?3, mixed) according to the number of the PIC elements, which obviously needed to be adjusted to evaluate applicability of the appropriateness of the width of the clinical questions. Our work can provide methodological references for clinicians and guideline developers.
[Abstract]Postoperative lung cancer patients experience a significant symptom burden that severely impacts their quality of life. Accurate assessment of their health experience during recovery is critical to postoperative management. Patient-reported outcomes (PROs), which provide valuable insights into health from the patient's perspective, are increasingly used in the postoperative management of lung cancer patients. This article reviews the existing patient-reported outcome measures (PROMs) for lung cancer patients, focusing on their measurement dimensions, clinical applicability, and current usage. It aims to provide a foundation for their scientific application, optimize postoperative management strategies, and promote high-quality recovery and management.
When prioritizing clinical questions in the development of the clinical practice guidelines, clinical questions with high recognition and low variability, or high score and less disagreement among experts were often prioritized, while questions with high recognition but high variability were excluded. By this approach, clinical questions with practical value but also showed high variability due to different causes were not accepted as priorities. There were some methodological and clinical limitations by doing so. By summarizing the causes and connotations of expert opinion variability in terms of clinical experience, expertise and values, this paper analyzed the advantages of the variability quantification application, and proposed corresponding methodological recommendations, so as to provide references for guideline developers in the priority selection of clinical questions.
Objective To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention. Methods One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis. Results The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy. Conclusions Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.
Recent studies have introduced attention models for medical visual question answering (MVQA). In medical research, not only is the modeling of “visual attention” crucial, but the modeling of “question attention” is equally significant. To facilitate bidirectional reasoning in the attention processes involving medical images and questions, a new MVQA architecture, named MCAN, has been proposed. This architecture incorporated a cross-modal co-attention network, FCAF, which identifies key words in questions and principal parts in images. Through a meta-learning channel attention module (MLCA), weights were adaptively assigned to each word and region, reflecting the model’s focus on specific words and regions during reasoning. Additionally, this study specially designed and developed a medical domain-specific word embedding model, Med-GloVe, to further enhance the model’s accuracy and practical value. Experimental results indicated that MCAN proposed in this study improved the accuracy by 7.7% on free-form questions in the Path-VQA dataset, and by 4.4% on closed-form questions in the VQA-RAD dataset, which effectively improves the accuracy of the medical vision question answer.
There are several main obstacles to structure clinical questions in the process of developing evidence-based clinical practice guidelines, such as clinicians have misconceptions about clinical question structure, and clinical questions do not fit clinical practice. These obstacles results in the incomplete structure and not standardized expression of the clinical questions, and reduce the quality and applicability of guidelines. To overcome these obstacles, this article introduced the application and specific details of clinical question framing and expression with practical examples, to assist clinicians in understanding clinical questions and to provide methodological references for clinical question formulation in the guidelines.
Objective To investigate problems in applying clinical epidemiology and evidence-based medicine in the field of dentistry in China. Method In early April of 2001, about 200 copies of a questionnaire were sent to chief editors of dental journals, directors and famous experts of the university dental schools and/or dental departments of the provincial/metropolitan hospitals located in the mainland of China. The sent back questionnaires were summarized and analysized. Results At the end of June, 2001, 40 replies from the experts of 12 universities and one metropolitan dental hospital were received. The main points are summarized as following: EBM in China is at starting stage of "anti-illiteracy" campaign. There are 6 out of 12 universities having delivered clinical epidemiology courses to postgraduates (2 to undergraduates), only 3 added lectures on evidence-based medicine to dental students and/or professionals, only one university held intensive training courses on EBM to clinicians. In dental practice there are still scram dentists making decisions simply by experiences. In the research practice some dentists are eager for quick success, and instant benefits, ignoring, scientific design aid quality control of the studies. Randomized controlled clinical trials are seldom appeared in Chinese dental journals. To popularize EBM in all dental clinicians is important for them to use and produce the best evidences. Conclusions EBM in dental field of China is at starling stage. Collection and dissemination of best dental evidences in dental professionals is a key to raise the dental care levels in China.
Objective To compare BODE index with GOLD staging for the severity evaluation in patients with chronic obstructive pulmonary disease ( COPD) . To investigate the relationship between BODE index and quality of life. Methods A total of 100 patients with stable COPD were enrolled. All participants were examined with lung function test and St George’s Respiratory Questionnaire ( SGRQ) for evaluation of quality of life. BODE index and it’s four components including body mass index( BMI) , airflow obstruction ( FEV1%pred) , dyspnea( MMRC) , and exercise capacity( 6MWD) were calculated. The participants were divided into four groups of severity using GOLD guidelines and BODE index quartiles. Results The associations between SGRQ total score and SGRQ subscales, and BODE index were significant( P lt;0. 01) .BODE index was a significant predictor of the quality of life, explaining 41. 3% of the total score of the SGRQ ( P lt;0. 01) . However, GOLD classification showed a correlation only with SGRQ activity score ( P lt;0. 05) but not with other SGRQ scores. There were significant differences in SGRQ total score and SGRQsubscales between different severity groups of BODE index( P lt;0. 01) . But there was no difference in SGRQ score between different severity groups of GOLD classification, except SGRQ activity score. Conclusion BODE scoring system is better correlated with the quality of life as assessed by the disease severity inpatients with COPD than the GOLD staging criteria.