ObjectiveTo investigate the clinical nursing path of health education in patients with gout. MethodsA total of 220 patients with gout treated in People's Hospital of Jiangyou from September 2010 to November 2011 were randomly divided into observation group and control group with 110 patients in each.After routine health education for the control group and clinical nursing path health education for the observation group,we compared patients'compliance with doctors,gout-related indicators and health education satisfaction degree between the two groups of patients. ResultsThere was no statistically significant difference in compliance with doctors between the two groups before health education (P>0.05).After health education,the score of five single items on compliance with doctors and the total score for patients in the observation group were all significantly improved (P<0.05).For patients in the control group,the scores of each item and the total score were also significantly improved (P<0.05) except the item of regular drug-taking and regular health examination (P>0.05).After health education,all scores and the total score of the observation group were higher than those of the control group (P<0.05). ConclusionFor health education for gout patients,clinical nursing path is better than routine health education in scores of compliance with doctors,improvements of symptoms,and health education satisfaction degree of the patients.
Objective To systematically evaluate correlation between exon-1 (locus 49, A/G) and promoter (locus -318, C/T) polymorphisms of Chinese population cytotoxic T lymphocytes associated antigen-4 (CTLA-4) gene and Graves’ Disease (GD). Methods Relevant studies were electronically searched in CNKI, VIP, CBM, PubMed, EMbase and The Cochrane Library from 1980.1 to 2011.12. According to the inclusion and exclusion criteria, we selected and screened all case-control studies on the correlation between CTLA-4 exon -1 (locus 49, A/G) and promoter (locus -318, C/T) polymorphisms of Chinese population and GD. Then we extracted the data and assessed the methodological quality of the included studies. Meta-analysis was performed using RevMan 5.0 and STATA 12.0 software. Results (1) Ten studies on exon-1 were included. Results of meta-analyses showed that Chinese population with genotype G/G had a higher GD risk than those with genotype A/A (OR=3.38, 95%CI 2.07 to 5.51) and A/G (OR=1.72, 95%CI 1.31 to 2.25). Also, the allele G showed significant association with increased GD risk compared to the allele A (OR=1.87, 95%CI 1.44 to 2.41). (2) Five studies on promoter-318 were included. Results of meta-analyses showed that Chinese population with genotype T/T presented no increased relative risk compared to those with genotype C/C (OR=0.75, 95%CI 0.26 to 2.12) or C/T (OR=0.92, 95%CI 0.31 to 2.73). Meanwhile, the allele T showed no increased relative risk compared to the allele C (OR=0.83, 95%CI 0.61 to 1.12). Conclusion The allele G at the locus 49 of exon -1 of Chinese population is significantly associated with increased GD risks, yet the correlation between promoter –318 C/T polymorphism and GD hasn’t been demonstrated. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to test the above conclusion.
ObjectiveTo analyze the asymmetry of posterior-anterior radiograph of patients with facial asymmetry after orthodontic and surgical treatment. MethodsWe retrospectively analyzed the clinical data of 50 patients with varying degrees of facial asymmetry treated with orthodontic and surgical methods between June 2013 and June 2014. The asymmetric rate of posterior-anterior radiograph of the patients before and after treatment were compared with that of another 50 healthy subjects. ResultsMaxillary indexes including L2, L3, L4, L5, L6, L7, L8, L9, and L10 asymmetric rates of the patients were significantly different from those of the normal subjects (P < 0.05); L3, L6, L7 and L10 asymmetric rates were significantly different before and after treatment (P < 0.05). Mandibular indexes including L1, L3, L4, L5, L6, L7, L8, L9, and L10 asymmetric rates were significantly different from normal indicators (P < 0.05); L1, L3, L4, L5, L6, L7, L8, L9, and L10 asymmetric rates changed significantly after treatment (P < 0.05). ConclusionClinical facial asymmetry mainly manifests on the bottom 1/3 part of the face, and facial mandibular asymmetry is the most obvious.
ObjectiveTo explore the current status of treatment adherence in patients with chronic kidney disease without dialysis and to analyze its influencing factors.MethodsThe patients who visited the Outpatient Department of Nephrology of West China Hospital of Sichuan University from September to December 2020 were taken as the research objects. Self-designed general information questionnaire, treatment adherence questionnaire, physician-patient communication satisfaction, health information seeking behavior questionnaire, and physician-patient concordance questionnaire were used to investigate, and path analysis was used to explore the influencing factors of treatment adherence.ResultsA total of 203 valid questionnaires were obtained. Treatment adherence score was (21.69±2.42) points, self-reported health status was (2.48±0.91) points, physician-patient concordance was (20.39±2.70) points, physician-patient communication satisfaction was (67.73±5.52) points, and health information seeking behavior was (13.17±2.65) points. Health information seeking behavior (r=0.214, P=0.002), physicians-patient concordance (r=0.494, P<0.001), physician-patient communication satisfaction (r=0.229, P=0.001) were positively correlated with treatment adherence. Self-reported health status was negatively correlated with treatment adherence (r=−0.225, P=0.001). Path analysis showed that physicians-patient concordance was the most influencing factor of treatment adherence (total effect=0.474).ConclusionHealth information-seeking behavior and physicians-patient concordance are important factors affecting treatment adherence in chronic kidney disease patients without dialysis. In order to improve treatment adherence of chronic kidney disease patients, healthcare providers can provide various ways to provide information, which can help make more disease-related health knowledge available to patients. Moreover, healthcare workers should also further explore ways to improve the concordance related to reaching agreement between doctors and patients on medical and treatment options.
In the study of real-world data, the pragmatic randomized controlled trial can provide the optimal evidence for clinical decisions. Although randomization protects against confounding, post-randomization confounding may still arise due to non-compliance. Traditional intention-to-treat analysis will drift apart from true estimation and lead to deviation of clinical decisions. Meanwhile, the alternative traditional methods would subject to bias and confounding. Thus, new methods are required for revolution, i.e., instrument variable method and modern per-protocol analysis. Our study reviews the defects of traditional methods in pragmatic randomized controlled trials, and then refers to two new methods with a detailed discussion of strengths and weaknesses. We aim to provide researches with insights on choosing the statistical methods for pragmatic trial.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.