ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.
Objective To assess the vision-related quality of life(VRQL) in patients with age-related maculopathy (AMD) and the related factors in Shanghai. Methods The VRQL of 105 patiens with AMD and 105 without (the control group) in Shanghai was investigated via Chinese-version low vision quality of life questionnaire. Resutls The Cronbach α coefficient of the questionnaire is 0.97 in the patients with AMD, whose scores of the various quality of life were significantly lower than those in the control group. The more the exudative defect happened, or the longer the disease course developed, the lower the sccores were. All the scores of the scales and the total questionnaire were significantly related to the better or worse monocular visual acuity. The better monocular visual acuity was the first independent risk factor affecting all aspects of VRQL in pateints with AMD. Conclusions Decreased visual acutiy may gradually impair the VRQL in patients with AMD. Chinese-version questionnaire of low vision quality of life can provide the general information of the VRQL in patients with AMD.(Chin J Ocul Fundus Dis，2004，20：303-306)
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.
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.
Objective To compare quality of life for HIV infected people or AIDS patients and their family members of noninfected people in two counties (Zizhong and Zhaojue) with high AIDS morbidity and high HIV infective rates. Methods The quality of life for HIV infected people or AIDS patients and 162 of their family members and 97 people noninfected HIV/AIDS was measured by a questionnaire containing the generic quality of life inventory 74 (GQOLI-74) and the social support scale (SSS). Data were analyzed with SPSS. Results Total GQOLI-74 scores and each of the four dimensionality scores were significantly lower for HIV/AIDS people and their family members compared with noninfected people (total score for HIV/AIDS people 52.20 [9.41]; family members 60.46 [11.92]; noninfected people 66.36 [8.90] (Plt;0.01)). Scores for each of the disease status (physical function, psychological function, social function and material status) were all lower compared with noninfected people (all comparisons Plt;0.01). GQOLI-74 scores of HIV/AIDS people were significantly correlated with disease status and social support, but age, education level and substance abuse did not show significantly correlation. Conclusions The quality of life for HIV infected people or AIDS patients and their families is significantly lower than the general population, and this is particularly related to the severity of their disease and lack of social support.
Objective To determine the safety and efficacy of surgical biliary bypass on the elderly patients with unresectable pancreatic head cancer. Methods The clinical data of 55 cases with unresectable pancreatic head cancer treated with palliation methods from July 2002 to June 2009 in our hospital were retrospectively analyzed. The patients were divided into three groups according to different age and therapeutic program: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (group A), 19 patients under 65 years of age were treated by surgical biliary bypass (group B) and 17 patients with the age of 65 years or older received percutaneous transhepatic biliary drainage (group C). Then the therapeutic results were compared.Results With respect to the postoperative level of serum bilirubin, the incidence of early complications, postoperative hospitalization and mean survival time, no statistically significant difference was found between group A and B (Pgt;0.05). There was one case of recurrent jaundice and one case of gastric output obstruction in group B, while no one suffered postoperative complication in group A, and the difference was statistically significant (Plt;0.01). Compared with group A, the postoperative level of serum bilirubin, the number of patient readmitted, the rate of recurrent jaundice and gastric output obstruction were higher in group C (Plt;0.05 or Plt;0.01). The mean postoperative hospitalization and overall survival time were significantly shorter in group C than group A (Plt;0.05 or Plt;0.01, respectively). Conclusion Surgical palliation does not increase the morbidity rate, but it does improve the quality of life in elderly patients with unresectable pancreatic head cancer.
Objective To investigate the reporting quality of randomized controlled trials (RCT) on laparoscopic surgery for treating colorectal disease in three SCI indexed. Methods We electronically retrieved the Ovid MEDLINE(R) from 1950 to present with Daily Updates for RCTs on laparoscopic surgery published in Diseases of the Colon amp; Rectum, International Journal of Colorectal Disease, or Colorectal Disease. The revised CONSORT statement and additional surgical items were adopted to assess the reporting quality. One point was assigned for each full description of an item, 0 for no description, and 0.5 for a partial description. Results A total of 20 RCTs were included and 8 RCTs were excluded. Their reporting quality was low. The average scores for the following items were relatively lower, 0.150 for settings where data collected; 0.250 for sample size estimation; 0.500 for sequence generation of randomization; 0.325 for allocation concealment; 0.150 for implementation; 0.475 for measurement of outcome; 0.150 for participant flow chart; 0.450 for adverse events; 0.450 for external validity; 0.400 for financial conflicts of interest; 0.250 for perioperative pharmacological treatment; 0.075 for perioperative nonphamacological treatment; 0.000 for participation of a trial methodologist; 0.350 for surgeon’s experience (years or position). Items with the lower scores were mainly in the methods and results section and surgical items. Conclusions The reporting quality of laparoscopic RCTs in these journals is low. Colorectal surgeons should rigorously evaluate reports in these journals before they apply to them in clinical practice.
Objective To assess the methodology and report quality of Chinese systematic reviews/ meta-analyses on prevention and control of six major diseases in public health. Methods Chinese literatures of systematic reviews/ meta-analyses on prevention and control of six major diseases, including cancer, cerebrovascular disease, cardiovascular disease, hepatitis B, tuberculosis, and AIDS were searched in CQVIP, WANFANG Database, CNKI, and the Chinese Biomedical Literature Database from the establishment date to June, 2010. Two researchers independently screened and evaluated the data, disagreements were resolved by discussion. Methodology quality and report quality of included reviews were evaluated by OQAQ scale and PRISMA scale. Result Of the 139 literatures included in the analysis, 32 were systematic reviews while 107 were meta-analyses. The highest and lowest scores of methodology quality were 6.5 and 1.5 respectively. The average score was 4.66±0.92 and no literature could meet all nine items. The main problems were insufficient in literatures resource, bias in data selection, lack of rigorous quality assessment for included original studies and so on. The average score of report quality were 15.28±2.91 and the main problems were incomplete report in abstract, data collection and analysis methods, bias control, conclusion and so on. Conclusion Both of the methodology quality and report quality of included literatures have problems in different levels, which require to be further improved.
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.
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.