Objective To explore the construction and application of a new follow-up visit model in the context of Internet hospital consultation, aiming to create a novel follow-up visit model that integrates precise identification of follow-up patients, messages of follow-up reminders, online free follow-up visits, and promotional activities. Methods Satisfaction surveys were conducted among outpatient patients and doctors at Jintang County First People’s Hospital from July 2023 to June 2024. Patients and doctors were divided into two groups based on whether the online free follow-up visit program had been implemented: the pre-implementation group (July to December 2023) and the post-implementation group (January to June 2024). The satisfaction levels of patients and doctors before and after the implementation were compared and analyzed. Results A total of 17 831 patient visits and 801 doctor visits were included. Since its launch, WeChat messages had been pushed to all outpatient patients, and both WeChat and SMS messages had been pushed to patients in surgical departments. The average waiting time for outpatient visits in January-June 2024 was shortened by 2 minutes compared with the same period last year (January-June 2023). The hospital’s Case Mix Index increased by 3.7%, and the surgical volume increased by 7.5%. After the launch of the Internet hospital, both patient and doctor satisfaction improved. Conclusion The new follow-up visit model of the Internet hospital represents an important initiative in the digital transformation of hospitals and holds value and significance for promotion in more county-level medical institutions.
To summarize the medium-term cl inical result of bio-derived bone transplantation in orthopedics with tissue engineering technique. Methods From December 2000 to June 2001, 10 cases of various types of bone defect were treated with tissue engineered bone, which was constructed in vitro by allogenous osteoblasts from periosteum (1 × 106/ mL) with bio-derived bone scaffold following 3 to 7 days co-culture. Six men and 4 women were involved in this study, aged from 14 to 70 years with a median of 42 years. Among them, there were 2 cases of bone cyst, 1 case of non-union of old fracture, 6 cases of fresh comminuted fracture with bone defect, and 1 case of chronic suppurative ostemyel itis. The total weight of tissue engineered bone was 3-15 g in all the cases, averaged 7.3 g in each case. Results The wound in all the case healed by first intention. For 7 year follow up, bone union was completed within 3.0 to 4.5 months in 9 cases, but loosening occurred and the graft was taken out 1 year after operation in 1 case. The X-ray films showed that 9 cases achieved union except one who received resection of the head of humerus. No obvious abnormities were observed, and the function of affected l imbs met daily l ife and work. Conclusion Bio-derived tissue engineered bone has good osteogenesis. No obvious rejection and other compl ications are observed in the cl inical appl ication.
Objective To investigate long-term echocardiography characteristics and their clinical significance of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 204 patients who underwent prosthetic MVR and finished echocardiography examination at least 5 years after surgery in West China Hospital of Sichuan University. There were 44 male patients and 160 female patients with their age of 23 to 73 （50.9±10.6）years. Postoperatively， all the patients were followed up for 5-15 （7.9±2.3）years and regularly received echocardiography examination at the outpatient department. Analysis variables included left atrium （LA） dimension， left ventricle （LV） dimension，right atrium （RA） dimension， right ventricle （RV） dimension， left ventricular ejection fraction （LVEF） and effective orificearea （EOA） of the mitral valve. Results Long-term echocardiography showed that LA and LV dimensions were signifi-cantly smaller than preoperative dimensions （P＜0.05）， while RA and RV dimensions were not statistically different from preoperative dimensions （P＞0.05）. Long-term LVEF was significantly higher than preoperative value （P＜0.05）. Long-term EOA was 1.1-4.8 （2.3±0.5）cm2， including EOA of 1.1-1.4 cm2 in 7 patients （3.4%，7/204），and 1.6-1.9 cm2in 42 patients （20.6%，42/204）. During long-term follow-up， 7 patients underwent their second heart surgery， including2 patients with prosthetic valve dysfunction， 1 patient with prosthetic perivalvular leak and severe hemolytic anemia，3 patients with severe tricuspid regurgitation which were not improved after medication treatment， and 1 patient with moderateaortic valve stenosis and regurgitation. Two patients had left atrial thrombosis during follow-up， including 1 patient who died of endocarditis 7 years after surgery， and another patient who was still receiving conservative therapy and further follow-up. Conclusion Concomitant tricuspid or aortic valve disease should be actively treated during MVR， and postoperative patients need better follow-up. Many patients after MVR need long-term cardiovascular medication treatment during follow-up in order to improve their heart function and long-term survival rate.
Objective To present early follow-up results of surgical closure of ruptured sinus of Valsalva aneurysm (RSVA). Methods We retrospectively analyzed the clinical data of 32 patients with RSVA or combined with RSVA in our hospital between January 2010 and December 2014. There were 20 males, 12 females aged 37.6±11.2 years. All the patients were surgically corrected under cardiopulmonary bypass. Results The mean cardiopulmonary bypass time was 79±18 min and the mean aortic cross-clamp time was 53±9 min. Except that 1 patient had the first degree A-V block and 2 patients with delayed wound healing, there was no other complication in the early postoperative period. One patient with surgically corrected RSVA was with infective endocarditis after 3 months follow-up. Most patients were with better New York Heart Association (NYHA) functional classⅠor Ⅱat the end of the follow-up. Conclusion Surgical closure of RSVA is a safe and effective alternative to surgery with early follow-up results.
Objective To explore the factors associated with clinic follow-up of old patients with colorectal cancer and provide more evidence to improve the efficiency and quality of clinic follow-up after sugery. Methods The data of 253 patients who were underwent sugery because of old colorectal cancer in our hospital from January 2009 to May 2010 were reviewed. Data about the rate and times of clinic follow-up within 6 months after operation were collected via Hospital Information Systerm, then the follow-up rate was calculated, and to analyse the possible factors associated with follow-up times and rate. Results The total follow-up rate was 84.2%（213/253）, and the total times of follow-up was between 0 to 24 times per one, （4.08±0.03）times on average. On the times of follow-up, patients inside the city was higher than that outside, patients with medical or postoperative complications were higher than those without, and patients with a stoma was lower than that without, and the differences were statistically significant （P＜0.05）.While on the follow-up rate, patients underwent a radical sugery or with a stoma were lower than those not or without, and the differences were statistically significant （P＜0.05）. Conclusions The clinic follow-up of old colorectal cancer patients is not satisfactory, and the possible factors associated with follow-up times or rate are the distance between residence and hospital, have medical complications or not, have postoperative complications or not, radical sugery or not, and with a stoma or without.
Objective To investigate the effects of online follow-up mode and online + offline follow-up mode on rehabilitation after total hip arthroplasty. Methods Patients who underwent total hip arthroplasty in the Department of Orthopedic Surgery, West China Hospital of Sichuan University between August and December 2022 were selected. According to personal preference, the included patients were divided into an observation group and a control group. The observation group underwent comprehensive follow-up mode, while the control group underwent simple online follow-up mode. Joint function, daily living ability, Huaxi Emotional-distress Index, follow-up satisfaction, complications and readmission were compared between the two groups at 3, 8, 26 and 52 weeks after surgery. Results A total of 83 patients were included. Among them, there were 41 cases in the control group and 42 cases in the observation group. There was no statistically significant difference in personal basic information and disease-related data between the two groups (P>0.05). The joint function and daily living ability of the observation group were better than those of the control group at 8, 26, and 52 weeks after surgery (P<0.05). There was no significant difference between the two groups in Huaxi Emotional-distress Index and follow-up satisfaction at 52 weeks after operation (P>0.05). The incidence of complications in the observation group was lower than that in the control group (P<0.05). Conclusions The comprehensive follow-up model has more advantages in direct physical assessment, wound assessment, in-depth communication, timely feedback and adjustment, which can improve patients’ postoperative joint function, enhance their daily life ability, and reduce the occurrence of postoperative complications.
Objective To investigate the influence of prior percutaneous coronary intervention (PCI) on the outcome of coronary artery bypass grafting (CABG). Methods Clinical data of 5 216 patients from Jiangsu Province CABG registry who underwent primary isolated CABG from 2016 to 2019 were retrospectively analyzed. Patients were divided into a PCI group (n=673) and a non-PCI group (n=4 543) according to whether they had received PCI treatment. The PCI group included 491 males and 182 females, aged 62.6±8.2 years, and the non-PCI group included 3 335 males and 1 208 females, aged 63.7±8.7 years. Multivariable logistic regression and propensity score matching (PSM) were used to compare 30-day mortality, incidence of major complications and 1-year follow-up outcomes between the two groups. Results Both in original cohort and matched cohort, there was no statistical difference in the 30-day mortality [14 (2.1%) vs. 77 (1.7%), P=0.579; 14 (2.1%) vs. 11 (1.6%), P=0.686], or the incidence of major complications (myocardial infarction, stroke, mechanical ventilation≥24 h, dialysis for new-onset renal failure, deep sternal wound infection and atrial fibrillation) (all P>0.05). The rate of reoperation for bleeding in the PCI group was higher than that in the non-PCI group [19 (2.8%) vs. 67 (1.5%), P=0.016; 19 (2.8%) vs. 7 (1.0%), P=0.029]. Both in original cohort and matched cohort, there was no statistical difference in 1-year survival rate between the two groups [613 (93.1%) vs. 4225 (94.6%), P=0.119; 613 (93.1%) vs. 630 (95.2%), P=0.124], while the re-admission rate in the PCI group was significantly higher than that in the non-PCI group [32 (4.9%) vs. 113 (2.5%), P=0.001; 32 (4.9%) vs. 17 (2.6%), P=0.040]. Conclusion This study shows that a history of PCI treatment does not significantly increase the perioperative mortality and major complications of CABG, but increases the rate of cardiogenic re-admission 1 year postoperatively.
ObjectiveTo investigate the efficacy of combined telephone and WeChat follow-up for patients discharged with an indwelling closed thoracic drainage tube after surgery for stage Ⅲ tuberculous empyema. MethodsPatients with stage Ⅲ tuberculous empyema who were discharged with an indwelling drainage tube from the Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, between November 2021 and November 2022 were enrolled in this study. They were divided into an observation group (combined telephone and WeChat follow-up) and a control group (telephone-only follow-up). The quality of life (QoL), treatment adherence, and recovery outcomes were compared between the two groups. Results A total of 81 patients were included. The observation group consisted of 49 patients (31 male, 18 female) with a mean age of (38.63±15.86) years. The control group consisted of 32 patients (27 male, 5 female) with a mean age of (36.91±17.33) years. The observation group showed significantly higher postoperative QoL scores in the domains of physical functioning, emotional functioning, physical symptoms, global health status, and overall QoL compared to the control group (all P<0.05). Regarding treatment adherence, the observation group demonstrated superior performance in daily activity duration, use of a respiratory trainer, and adherence to coughing exercises compared to the control group (all P<0.001). The duration of chest tube indwelling was significantly shorter in the observation group (P<0.001). Furthermore, the observation group showed better recovery in albumin and hemoglobin levels (P<0.001). ConclusionA combined telephone and WeChat follow-up approach can significantly improve the QoL and treatment adherence for patients discharged with an indwelling drainage tube. This method effectively shortens the duration of postoperative tube drainage, promotes nutritional recovery, and accelerates overall postoperative rehabilitation.
ObjectiveTo evaluate the mid-term safety, efficacy and feasibility of perventricular device closure for subarterial ventricular septal defect.MethodsClinical data of 97 patients diagnosed with subarterial ventricular septal defect through echocardiography in West China Hospital from September 2013 to December 2015 were retrospectively analyzed. There were 66 males and 31 females aged 3 (1.8, 5.9) years. All the patients underwent perventricular device closure under the guidance of transesophageal echocardiography using eccentric occlusion device. Possible complications such as residual shunt, valvular regurgitation, atrioventricular conduction block and arrhythmias were recorded during the 1-year, 3-year and 5-year follow-up.ResultsAll the patients received perventricular device closure successfully except that 1 patient underwent open surgical repair under cardiopulmonary bypass 3 months later because of the migration of device. So the rate of complete closure was 99.0%. No residual shunt, moderate or severe valvular regurgitation, atrioventricular conduction block or arrhythmias were observed 5 years later.ConclusionTreating subarterial ventricular septal defect through perventricular device closure exhibits remarkable mid-term efficacy, safety and feasibility with high success rate.
ObjectiveTo explore the influencing factors for lost follow-up of diabetic patients, looking for suitable follow-up methods for patients in the region of Central and Western China, in order to help ensure the quality of follow-up, improve the rate of follow-up and provide a basis for improving the quality of patients' continuous nursing outside of the hospital. MethodsContinuous nursing was carried out for 600 patients discharged from our department by two full-time diabetes education nurses from September 2012 to April 2014. The data of outside hospital patients who were lost in the follow-up were retrospectively analyzed. According to the sequential order of the patients, they were divided into three groups. The difference among the three groups of patients was analyzed and the effect of nursing intervention on patients' follow-up loss was also analyzed. ResultsThe rate of lost follow-up for the three groups were 29.4%, 20.3%, and 12.2%. Big classroom participation rate was 29.4%, 50.5%, and 57.5%. The lost follow-up rate of group three using team comprehensive management pattern was lower than that in group 1 with traditional supervision intervention. The age of the patients who were lost in the follow-up concentrated under 40 and above 75 years old. The patients with a disease history longer than 10 years with more complications were more likely to be lost in the follow-up. The main reason for lost follow-up was self-conceit and lack of awareness of the follow-up. ConclusionDiversified ways of follow-up can complement each other which can reduce the rate of lost follow-up.