Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in ...Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.展开更多
Objectives:This study aimed to explore the characteristics of outpatient blood collection center visit fluctuation and nursing workforce allocation based on a time series model,and the application effect was evaluated...Objectives:This study aimed to explore the characteristics of outpatient blood collection center visit fluctuation and nursing workforce allocation based on a time series model,and the application effect was evaluated.Methods:To enhance the efficiency of phlebotomy at the hospital outpatient window and improve patient satisfaction,the First Affliated Hospital with Nanjing Medical University implemented a time series analysis model in 2024 to optimize nursing staff allocation.The management team was led by a head nurse of the outpatient blood collection department with extensive experience.It included one director of the nursing department,six senior clinical nurses,one informatics expert,and one nursing master's degree holder.Retrospective time-series data from the hospital's smart blood collection system(including hourly blood collection volumes and waiting times)were extracted between January 2020 and December 2023.Time series analysis was used to identify annual,seasonal,monthly,and hourly variation patterns in blood collection volumes.Seasonal decomposition and the Autoregressive Integrated Moving Average Model(ARIMA)were employed to forecast blood collection fluctuations for 2024 and facilitate dynamic scheduling.A comparison was conducted to evaluate differences in blood collection efficiency and patient satisfaction before(January-June 2023)and after(January-June 2024)implementing the dynamic scheduling model based on the time series analysis and forecasting.Results:Visit volumes showed periodicity and slow growth,peaking every second and third quarter of the year and daily at 8:00-9:00 a.m.and 2:00-3:00 p.m.The ARIMA model demonstrated a good fit(R2=0.692,mean absolute percentage error=8.28%).After adjusting the nursing staff allocation based on the fluctuation characteristics of the number of phlebotomy per hour in the time series analysis model,at the peak period of the blood collection window,at least three nurses,one mobile nurse and two volunteers were added.The number of phlebotomy per hour increased from 289.74±54.55 to 327.53±37.84 person-time(t=-10.041,P<0.01),waiting time decreased from 5.79±2.68 to 4.01±0.46 min(t=11.531,P<0.01),and satisfaction rose from 92.7%to 97.3%(χ^(2)=6.877,P<0.05).Conclusions:Based on the time series analysis method,it is helpful for nursing managers to accurately allocate human resources and optimize the efficiency of outpatient service resources by mining the special change rule of the outpatient blood collection window and predicting the future fluctuation trend.展开更多
Background:This study investigated the relationship between meteorological factors and daily outpatient visits to rabies post-exposure prophylaxis clinics to inform animal injury prevention strategies.Methods:Daily ou...Background:This study investigated the relationship between meteorological factors and daily outpatient visits to rabies post-exposure prophylaxis clinics to inform animal injury prevention strategies.Methods:Daily outpatient visit data from rabies post-exposure prophylaxis clinics in Jinan and corresponding meteorological data were collected from January 1,2020,to December 31,2022.A generalized additive model was used to quantitatively assess the relationship between these factors.A total of 202,010 patients visited these clinics during this period.Results:Daily mean,maximum,and minimum temperatures,and relative humidity were positively associated with outpatient visits.A 1°C increase in mean,maximum,and minimum temperatures corresponded to increases in daily visits of 1.65%(95%Confidence Interval(CI):1.55–1.76),1.59%(95%CI:1.50–1.69),and 1.27%(95%CI:1.17–1.36)respectively.Each 1%increase in relative humidity was associated with a 0.18%(95%CI:0.15–0.20)increase in visits.Mean pressure was negatively associated with outpatient visits,the outpatient visits decreased by 0.91%(95%CI:−1.71 to−0.11)for every 1 kPa increased in mean pressure.Conclusion:The change of meteorological factors will lead to the increase of outpatient visits in rabies exposure treatment clinic.展开更多
BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safel...BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.展开更多
Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and manageme...Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and management.Methods In this cross-sectional study,consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain(IASP)criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025.CNCP was diagnosed based on the Neuropathic Pain Special Interest Group(NeuPSIG)criteria.Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria,regardless of coexisting visceral or bone pain.Demographic,oncologic,and pain-related data were collected through standardized interviews.Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests.Logistic regression analyses were conducted to identify clinical factors associated with CNCP.Results Of 138 eligible patients with CCP,85(61.6%)were classified into the CNCP group and 53(38.4%)into the non-CNCP group.Multivariable logistic regression analysis revealed that bone metastasis(adjusted OR=2.316,95%CI:1.074-5.178,P=0.032),radiotherapy(adjusted OR=2.489,95%CI:1.119-5.803,P=0.025),and voiding dysfunction(adjusted OR=5.470,95%CI:2.150-16.396,P<0.001)were independently associated with CNCP.Pancreatic cancer was inversely associated with CNCP(OR=0.371,P=0.031).Only 5(3.6%)patients in the CNCP group received neuropathic pain-specific interventions,indicating a predominant reliance on single-modality pain management.Conclusions CNCP was present in nearly two-thirds of outpatients with CCP.The identified associations with bone metastasis,radiotherapy,and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.展开更多
BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with hig...BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with higher prevalence among females and the elderly.While existing research suggests a bidirectional relationship between insomnia and emotional disorders,the specific impact of insomnia severity on depression,anxiety,and quality of life remains unclear.This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients,hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety,as well as poorer quality of life.AIM To explore the correlation between insomnia severity and depression,anxiety,and quality of life in primary chronic insomnia patients.METHODS From June to December 2023,345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index(PSQI)scores:Mild(n=137),moderate(n=162),and severe(n=46).Demographic data were collected via questionnaires.Self-rating depression scale(SDS),self-rating anxiety scale(SAS),PSQI,and short form 36(SF-36)scores were compared,and Pearson and partial correlation analyses were performed.RESULTS The greater the degree of insomnia,the greater the symptoms of depression and anxiety(P<0.001).The more severe the insomnia,the lower the SF-36 score(excluding body pain),and the difference between the three groups was statist ically significant(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia(P<0.05).CONCLUSION Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients.Higher depression/anxiety levels correlate with worse insomnia,impacting quality of life.展开更多
BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatie...BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatient clinics in these hospitals.AIM To establish precision valuation reservation registration aimed at shortening waiting time,improving patient experience and promoting the satisfaction of outpatients and medical staff.METHODS On the basis of the implementation of a conventional appointment system,more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients,and appointment times were made more accurate through intervention.The change in consultation waiting time of patients was then compared.Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed.RESULTS After precision valuation reservation registration,the average consultation waiting time of patients reduced from 18.47 min to 10.11 min(t=8.90,P<0.001).The satisfaction score of patients increased from 91.33 to 96.27(t=-8.62,P<0.001),and the satisfaction score of medical staff increased from 90.51 to 96.04(t=-10.50,P<0.001).The consultation waiting time of patients was negatively correlated with their satisfaction scores(γ=-0.89,P<0.001).The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores(γ=-0.96,P<0.001).CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff.This approach played an important role in improving outpatient services,provided a model that is supported by relevant evidence and could continuously improve the quality of management.Precision valuation reservation registration is worth promoting and applying in the clinic.展开更多
Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The ...Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The time from AN debut to the treatment initiation is normally unreasonably long.Over the past 20 years there has been empirical support for the efficacy of several treatments for AN.Moreover,outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients.Early intervention improves outcomes and should be a priority for all patients.Outpatient treatment is usually the best format for early intervention,and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable.Inpatient care is more disruptive,more costly,and usually has a longer waiting list than does outpatient care.The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult.The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN.The scientific essentials for outpatient treatment are described,including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated.The following aspects are discussed:early intervention,outpatient treatment of AN,including outpatient psychotherapy for severe and extreme AN,how to determine when outpatient treatment is safe,and when transfer to inpatient healthcare is indicated.Emerging treatments,ethical issues and outstanding research questions are also addressed.展开更多
Based on the outpatient interview and literature review, the initial framework of the outpatient experience of human caring scale was formed with 9 dimensions of outpatient process. The research aim was to improve the...Based on the outpatient interview and literature review, the initial framework of the outpatient experience of human caring scale was formed with 9 dimensions of outpatient process. The research aim was to improve the scale by Delphi method. Sixteen experts in medical management, human caring or medical education were invited to evaluate the importance of the dimensions and items of the scale and provided some expertise via filling out the DeLphi consultation questionnaires twice in the consulting round. In the first round, the recovery rate showing the experts＇ positivity was 80%; the coefficient of reliability （Cr） ascertaining the authority of the evaluation was 0.92; the mean and full mark ratios responding the concentration of the evaluation were 2.88-4.94 and 6.25%-93.75% respectively; the coefficients of variation （CV） and the Kendall＇s W determining the concordance of the evaluation were 5.06%-52.15% and 0.21-0.24 respectively. In the second round, the recovery rate was 93.75%; the Cr was 0.93; the mean was 3.93-4.93; the full mark ratios were 26.67%-93.33%; the Kendall＇s W was 0.14- 0.31, the CV was 5.25%-23.61%. Via the two-round Delphi study, the scale that included 10 dimensions and 61 items has been improved. Ten dimensions are pre-hospital medical service, guidance, registration, waiting, diagnosis ＆ treatment, paying, inspection ＆ assay, medicine receiving, therapy/injection/transfusion and global evaluation. It was concluded that Chinese scholars have paid high attention to human caring and outpatient experience. The experts have given high agreements about the dimensions which were established with Chinese outpatient process. The dimensions are different from the similar researches about outpatient experience study. In the future, it is necessary to survey the outpatients to test the construct validity, internal consistency reliability and others of the scale to improve the scale.展开更多
Hypertriglyceridemic pancreatitis(HTGP) accounts for up to 10% of acute pancreatitis presentations in nonpregnant individuals and is the third most common cause of acute pancreatitis after alcohol and gallstones. Ther...Hypertriglyceridemic pancreatitis(HTGP) accounts for up to 10% of acute pancreatitis presentations in nonpregnant individuals and is the third most common cause of acute pancreatitis after alcohol and gallstones. There are a number of retrospective studies and case reports that have suggested a role for apheresis and insulin infusion in the acute inpatient setting. We report a case of HTGP in a male with hyperlipoproteinemia type Ⅲ who was treated successfully with insulin and apheresis on the initial inpatient presentation followed by bi-monthly outpatient maintenance apheresis sessions for the prevention of recurrent HTGP. We also reviewed the literature for the different inpatient and outpatient management modalities of HTGP. Given that there are no guidelines or randomized clinical trials that evaluate the outpatient management of HTGP, this case report may provide insight into a possible role for outpatient apheresis maintenance therapy.展开更多
AIM:To investigate the prevalence and physicians' detection rate of depressive and anxiety disorders in gastrointestinal(GI)outpatients across China. METHODS:A hospital-based cross-sectional survey was conducted i...AIM:To investigate the prevalence and physicians' detection rate of depressive and anxiety disorders in gastrointestinal(GI)outpatients across China. METHODS:A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals.A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale(HADS).The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results.Subjects with HADS scores≥8 were subsequently interviewed by psychiatrists using the Mini International Neuropsy-chiatric Interview(MINI)to make further diagnoses. RESULTS:There were 1059 patients with HADS score ≥8 and 674(63.64%)of them undertook the MINI interview by psychiatrists.Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition),the adjusted current prevalence for depressive disorders,anxiety disorders,and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42%and 4.66%,respectively.Prevalence of depressive disorders with suicidal problems[suicide attempt or suicide-related ideation prior or current;module C (suicide)of MINI score≥1]was 5.84%in women and 1.64%in men.The GI physicians'detection rate of depressive and anxiety disorders accounted for 4.14%. CONCLUSION:While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients, the detection rate of depressive and anxiety disorders by physicians is low.展开更多
Eczema is a very common inflammatory skin disease characterized by patches of erythematous,itchy, cracked, and scaly skin.According to the 2010 Global Burden of Disease Study, the global prevalence of eczema is 3.33% ...Eczema is a very common inflammatory skin disease characterized by patches of erythematous,itchy, cracked, and scaly skin.According to the 2010 Global Burden of Disease Study, the global prevalence of eczema is 3.33% and the leading cause of skin condition-based disability-adjusted life years is eczema[1].The large health burden brought about by eczema suggests high direct medical costs and health care utilization[2].Thus, eczema prevention is of great importance in efforts to eliminate the public health burden of the disease.展开更多
BACKGROUND: Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has no...BACKGROUND: Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC. METHODS: Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. RESULTS: One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Followup showed that 90% of the patients were satisfied with the procedure. In the OPLC group, 99% of the patients underwent the procedure with a median operative time of 21.6 minutes and bleeding of 14.7 ml. The patients took liquid 11.3 hours then soft diet 20.1 hours after surgery. The mean postoperative hospital stay was 28.5 hours. In this group, 89% of the patients were discharged within the first 24 hours, and the remaining 11% were released within 48 hours after surgery. Two patients developed local complications. The cost for surgery and hospitalization was 7235.7 RMB yuan, which was 17.5% less than that in the IPLC group. At follow-up, 94% of the patients were satisfied with the surgery and short hospital stay. CONCLUSIONS: OPLC can effectively treat a variety of benign, non-acute gallbladder diseases with shortened waiting time and postoperative hospital stay. OPLC benefits the hospital with a rapid bed turnover rate, and reduces cost for surgery and hospitalization.展开更多
Asthma is a common chronic inflammatory disorder that is more prevalent in children than in adults.China has seen an increasing prevalence of childhood asthma in recentdecades[1].Earlier studies have shown that air pa...Asthma is a common chronic inflammatory disorder that is more prevalent in children than in adults.China has seen an increasing prevalence of childhood asthma in recentdecades[1].Earlier studies have shown that air particulate matter (PM),particularly fine particulate matter(PM2.5)[2],is an important factor triggering childhood asthma. Since nationalPM2.5data were nota vailabl euntil 2013,展开更多
The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the rela...The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold （first percentiles of temperature throughout the study period） and cold （10th percentile of temperature） temperature over lags 0-14 d were 2.98 [95% confidence intervals （CI）： 1.77, 5.04] and 1.63 （95% Ch 1.21, 2.19）, compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.展开更多
Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics(CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the...Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics(CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format(i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT(IOP CBIT) for the treatment of 2 preadolescent males(ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evi-denced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients' treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.展开更多
Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis ...Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data（2010-2011）.Results Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai.The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants.For lag06,a 10 μg/m3 increase in the concentrations of PM10,SO2,and NO2 corresponded to 0.94%（95% CI：0.83%,1.05%）,11.12%（95% CI：10.76%,11.48%）,and 4.84%（95% CI：4.49%,5.18%） increases in hospital visits for acute bronchitis,respectively.These associations appeared to be stronger in females（P〈0.05）.Between-age differences were significant for SO2（P〈0.05）,and between-season differences were also significant for SO2（P〈0.05）.Conclusion Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.展开更多
Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional stu...Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation(40.3%) and maintenance treatment(40.7%). The total economic burden of epilepsy was US$ 1143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized,using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.展开更多
BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for childre...BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.展开更多
AIM Acute upper gastrointestinal hemorrhage is a common reason for hospitalization. Clinical and endoscopic characteristics predict outcome. The aim of this study was to determine the characteristics and outcome of p...AIM Acute upper gastrointestinal hemorrhage is a common reason for hospitalization. Clinical and endoscopic characteristics predict outcome. The aim of this study was to determine the characteristics and outcome of patients with acute upper gastrointestinal hemorrhage cared for without hospitalization. METHODS One hundred seventy six consecutive patients in a staff model health maintenance organization were selected for outpatient care based on absolute endoscopic and non absolute clinical criteria. Clinical and endoscopic characteristics, British national audit “risk scores”, and rates of recurrent bleeding, hospitalization, and mortality were determined. RESULTS Mean patient age (±SD) was 56 4±16 0 years, and 106 patients (60%) were men. One hundred one (57%) had endoscopy within 2 days of the onset of hemorrhage. The mean initial hemoglobin concentration was 11 7mg/dL±2 3mg/dL. Ninety seven patients (55%) had a peptic ulcer, and 57 (32%) had a British risk score greater than 2. Hospitalization, recurrent bleeding, and mortality occurred in two (1%), one (1%), and zero (0%) patients, respectively, during 16 0±10 8 months of follow up. CONCLUSION Many patients with acute upper gastrointestinal hemorrhage can be safely treated as outpatients using endoscopic and clinical guidelines.展开更多
文摘Objective:To explore the self-management experiences and outpatient nursing needs of intestinal stoma patients during the post-discharge transition period,in order to provide a basis for scientific decision-making in patient self-care and improvements in specialized stoma outpatient services.Methods:Using purposive sampling,13 colorectal cancer patients in the post-discharge transition period who had undergone intestinal stoma surgery were selected from a tertiary hospital in Shandong Province between November 2024 and March 2025.Semi-structured interviews were conducted,and data were analyzed using Colaizzi’s seven-step method to extract themes.Results:Three core themes were identified:challenges in self-management during the transition period,outpatient nursing needs during the transition period,and gaps in doctor-patient information continuity.Conclusion:Future efforts should focus on high-risk groups of stoma patients during the transition period by building intelligent and systematic outpatient guidance and support systems to improve their quality of life.
基金funded by the Nursing project,“Clinical ability improvement project”in the First Affliated Hospital with Nanjing Medical University(JSPH-NC-2021-09).
文摘Objectives:This study aimed to explore the characteristics of outpatient blood collection center visit fluctuation and nursing workforce allocation based on a time series model,and the application effect was evaluated.Methods:To enhance the efficiency of phlebotomy at the hospital outpatient window and improve patient satisfaction,the First Affliated Hospital with Nanjing Medical University implemented a time series analysis model in 2024 to optimize nursing staff allocation.The management team was led by a head nurse of the outpatient blood collection department with extensive experience.It included one director of the nursing department,six senior clinical nurses,one informatics expert,and one nursing master's degree holder.Retrospective time-series data from the hospital's smart blood collection system(including hourly blood collection volumes and waiting times)were extracted between January 2020 and December 2023.Time series analysis was used to identify annual,seasonal,monthly,and hourly variation patterns in blood collection volumes.Seasonal decomposition and the Autoregressive Integrated Moving Average Model(ARIMA)were employed to forecast blood collection fluctuations for 2024 and facilitate dynamic scheduling.A comparison was conducted to evaluate differences in blood collection efficiency and patient satisfaction before(January-June 2023)and after(January-June 2024)implementing the dynamic scheduling model based on the time series analysis and forecasting.Results:Visit volumes showed periodicity and slow growth,peaking every second and third quarter of the year and daily at 8:00-9:00 a.m.and 2:00-3:00 p.m.The ARIMA model demonstrated a good fit(R2=0.692,mean absolute percentage error=8.28%).After adjusting the nursing staff allocation based on the fluctuation characteristics of the number of phlebotomy per hour in the time series analysis model,at the peak period of the blood collection window,at least three nurses,one mobile nurse and two volunteers were added.The number of phlebotomy per hour increased from 289.74±54.55 to 327.53±37.84 person-time(t=-10.041,P<0.01),waiting time decreased from 5.79±2.68 to 4.01±0.46 min(t=11.531,P<0.01),and satisfaction rose from 92.7%to 97.3%(χ^(2)=6.877,P<0.05).Conclusions:Based on the time series analysis method,it is helpful for nursing managers to accurately allocate human resources and optimize the efficiency of outpatient service resources by mining the special change rule of the outpatient blood collection window and predicting the future fluctuation trend.
基金supported by Chinese Association of Preventive Medicine-Vaccine and Immunization Youth Talent Support Project(CPMAQT-YM0314)Shandong medical and health science and technology development plan project(202012050267)Shandong Center for Disease Control and Prevention-Youth Innovation Fund Project(QC-202301).
文摘Background:This study investigated the relationship between meteorological factors and daily outpatient visits to rabies post-exposure prophylaxis clinics to inform animal injury prevention strategies.Methods:Daily outpatient visit data from rabies post-exposure prophylaxis clinics in Jinan and corresponding meteorological data were collected from January 1,2020,to December 31,2022.A generalized additive model was used to quantitatively assess the relationship between these factors.A total of 202,010 patients visited these clinics during this period.Results:Daily mean,maximum,and minimum temperatures,and relative humidity were positively associated with outpatient visits.A 1°C increase in mean,maximum,and minimum temperatures corresponded to increases in daily visits of 1.65%(95%Confidence Interval(CI):1.55–1.76),1.59%(95%CI:1.50–1.69),and 1.27%(95%CI:1.17–1.36)respectively.Each 1%increase in relative humidity was associated with a 0.18%(95%CI:0.15–0.20)increase in visits.Mean pressure was negatively associated with outpatient visits,the outpatient visits decreased by 0.91%(95%CI:−1.71 to−0.11)for every 1 kPa increased in mean pressure.Conclusion:The change of meteorological factors will lead to the increase of outpatient visits in rabies exposure treatment clinic.
文摘BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.
文摘Objective To determine the prevalence,distribution,and associated clinical factors of chronic neuropathic cancer pain(CNCP)among outpatients with chronic cancer pain(CCP)and to inform improved recognition and management.Methods In this cross-sectional study,consecutive outpatients with CCP diagnosed according to the International Association for the Study of Pain(IASP)criteria were recruited from the pain clinic at Peking Union Medical College Hospital between June and October 2025.CNCP was diagnosed based on the Neuropathic Pain Special Interest Group(NeuPSIG)criteria.Patients were classified into the CNCP group if they met at least one of the four NeuPSIG criteria,regardless of coexisting visceral or bone pain.Demographic,oncologic,and pain-related data were collected through standardized interviews.Between-group differences in baseline characteristics were assessed using absolute standardized differences and Chi-square or t-tests.Logistic regression analyses were conducted to identify clinical factors associated with CNCP.Results Of 138 eligible patients with CCP,85(61.6%)were classified into the CNCP group and 53(38.4%)into the non-CNCP group.Multivariable logistic regression analysis revealed that bone metastasis(adjusted OR=2.316,95%CI:1.074-5.178,P=0.032),radiotherapy(adjusted OR=2.489,95%CI:1.119-5.803,P=0.025),and voiding dysfunction(adjusted OR=5.470,95%CI:2.150-16.396,P<0.001)were independently associated with CNCP.Pancreatic cancer was inversely associated with CNCP(OR=0.371,P=0.031).Only 5(3.6%)patients in the CNCP group received neuropathic pain-specific interventions,indicating a predominant reliance on single-modality pain management.Conclusions CNCP was present in nearly two-thirds of outpatients with CCP.The identified associations with bone metastasis,radiotherapy,and voiding dysfunction may aid in the early recognition of neuropathic pain components and support the adoption of mechanism-based multimodal pain management strategies.
文摘BACKGROUND Insomnia is a common sleep disorder that negatively impacts quality of life and is frequently comorbid with depression and anxiety.Chronic insomnia affects approximately 15%of the global population,with higher prevalence among females and the elderly.While existing research suggests a bidirectional relationship between insomnia and emotional disorders,the specific impact of insomnia severity on depression,anxiety,and quality of life remains unclear.This study investigates the correlation between insomnia severity and these factors in psychiatric outpatients,hypothesizing that greater insomnia severity is associated with higher levels of depression and anxiety,as well as poorer quality of life.AIM To explore the correlation between insomnia severity and depression,anxiety,and quality of life in primary chronic insomnia patients.METHODS From June to December 2023,345 patients with primary insomnia in Chifeng city were recruited and divided into three groups based on Pittsburgh sleep quality index(PSQI)scores:Mild(n=137),moderate(n=162),and severe(n=46).Demographic data were collected via questionnaires.Self-rating depression scale(SDS),self-rating anxiety scale(SAS),PSQI,and short form 36(SF-36)scores were compared,and Pearson and partial correlation analyses were performed.RESULTS The greater the degree of insomnia,the greater the symptoms of depression and anxiety(P<0.001).The more severe the insomnia,the lower the SF-36 score(excluding body pain),and the difference between the three groups was statist ically significant(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SDS score and SAS score were apparently positively correlated with the severity of insomnia(P<0.001).Pearson correlation analysis and partial correlation analysis depicted the SF-36 scores were apparently positively correlated with the severity of insomnia(P<0.05).CONCLUSION Depression and anxiety are independent factors influencing insomnia severity in primary chronic insomnia patients.Higher depression/anxiety levels correlate with worse insomnia,impacting quality of life.
文摘BACKGROUND Due to improvements in living standards,people are now paying more attention to their health.In China,more patients choose to go to large or well-known hospitals,which leads to constant crowding of outpatient clinics in these hospitals.AIM To establish precision valuation reservation registration aimed at shortening waiting time,improving patient experience and promoting the satisfaction of outpatients and medical staff.METHODS On the basis of the implementation of a conventional appointment system,more reasonable time intervals were set for different doctors by evaluating the actual capacity of each doctor to receive patients,and appointment times were made more accurate through intervention.The change in consultation waiting time of patients was then compared.Correlations between the consultation waiting time of patients and the satisfaction of patients or satisfaction of medical staff were analyzed.RESULTS After precision valuation reservation registration,the average consultation waiting time of patients reduced from 18.47 min to 10.11 min(t=8.90,P<0.001).The satisfaction score of patients increased from 91.33 to 96.27(t=-8.62,P<0.001),and the satisfaction score of medical staff increased from 90.51 to 96.04(t=-10.50,P<0.001).The consultation waiting time of patients was negatively correlated with their satisfaction scores(γ=-0.89,P<0.001).The consultation waiting time of patients was also negatively correlated with medical staff satisfaction scores(γ=-0.96,P<0.001).CONCLUSION Precision valuation reservation registration significantly shortened outpatient waiting times and improve the satisfaction of not only patients but also medical staff.This approach played an important role in improving outpatient services,provided a model that is supported by relevant evidence and could continuously improve the quality of management.Precision valuation reservation registration is worth promoting and applying in the clinic.
文摘Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The time from AN debut to the treatment initiation is normally unreasonably long.Over the past 20 years there has been empirical support for the efficacy of several treatments for AN.Moreover,outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients.Early intervention improves outcomes and should be a priority for all patients.Outpatient treatment is usually the best format for early intervention,and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable.Inpatient care is more disruptive,more costly,and usually has a longer waiting list than does outpatient care.The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult.The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN.The scientific essentials for outpatient treatment are described,including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated.The following aspects are discussed:early intervention,outpatient treatment of AN,including outpatient psychotherapy for severe and extreme AN,how to determine when outpatient treatment is safe,and when transfer to inpatient healthcare is indicated.Emerging treatments,ethical issues and outstanding research questions are also addressed.
文摘Based on the outpatient interview and literature review, the initial framework of the outpatient experience of human caring scale was formed with 9 dimensions of outpatient process. The research aim was to improve the scale by Delphi method. Sixteen experts in medical management, human caring or medical education were invited to evaluate the importance of the dimensions and items of the scale and provided some expertise via filling out the DeLphi consultation questionnaires twice in the consulting round. In the first round, the recovery rate showing the experts＇ positivity was 80%; the coefficient of reliability （Cr） ascertaining the authority of the evaluation was 0.92; the mean and full mark ratios responding the concentration of the evaluation were 2.88-4.94 and 6.25%-93.75% respectively; the coefficients of variation （CV） and the Kendall＇s W determining the concordance of the evaluation were 5.06%-52.15% and 0.21-0.24 respectively. In the second round, the recovery rate was 93.75%; the Cr was 0.93; the mean was 3.93-4.93; the full mark ratios were 26.67%-93.33%; the Kendall＇s W was 0.14- 0.31, the CV was 5.25%-23.61%. Via the two-round Delphi study, the scale that included 10 dimensions and 61 items has been improved. Ten dimensions are pre-hospital medical service, guidance, registration, waiting, diagnosis ＆ treatment, paying, inspection ＆ assay, medicine receiving, therapy/injection/transfusion and global evaluation. It was concluded that Chinese scholars have paid high attention to human caring and outpatient experience. The experts have given high agreements about the dimensions which were established with Chinese outpatient process. The dimensions are different from the similar researches about outpatient experience study. In the future, it is necessary to survey the outpatients to test the construct validity, internal consistency reliability and others of the scale to improve the scale.
文摘Hypertriglyceridemic pancreatitis(HTGP) accounts for up to 10% of acute pancreatitis presentations in nonpregnant individuals and is the third most common cause of acute pancreatitis after alcohol and gallstones. There are a number of retrospective studies and case reports that have suggested a role for apheresis and insulin infusion in the acute inpatient setting. We report a case of HTGP in a male with hyperlipoproteinemia type Ⅲ who was treated successfully with insulin and apheresis on the initial inpatient presentation followed by bi-monthly outpatient maintenance apheresis sessions for the prevention of recurrent HTGP. We also reviewed the literature for the different inpatient and outpatient management modalities of HTGP. Given that there are no guidelines or randomized clinical trials that evaluate the outpatient management of HTGP, this case report may provide insight into a possible role for outpatient apheresis maintenance therapy.
基金Supported by The former Wyeth Pharmaceutical Co.,Ltd., Madison,NJ,United States
文摘AIM:To investigate the prevalence and physicians' detection rate of depressive and anxiety disorders in gastrointestinal(GI)outpatients across China. METHODS:A hospital-based cross-sectional survey was conducted in the GI outpatient departments of 13 general hospitals.A total of 1995 GI outpatients were recruited and screened with the Hospital Anxiety and Depression Scale(HADS).The physicians of the GI departments performed routine clinical diagnosis and management without knowing the HADS score results.Subjects with HADS scores≥8 were subsequently interviewed by psychiatrists using the Mini International Neuropsy-chiatric Interview(MINI)to make further diagnoses. RESULTS:There were 1059 patients with HADS score ≥8 and 674(63.64%)of them undertook the MINI interview by psychiatrists.Based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (4th edition),the adjusted current prevalence for depressive disorders,anxiety disorders,and comorbidity of both disorders in the GI outpatients was 14.39%, 9.42%and 4.66%,respectively.Prevalence of depressive disorders with suicidal problems[suicide attempt or suicide-related ideation prior or current;module C (suicide)of MINI score≥1]was 5.84%in women and 1.64%in men.The GI physicians'detection rate of depressive and anxiety disorders accounted for 4.14%. CONCLUSION:While the prevalence of depressive and anxiety disorders is high in Chinese GI outpatients, the detection rate of depressive and anxiety disorders by physicians is low.
基金supported by the Key Project of Natural Science Funds of China [No.81230066]the National Natural Science Fund Projects of China [No.81473043]
文摘Eczema is a very common inflammatory skin disease characterized by patches of erythematous,itchy, cracked, and scaly skin.According to the 2010 Global Burden of Disease Study, the global prevalence of eczema is 3.33% and the leading cause of skin condition-based disability-adjusted life years is eczema[1].The large health burden brought about by eczema suggests high direct medical costs and health care utilization[2].Thus, eczema prevention is of great importance in efforts to eliminate the public health burden of the disease.
基金supported by a grant from the Special Purpose Fund of the Medical Science Project of the PLA (08Z007)
文摘BACKGROUND: Outpatient laparoscopic cholecystectomy (OPLC) developed in the United States and other developed countries as one of the fast-track surgeries performed in ambulatory centers. However, this practice has not been installed as a routine practice in the major general hospitals and medical centers in China. We designed this case-control study to evaluate the feasibility, benefits, and safety of OPLC. METHODS: Two hundred patients who had received laparoscopic cholecystectomy for various benign gallbladder pathologies from April 2007 to December 2008 at Jinling Hospital of Nanjing University School of Medicine were classified into two groups: OPLC group (100 patients), and control group (100), who were designated for inpatient laparoscopic cholecystectomy (IPLC). Data were collected for age, gender, indications for surgery, American Society of Anesthesiology (ASA) class, operative time, blood loss during surgery, length of hospitalization, and intra- and post-operative complications. The expenses of surgery and in-hospital care were calculated and analyzed. The operative procedures and instrumentation were standardized for laparoscopic cholecystectomy, and the procedures were performed by two attending surgeons specialized in laparoscopic surgery. OPLC was selected according to the standard criteria developed by surgeons in our hospital after review. Reasons for conversion from laparoscopic to open cholecystectomy were recorded and documented. RESULTS: One hundred patients underwent IPLC following the selection criteria for the procedure, and 99% completed the procedure. The median operative time for IPLC was 24.0 minutes, blood loss was 16.2 ml, and the time for resuming liquid then soft diet was 10.7 hours and 22.0 hours, respectively. Only one patient had postoperative urinary infection. The mean hospital stay for IPLC was 58.2 hours, and the cost for surgery and hospitalization was 8770.5 RMB yuan on average. Followup showed that 90% of the patients were satisfied with the procedure. In the OPLC group, 99% of the patients underwent the procedure with a median operative time of 21.6 minutes and bleeding of 14.7 ml. The patients took liquid 11.3 hours then soft diet 20.1 hours after surgery. The mean postoperative hospital stay was 28.5 hours. In this group, 89% of the patients were discharged within the first 24 hours, and the remaining 11% were released within 48 hours after surgery. Two patients developed local complications. The cost for surgery and hospitalization was 7235.7 RMB yuan, which was 17.5% less than that in the IPLC group. At follow-up, 94% of the patients were satisfied with the surgery and short hospital stay. CONCLUSIONS: OPLC can effectively treat a variety of benign, non-acute gallbladder diseases with shortened waiting time and postoperative hospital stay. OPLC benefits the hospital with a rapid bed turnover rate, and reduces cost for surgery and hospitalization.
基金supported by the Development Foundation of Shanghai Meteorological and Health Key Laboratory [QXJK201606]the Investigation of Science&Technology Basic Resources Program of China [2017FY101206]the General Program Foundation of Hebei Meteorological Bureau [17KY10]
文摘Asthma is a common chronic inflammatory disorder that is more prevalent in children than in adults.China has seen an increasing prevalence of childhood asthma in recentdecades[1].Earlier studies have shown that air particulate matter (PM),particularly fine particulate matter(PM2.5)[2],is an important factor triggering childhood asthma. Since nationalPM2.5data were nota vailabl euntil 2013,
基金supported by the National Clinical key subject construction funds(occupational disease program)the National Basic Research Program(973 program)of China(2011CB503802)+3 种基金Gong-Yi Program of China Ministry of Environmental Protection(201209008)China Medical Board Collaborating Program(13-152)Public Welfare Research Program of National HealthFamily Planning Commission of China(201402022)
文摘The association between ambient temperature and acute exacerbation of chronic bronchitis （AECB） was still unknown. Therefore, we performed an epidemiological study in a large hospital of Shanghai to explore the relationship about temperature and outpatient visit for AECB. We adopted a quasi-Poisson generalized additive models and distributed lag nonlinear models to estimate the accumulative effects of temperature on AECB across multiple days. We found significant non-linear effects of cold temperature on hospital visits for AECB, and the potential effect of cold temperature might last more than 2 weeks. The relative risks of extreme cold （first percentiles of temperature throughout the study period） and cold （10th percentile of temperature） temperature over lags 0-14 d were 2.98 [95% confidence intervals （CI）： 1.77, 5.04] and 1.63 （95% Ch 1.21, 2.19）, compared with the 25th percentile of temperature. However, we found no positive association between hospital visits and hot weather. This study showed that exposure to both extreme cold and cold temperatures were associated with increased outpatient visits for AECB in a large hospital of Shanghai.
文摘Recent randomized clinical trials have established the efficacy of Comprehensive Behavioral Intervention for Tics(CBIT) in treating children and adults with Tourette syndrome and persistent tic disorders. However, the standard CBIT protocol uses a weekly outpatient treatment format(i.e., 8 sessions over 10 wk), which may be inconvenient or impractical for some patients, particularly patients, who are required to travel long distances in order to receive care. In contrast, an intensive outpatient program may increase accessibility to evidence-based behavioral treatments for Tourette syndrome and other persistent tic disorders by eliminating the necessity of repeated travel. This case series evaluated the use of an intensive outpatient program CBIT(IOP CBIT) for the treatment of 2 preadolescent males(ages 10 and 14 years) with Tourette syndrome. The IOP CBIT treatment protocol included several hours of daily treatment over a 4-d period. Both children evi-denced notable reductions in their tics and maintained treatment gains at follow-up. Moreover, both patients and their parents expressed treatment satisfaction with the IOP CBIT format. This case series addresses an important research gap in the behavioral treatment of tic disorders literature. The patients' treatment outcomes indicate that IOP CBIT is a promising treatment that warrants more systematic investigation.
基金supported by the National Clinical Key Subject Construction for founds(occupational disease Program),the National Basic Research Program(973 program)of China(2011CB503802)National Natural Science Foundation of China(81222036)Gong-Yi Program of China Ministry of Environmental Protection(201209008)
文摘Objective To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis,which is a rare subject of research in the mainland of China.Methods A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data（2010-2011）.Results Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai.The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants.For lag06,a 10 μg/m3 increase in the concentrations of PM10,SO2,and NO2 corresponded to 0.94%（95% CI：0.83%,1.05%）,11.12%（95% CI：10.76%,11.48%）,and 4.84%（95% CI：4.49%,5.18%） increases in hospital visits for acute bronchitis,respectively.These associations appeared to be stronger in females（P〈0.05）.Between-age differences were significant for SO2（P〈0.05）,and between-season differences were also significant for SO2（P〈0.05）.Conclusion Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.
文摘Objective: To better understand the economic burden of patients with epilepsy receiving outpatient services in China and to analyze potential factors influencing epileptic economic burden through a cross-sectional study. Methods: Using a self-designed questionnaire, we collected information retrospectively from 754 patients with epilepsy evaluated in neurology clinics in Shanghai Municipality, Shanxi Province and Sichuan Province. Descriptive analyses were used after cost variables were presented as logarithms, and multiple linear regressions were performed to explore influencing factors. Results: Fifty percent of the investigated patients experienced an epilepsy attack before the age of 15, and 51.3% had suffered from epilepsy for more than five years. In the past year, 87.9% of patients had visited different hospitals multiple times for evaluation(40.3%) and maintenance treatment(40.7%). The total economic burden of epilepsy was US$ 1143.2. The average direct economic burden and indirect economic burden were US$ 939.0 and US$ 110.2, respectively. Multiple linear regressions showed that patients had to bear greater economic burden if they were hospitalized,using multiple antiepileptic drugs, experiencing illness for less than 5 years, in severe seizure index or active epilepsy with drug resistance, which was statistically significant. Totally only14.3% of patients could get reimbursement in outpatient services. Conclusions: Patients with epilepsy must present to hospitals regularly for satisfactory prognosis, which results in economic burden. Patients bear greater economic burden, especially direct medical costs, if they are newly diagnosed, experience severe seizures, or undergo multiple drug treatments that require more frequent monitoring. However, current insurance policy for outpatient services do not help reduce economic burden of patients efficiently.
基金This study was supported by the Science and Technology Innovation-Biomedical Supporting Program of Shanghai Science and Technology Committee(19441904400)Program for artificial intelligence innovation and development of Shanghai Municipal Commission of Economy and Informatization(2020-RGZN-02048).
文摘BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.
文摘AIM Acute upper gastrointestinal hemorrhage is a common reason for hospitalization. Clinical and endoscopic characteristics predict outcome. The aim of this study was to determine the characteristics and outcome of patients with acute upper gastrointestinal hemorrhage cared for without hospitalization. METHODS One hundred seventy six consecutive patients in a staff model health maintenance organization were selected for outpatient care based on absolute endoscopic and non absolute clinical criteria. Clinical and endoscopic characteristics, British national audit “risk scores”, and rates of recurrent bleeding, hospitalization, and mortality were determined. RESULTS Mean patient age (±SD) was 56 4±16 0 years, and 106 patients (60%) were men. One hundred one (57%) had endoscopy within 2 days of the onset of hemorrhage. The mean initial hemoglobin concentration was 11 7mg/dL±2 3mg/dL. Ninety seven patients (55%) had a peptic ulcer, and 57 (32%) had a British risk score greater than 2. Hospitalization, recurrent bleeding, and mortality occurred in two (1%), one (1%), and zero (0%) patients, respectively, during 16 0±10 8 months of follow up. CONCLUSION Many patients with acute upper gastrointestinal hemorrhage can be safely treated as outpatients using endoscopic and clinical guidelines.
