ObjectivesTo investigate the status quo of follow-up services for patients with cervical spondylosis, to explore its influencing factors, and to provide reference for the follow-up management model after postoperative discharge of patients with cervical spondylosis.MethodsA total of 220 patients with cervical spondylosis were selected by using convenient sampling from October 2018 to May 2019, and the general information questionnaire and the follow-up service needs questionnaire were used for the investigation.ResultsThe score of follow-up service content requirement for patients with cervical spondylosis was 54.87±7.56, and the rehabilitation training instruction was the highest. Multiple linear regression analysis showed that the follow-up service content score was influenced by education level [non-standardized partial regression coefficient (b)=3.186, 95% confidence interval (CI) (2.490, 3.882), P<0.001], length of hospital stay [b=5.140, 95%CI (3.914, 6.365), P<0.001], Neck Disability Index [b=1.326, 95%CI (0.189, 2.463), P=0.022], and age [≥75 years as the reference, 45-59 years: b=3.766, 95%CI (0.671, 6.860), P=0.017; 60-74 years: b=4.081, 95%CI(0.849, 7.314), P=0.014]. The method of obtaining follow-up services was mainly based on outpatient follow-up (85.5%), telephone follow-up (50.5%), and established a follow-up service center (40.5%) for discharged patients. The executives were multidisciplinary teams (60.5%) and hospital-community integration teams (48.2%). There were 19.1% of discharged patients who were willing to pay for relevant follow-up services.ConclusionsPatients with postoperative cervical spondylosis have strong demand for post-discharge follow-up services, which are affected by many factors. Medical staff should pay attention to this and develop a personalized follow-up service plan according to patient characteristics to meet different discharged patients and improve the quality of medical services.
Objective
To summarize the clinical characteristics of interstitial pneumonia with autoimmune features (IPAF).
Methods
The interstitial lung disease (ILD) patients diagnosed in our department between January 2010 and August 2013 were retrospectively analyzed to screen out the patients with IPAF.The clinical manifestations, laboratory examination, imaging, pulmonary function and treatment were summarized.
Results
In 254 ILD patients, 25 patients met the diagnosis criteria of IPAF, and 26 patients were diagnosed with definite connective tissue diseases associated ILD (DCTD-ILD). There were differences in arthralgia, sicca symptoms, mechanic’s hand, positive antinuclear antibodies, anti-CCP antibodies and residual lung volume between the IPAF patients and the DCTD-ILD patients (all P < 0. 05). Five IPAF patients were revealed hug or “pancake” the diaphragm in their chest high resolution CT radiographs. The microscopic performance showed that diffuse thickened with collagen fiber, alveolar wall thickening with marked interstitial lymphocyte inflammatory cells infiltration, and granulation tissue that filled bronchiolar lumina. The patients were pathologically diagnosed with nonspecific interstitial pneumonia (NSIP) overlap organized pneumonia (OP). During following-up, the progression-free survival time of the IPAF patients was significant longer and that of the DCTD-ILD patients [(14.32±5.74)months vs. (10. 31± 3. 70) months, P < 0. 05].
Conclusions
If an ILD patient has mechanic’s hand, positive antinuclear antibodies or NISP overlap OP in image, the diagnosis of IPAF should be considered. IPAF have slower disease progression and better prognosis than DCTD-ILD.
Objective To observe the retinoblastoma (RB) reexamination of children with new and recurrence retinoblastoma under special circumstances.MethodsFrom January 2, 2020 to March 15, 2020, 30 children with RB who had fundus examination in Henan Children's Hospital were enrolled in this study. Among them, 14 were male, 16 were female; 18 were monocular and 12 were binocular. The average age was 37.07±18.15 months. The mean age of initial diagnosis was 20.23±13.77 months. Two patients had a family history (6.67%). In 42 eyes, stage B, C, D and E were 7, 8, 20 and 7 eyes, respectively. Twenty-one eyes had finished the treatment course and 21 eyes were during treatment. All the children underwent RetCam fundus examination, orbital MRI, ocular B-ultrasound and so on. Whether the children had new tumor or recurrence at different treatment stages was observed.ResultsAmong 7 eyes in stage B, there was no recurrence or new tumor at the end of treatment or in the process of treatment. Among 8 eyes in stage C, there were 1 eye with new tumor and 1 eye with activity tumor at the end of treatment. Among 20 eyes in stage D, there were 1 eye with recurrence tumor at the end of treatment, 3 eyes with new tumor and 7 eyes with activity tumor at the end of treatment. Among 7 eyes in stage E, 5 eyes had eyeball enucleation and 2 eyes were receiving treatment; there were 1 eye with activity tumor at the end of treatment, 1 eye with recurrence tumor, 1 eye with activity tumor. Among 18 monocular eyes, there were 11 eyes in the treatment process, 2 eyes with new tumor, 1 eye with recurrence tumor and 3 eyes with activity tumor. Of the 24 binocular eyes, 10 were receiving treatment and there were 3 eyes with new tumor, 6 eyes with activity tumor. Twenty-one eyes had finished the treatment course, the average time required for follow-up was 3.71±0.31 months, and the average time delayed for follow-up was 6.43±1.66 weeks. There was a recurrence of tumor in 1 patient who had finished the whole treatment, the incidence was 4.76%. In the course of treatment, 21 eyes were required to have a follow-up time of 3 weeks, and the average delayed follow-up time was 6.00 ± 1.89 weeks. There were 5 eyes with new tumors, with a incidence of 21.74%. Nine eyes still had activity and needed to be treated in time.ConclusionsThe higher the risk of tumor staging, the more relapses and new tumors. The patients who are being treated, the time of delayed follow-up, the higher the recurrence or new tumor than the children who have finished the treatment course and delayed the follow-up. The children who have relapsed or new tumor in the treatment course of binocular are higher than the children who have monocular.
Objective To build a systematic, comprehensive, high efficient and maneuverable follow-up system in multi-disciplinary team (MDT). Methods Comparing with abroad follow-up practical management, the advantages and disadvantages were analyzed by using multiple follow-up forms and the construct of staffs to guide and evaluate the postoperative patients in colorectal carcinoma at the beginning of follow up system. Results Follow-up system was made rationalized, and an effective follow-up model was built up to extend in MDT. Conclusion Following up the present situation with patients of colorectal cancer in this country, the correct direction which is based on current follow-up system would be put out. That would be the important study to improve the medical treatment in next stage.
Abstract： Objective To analyze the mid-term outcomes after correction of type Ⅰ and type Ⅱ persistent truncus arteriosus in all patients operated in our institution over the past 5 years. Methods Between May 2006 and October 2010, 17 patients, mean age 4.7（ 0.7-19.0）years, underwent repair of truncus arteriosus（ type Ⅰ in 13 and type Ⅱ in 4） in Fu Wai Cardiovascular Hospital. Some other concomitant cardiovascular malformations included truncal valve regurgitation, partial anomalous pulmonary venous connection, mitral regurgitation and atrial septal defect. Their average pulmonary vascular resistance was （4.4±2.2） Wood units detected by cardiac catheterization before operation. Repair with reconstruction of the right ventricular to pulmonary artery continuity was performed using a valved conduit in all 17 patients （aortic homografts in 3, pulmonary homografts in 2, and bovine jugular vein in 12 patients）. Survivors were followed up for assessment of residual heart lesions. Results The early mortality was 5.8% （1/17）. The mean cardiopulmonary bypass time was （165±52） min, mean aortic cross-clamping time was （114±29） min, and mean postoperative ventilation time was （106±148） h. Two patients had pleural effusion after surgery, 2 patients underwent tracheostomy, and other patients recovered uneventfully. The surviving 16 patients were followed up for 0.6-5.0 years. All patients were alive with their original conduit during follow-up. No patient required re-operation for conduit dysfunction after correction. Conclusion Truncus arteriosus remains a challenging congenital heart disease. For patients with type Ⅰ and type Ⅱ persistent truncus arteriosus who have missed their best age for correction, cardiac catheterization should be routinely examined, and the operation should be performed if the pulmonary vascular resistance is under 8 Wood units before operation. Although the short- and mid-term results of surgery are good, more observations are needed to assess its long-term effect.
ObjectiveTo summarize the indication and surgical experiences of valve replacement, high-risk factors and long-term results for aortic regurgitation and large left ventricle.
MethodsWe retrospectively analyzed the clinical data of 42 patients with aortic regurgitation and left ventricle end-diastolic diameter (LVEDD) ≥70 mm and left ventricle end-systolic diameter (LVESD) ≥ 50 mm in our hospital from March 2004 through December 2012. There were 38 males and 4 females,aged 16-73 (45.86±14.99) years. The patients underwent aortic valve replacement, who were evaluated by echocardiography at pre-operation, pre-discharge and early follow-up. The follow up period was 12-132 months.
ResultsEarly death occurred in one patient. And five patients died during the follow-up. One week after surgery in 41 patients, LVEDD (62.00±13.21 mm), LVESD (50.71±14.02 mm), indexed LVEDD (35.23±8.58 mm/m2), indexed LVESD (28.92±9.08 mm/m2), LVEF (46.41%±12.49%), were significantly smaller than those before the operation (P<0.01). Heart function grades, preoperative EF, LVEDD and indexed LVEDD were the predictors for left ventricular function recovery. One-year, 5-year, 10-year survival rate was 92.9%, 90.2%, 83.8%, respectively.
ConclusionMost of patients with aortic regurgitation and large left ventricle still have indications for surgical treatment, but severe left ventricular dysfunction and ventricular arrhythmia are high risk factors for long-term survival.
Objective The survival data of patients with colon cancer who were treated by laparoscopic-assisted surgery and open surgery three years after operation were analyzed and contrasted, which provided data to support the future treatment. Methods The 217 patients who were cured by laparoscopic-assisted surgery and 193 patients who were cured by open surgery were followed up, and the rates of local recurrence, metastasis, implantative, and survival were contrasted and analyzed. Results Three years after laparoscopic-assisted surgery and open surgery, the disease-free survival rate was 86.2% （187/217） and 85.5% （165/193）, respectively, and the overall survival rate was 91.2% （198/217） and 92.7% （179/193）, respectively, the difference between the two groups was not statistic significance（P＞0.05）. The differences of the rates of local recurrence, metastasis, and implantative between the two groups were not statistic significance（P＞0.05）. Conclusions Laparoscopic-assisted surgery is similar with open surgery in the rates of local recurrence, forward metastasis, and overall survival. So laparoscopic-assisted surgery is a safe and radical curative surgery.
ObjectiveTo enhance the management of occupational exposure, improve post-exposure reporting, promote post-exposure follow-up, reduce blood-borne infections caused by exposure, and ensure occupational safety among medical staff by using comprehensive measures based on nosocomial infection management system.MethodsAll the reported cases of occupational exposure were retrospectively collected from August 2012 to July 2018. The cases were divided into the control group (from August 2012 to July 2015) in which the data were reported in paper, and the observation group (from August 2015 to July 2018) in which the data were reported by nosocomial infection management system. The report and follow up results of occupational exposure in the two groups were compared and analyzed.ResultsAfter three years application of nosocomial infection management system, the occupational exposure report increased 95.8% (increased from 16.7 cases per year to 32.7 cases per year); the follow-up ratio of occupational exposure after one month,3 months and 6 months increased from 65.0% to 93.3% (χ2=15.184, P<0.001), 45.0% to 73.3% (χ2=9.033, P=0.003), and 25.0% to 53.3% (χ2=8.522, P=0.004), respectively.ConclusionApplication of nosocomial infection management system can increase the report of occupational exposure and the follow-up ratio of occupational exposure significantly.
Objective To evaluate the function of the reconstructed thumbs and the donor feet after thumb reconstructions with modified wrap-around flap. Methods A total of 65 patients who accepted thumb reconstruction with the modified wrap-around flap between January 2003 and October 2007 were followed up, including 54 males and 11 females with an average age of 33 years (range 15-46 years). There were 12 cases of skin degloving injury and late class I B defect, 44 cases of class II defect and 9 cases of class III A defect. The reconstructed thumbs and donor feet were examined andevaluated. Foot function index-verbal rating scales (FFI-5pt), American Orthopaedic Foot and Ankle Society (AOFAS) forhallux metatarsophalangeal-interphalangeal score, gait analysis and dynamic pedobarography were conducted to 20 patients who were followed up recently. Results Sixty-five patients were followed up 6-60 months with an average of 22 months. The reconstructed thumbs had aesthetic appearance and satisfactory range of motion. The two-point discrimination was (9.7 ± 2.8) mm, showing statistically significant difference (P lt; 0.05) when compared with that of the contralateral normal thumb [(4.2 ± 1.1) mm]. Full or most length of the donor toes were preserved in 63 patients. The width of remaining plantar strip skin that covered the plantar weight-bearing area was (24.5 ± 3.7) mm, and its two-point discrimination was (9.0 ± 2.6) mm; showing no statistically significant difference (P gt; 0.05) when compared with that of contralateral normal one [(8.1 ± 1.9) mm]. Of the 20 patients who were followed up recently, the evaluation of the FFI-5pt score showed that the pain scale score was 5.6 ± 4.5, the disabil ity scale score was 1.2 ± 2.7, and the FFI-5pt total scale score was 3.2 ± 2.9. The results of AOFAS cl inical rating scale showed that the pain scale score was 34.0 ± 5.0, the function scale score was 38.7 ± 4.2, the al igment scale score was 15.0 ± 0, and the total AOFAS scale score was 87.7 ± 7.4. There was no statistically significant difference (P gt; 0.05) in the durations of subphases of the gait cycle between the donor foot and the contralateral normal foot, and in the peak force and force-time integral of the two whole foot. The peak force of the donor toe was significantly smaller than that of the contralateral normal toe (P lt; 0.05), but there was no significant difference in the peak pressure (P gt; 0.05); and there were no significant differences in the peak forcesand peak pressures of other six anatomical sites of the two feet (P gt; 0.05). Conclusion Using the modified wrap-around flap for thumb reconstruction, aesthetic and functional thumbs can be obtained, and most of the function of the donor feet can be preserved.
During the coronavirus disease 2019 epidemic, West China Hospital, Sichuan University explored a new management model to ensure timely diagnosis and treatment and regular follow-up for breast cancer patients. On the basis of previous internet Breast Cancer Information Management System, patient management WeChat groups were integrated to develop an online and offline interconnect management platform. Regular follow-up of patients was mainly conducted by telephone, with WeChat management group as auxiliary. Coronavirus infections were screened during telephone follow-up. In the meanwhile, patients who needed to be further treated would be identified and recommended to the outpatient follow-up. The new management model can improve the efficiency of follow-up management, on the premise of reducing the risk of coronavirus disease 2019 transmission for both health care providers and patients.
