ObjectiveTo preliminarily explore the effect of Osteoporosis Self-assessment Tool for Asians (OSTA) and Fracture Risk Assessment Tool (FRAX) on predicting osteoporosis and osteoporosis fracture in postmenopausal patients with maintenance hemodialysis (MHD).MethodsThirty-six postmenopausal patients undergoing MHD from August 2017 to October 2018 in Hemodialysis Center of Nephrology Department, West China Hospital of Sichuan University were selected. Relevant data such as age, height, and weight were collected. OSTA index and the 10-year probability of major osteoporotic fractures and 10-year probability of hip fractures of FRAX score were calculated. Bone mineral densities (BMD) of the hip and lumbar spine were measured by dual energy X-ray absorptiometry (DXA) at the same time. The value of OSTA index and FRAX scale in evaluating the risk of osteoporosis predicated on T value ≤?2.5 determined by DXA BMD and fracture in postmenopausal patients with MHD were analyzed.ResultsThe DXA BMD of the 36 patients showed that 50.0% (18/36) had a T value≤?2.5, and 30.6% (11/36) had a fracture history. BMD in postmenopausal patients with MHD was negatively correlated with FRAX score (model without BMD values), and positively correlated with OSTA index. The sensitivity and specificity of OSTA in the prediction of osteoporosis were 94.4% and 61.1%, respectively; and the sensitivity and specificity of FRAX (the model without BMD values) in the prediction of osteoporosis were 88.9% and 50.0%, respectively. The FRAX score with or without BMD had the same clinical value in predicting osteoporosis.ConclusionsPostmenopausal MHD patients have a higher risk of osteoporosis and fracture. Both OSTA index and FRAX scale can predict osteoporosis risk among postmenopausal MHD patients, and the FRAX scale with or without BMD has the same clinical value in predicting osteoporosis risk. In clinical work, for primary hospitals and dialysis centers lacking DXA, preliminary screening of osteoporosis in MHD patients can be performed with OSTA and FRAX scales.
At present the parkinsonian rigidity assessment depends on subjective judgment of neurologists according to their experience. This study presents a parkinsonian rigidity quantification system based on the electromechanical driving device and mechanical impedance measurement method. The quantification system applies the electromechanical driving device to perform the rigidity clinical assessment tasks (flexion-extension movements) in Parkinson’s disease (PD) patients, which captures their motion and biomechanical information synchronously. Qualified rigidity features were obtained through statistical analysis method such as least-squares parameter estimation. By comparing the judgments from both the parkinsonian rigidity quantification system and neurologists, correlation analysis was performed to find the optimal quantitative feature. Clinical experiments showed that the mechanical impedance has the best correlation (Pearson correlation coefficient r = 0.872, P < 0.001) with the clinical unified Parkinson’s disease rating scale (UPDRS) rigidity score. Results confirmed that this measurement system is capable of quantifying parkinsonian rigidity with advantages of simple operation and effective assessment. In addition, the mechanical impedance can be adopted to help doctors to diagnose and monitor parkinsonian rigidity objectively and accurately.
ObjectivesTo assess the methodological quality of clinical practice guidelines of cervical cancer in China published from 2014 to 2018.MethodsCNKI, WanFang Data, CBM, VIP, Medlive.cn, the National Guideline Clearinghouse, PubMed, The Cochrane Library and EMbase were searched for cervical cancer clinical practice guidelines published in China from January 1st, 2014 to December 31st, 2018. Four reviewers searched and selected the literature independently according to the inclusion and exclusion criteria and assessed the methodological quality of the included guidelines by using AGREE Ⅱ.ResultsA total of 9 guidelines were included. The average score for each area was: scope and purpose 75.47%, stakeholders’ involvement 35.09%, the rigor of development 43.70%, clarity of presentation 87.74%, applicability 80.76%, and editorial independence 0%.ConclusionsThe quality of cervical cancer clinical practice guidelines in China requires further improvement.
ObjectiveTo explore the significance of thyroglobulin in the evaluation of lymph node metastasis during the treatment and follow-up of differentiated thyroid carcinoma.MethodThe literatures about thyroid globulin evaluation of lymph node metastasis of differentiated thyroid carcinoma were collected through online database and summarized.ResultsThe determination of thyroglobulin played an important role in the perioperative evaluation of lymph node metastasis in patients with differentiated thyroid carcinoma, the guidance of postoperative radiotherapy for metastasis, and the monitoring of recurrence and metastasis, and thyroglobulin combined with imaging examination could improve its evaluation efficiency.ConclusionsThyroglobulin is an important marker for the evaluation of lymph node metastasis in the treatment and follow-up of differentiated thyroid carcinoma. Combination between thyroglobulin and imaging examination or other laboratory indicators to comprehensively explore its diagnostic threshold is a new idea, that can improve its value in the evaluation of lymph node metastasis.
ObjectiveTo evaluate the operation status of the clinical departments of a hospital through the establishment of the evaluation index system and comprehensive evaluation model.MethodsThe data on workload, service difficulty, service efficiency, health economics and other related indicators of the clinical departments of a hospital from January to June 2018 were collected. The comprehensive evaluation model was constructed by comprehensive scoring method. The data of each index were centralized, then the comprehensive evaluation model of clinical departments was established and the scores were calculated by weighted summation. Microsoft Excel 2010 and SPSS 17.0 software were used for data processing.ResultsThere were certain differences in comprehensive scores and detailed indicators among different clinical departments. Ranked by comprehensive scores, the top three surgical departments were Department of Thoracic Surgery (1.45), Department of Breast Surgery (1.32), and Department of Vascular Surgery (1.22), and the top three internal departments were Department of Oncology (5.76), Department of Cardiology (3.47), and Department of Hematology (3.41).ConclusionsIn general, there are some differences in the operating conditions among different departments. There are also differences in the detailed indicators among different departments. The results can be used to find out problems and gaps, and finally improve the operation of the departments.
Objective We aimed to evaluate the comparative efficacy and cost-effectiveness of the ECMO versus mechanical ventilation through a rapid health technology assessment. Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data, and CBM databases were electronically searched to collect randomized controlled trials (RCTs), systematic reviews, meta-analyses, complete economic evaluations, and CRD database for HTA reports from inception to December 2020. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Descriptive analysis and summary were then performed. Results A total of 21 references were involved, including 2 HTA reports, 5 RCTs, 11 systematic reviews or meta-analyses, and 3 economic evaluations. The quality of the literature evidence was heterogenous, and only 2 RCTs of high quality were included for meta-analysis. The results showed that the difference of 60-day mortality between ECMO and mechanical ventilation was statistically significant (RR=0.73, 95%CI 0.57 to 0.92, P=0.007). The majority of recent meta-analysis literature showed that short-term mortality of ECMO treatment was lower than that of mechanically ventilated patients. The cost-effective literature from different countries all showed that it was cost-effective in their respective health system, however, the quality of the literature varied. Conclusions Current evidence shows that ECMO has better safety, effectiveness and cost-effectiveness for ARDS compared with mechanical ventilation. However, it still required to be verified by high-quality studies with a long-term follow-up. Validate conclusions are needed through rigorous health technology assessments.
Cerebral hemorrhage is a common clinical critical disease, and venous thromboembolism is one of its common complications. How to diagnose and treat venous thromboembolism early is still the main problem in the management of patients with cerebral hemorrhage. This article reviews the concept, pathogenesis, risk factors, evaluation tools, prevention and treatment of venous thromboembolism in patients with cerebral hemorrhage. Suggestions are put forward on the development of evaluation tools and improvement of prevention and treatment, in order to provide reference for clinical management and related research of patients with cerebral hemorrhage complicated with venous thromboembolism.
In order to better incorporate patient input in clinical trials, the US Food and Drug Administration has included "patient-focused drug development" in the selection and development of clinical outcome assessments, and formulated a series of guidelines. Based on the third guiding principle, "Selecting, Developing, or Modifying Fit-for-Purpose Clinical Outcome Assessments", this article summarizes the clinical outcome assessments from five aspects: concept, development process, scoring mechanism, interference factors and sensitivity, and introduces four different types of clinical outcome assessments, providing new ideas for "patient-focused drug development" efficacy evaluation in clinical trials.
Objective
To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty (TKA).
Methods
A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale (SER) and the range of motion (ROM) of knee were observed and recorded.
Results
There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain (t=–2.736, P=0.007), types and frequencies of temporary rescue medicine (χ2=10.276, P<0.05), the overall postoperative pain score (Z=–2.146, P=0.032), average hospitalization time after surgery (t=–2.468, P=0.015), SER scores 7 days after surgery (F=2.390, P=0.018) and 14 days after surgery (F=3.427, P=0.001), and ROM at the postoperative day 7 (F=2.109, P=0.037); there were no significant differences in postoperative daily pain scores (Z=–1.779, P=0.077), SER scores at the postoperative day 3 (F=1.010, P=0.314), ROM at the postoperative day 1 (F=1.319, P=0.189) and day 14 (F=1.603, P=0.111).
Conclusion
Self-assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.
ObjectiveTo explore the possible association between early injury assessment indexes and the length of stay (LOS) in first-line hospitals, in order to help the hospitals take advantage of resource effectively and transfer victims reasonably during earthquakes.
MethodWe retrospectively analyzed the medical information of 3 576 traumatic patients injured in the Wenchuan Earthquake who were transferred to 242 first-line medical institutes between 14:28, May 12th and 14:30, May 19th in 2008. Three kinds of 15 variables were extracted for the analysis, including gender, age, heart or lung disease, pre-hospital time, head injury, trunk injury, open injury, crush injury, asphyxia, body temperature, heart rate, respiration, systolic blood pressure, diastolic blood pressure, and Glasgow coma score. Multiple stepwise linear regression analysis was performed to identify the factors associated with LOS.
ResultsThe multiple linear regression analysis showed that age as well as other six factors affected LOS significantly (P<0.05). The partial regression coefficients of age, pre-hospital time, head injury, trunk injury, crush injury, complication of cardiac or pulmonary disease, and Glasgow coma score were -0.062, 0.157, 3.703, 4.111, 12.602, 14.762 and -1.312, respectively.
ConclusionsEarthquake trauma patients with older age, long pre-hospital time, head injury, trunk injury, heart or lung disease, crush injury, and lower Glasgow coma score are at increased risk for extended LOS.
