ObjectiveTo compare the 5-year survival rates between two different follow-up patterns of postoperative stage Ⅰ-ⅢA non-small cell lung cancer (NSCLC) patients.MethodsPathological stage Ⅰ-ⅢA NSCLC 11 958 patients who underwent surgical resection and received follow-up within 6 months after initial diagnosis through telephone follow-up system were included in nine hospitals from July 2014 to July 2020. The patients were divided into two groups including a proactive follow-up group (n=3 825) and a passive follow-up group (n=8133) according to the way of following-up. There were 6 939 males and 5 019 females aged 59.8±9.5 years. The Kaplan-Meier and Cox proportional hazards regression model were used.ResultsThe median follow-up frequency was 8.0 times in the proactive follow-up group and 7.0 times in the passive follow-up group. The median call duration was 3.77 minutes in the proactive follow-up group and 3.58 minutes in the passive follow-up group. The 5-year survival rate was 81.8% and 74.2% (HR=0.60, 95CI 0.53-0.67, P<0.001) in the proactive follow-up group and the passive follow-up group, respectively. Multivariate analysis showed that follow-up pattern, age, gender and operation mode were independent prognostic factors, and the results were consistent in all subgroups stratified by clinical stages.ConclusionThe proactive follow-up leads to better overall survival for resected stage Ⅰ-ⅢA NSCLC patients, especially in the stage ⅢA.
ObjectiveTo understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors, so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.MethodsConvenience sampling was used to conduct a questionnaire survey on the follow-up need, recovery, anxiety, and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020. The self-designed follow-up needs questionnaire, the Quality of Recovery Questionnaire 15 (QoR-15), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS-4) were scored. The higher score, the higher need, the better recovery, and the more serious anxiety and stress.ResultsIn this study, 382 questionnaires were distributed, which of 351 were returned and of 349 were valid, the valid callback rate was 99.4% (349/351). ① Follow-up needs. Follow-up form: Online platform was the preferred follow-up method (72.2%), the most patients hoped that the follow-up would be conducted by a doctor (82.5%) and hoped to start the follow-up at 1 month after the operation (67.6%) and in the afternoon (50.7%), the duration of each follow-up was 10–15 min (47.3%), and accepted the follow-up frequency of 1 times per month (41.3%) and the lifetime follow-up (69.9%). Needs degree of follow-up contents: There were 13 follow-up items requiring more than 80% of patients. The top 5 items with the higher follow-up needs score were the question on test results, returning visit guidance, knowledges of metastasis and recurrence, medication guidance, and issuance of inspection orders, and their scores were 4.78±0.47, 4.70±0.51, 4.70±0.57, 4.65±0.59, 4.57±0.64, respectively. The results of multiple linear regression analysis were found that the age (young), marital status (unmarried), medical payment method (with medical insurance), and postoperative interval (<1 month) were closely related to the follow-up needs score (P<0.05). ② Recovery, anxiety, and stress statuses: The total QoR-15 score of patients was 79.87±29.95, which was positively correlated with the total score of follow-up needs (72.93±8.52, r=0.131, P=0.014). No significant correlation was found between the total score of GAD-7 (4.77±3.59) or PSS-4 (6.51±3.10) and the total score of follow-up needs (r=0.068, P=0.207; r=0.008, P=0.881).ConclusionsYoung, unmarried, medically insured, and early postoperative patients with thyroid cancer have higher follow-up needs. Patients with better recovery after surgery have a higher follow-up needs. Medical staff should pay attention to follow-up services after discharge, rationally arrange content, frequency, and time period of follow-up according to follow-up needs of patients, so as to improve quality of medical services.
The anesthetic work of day surgery should be guided by the standardized perioperative evaluation system. The evaluation methods and standards with strong operability and repeatability are the prerequisites to ensure the safety and efficiency of day surgery. For the assessment of patients’ preoperative physiological status, preoperative preparation and postoperative rehabilitation, standardized work procedures should be established to ensure patients’ medical safety to the greatest extent. Through summarizing the advanced management experience of day surgery anesthesia at home and abroad, and combining with the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, the First Affiliated Hospital of Dalian Medical University has repeatedly revised the perioperative anesthesia evaluation methods in practice, and gradually explored a comprehensive, rigorous and standardized perioperative anesthesia evaluation system. This paper will focus on the evaluation of perioperative anesthesia and postoperative follow-up procedures in day surgery.
Objective To investigate the influence of prior percutaneous coronary intervention (PCI) on the outcome of coronary artery bypass grafting (CABG). Methods Clinical data of 5 216 patients from Jiangsu Province CABG registry who underwent primary isolated CABG from 2016 to 2019 were retrospectively analyzed. Patients were divided into a PCI group (n=673) and a non-PCI group (n=4 543) according to whether they had received PCI treatment. The PCI group included 491 males and 182 females, aged 62.6±8.2 years, and the non-PCI group included 3 335 males and 1 208 females, aged 63.7±8.7 years. Multivariable logistic regression and propensity score matching (PSM) were used to compare 30-day mortality, incidence of major complications and 1-year follow-up outcomes between the two groups. Results Both in original cohort and matched cohort, there was no statistical difference in the 30-day mortality [14 (2.1%) vs. 77 (1.7%), P=0.579; 14 (2.1%) vs. 11 (1.6%), P=0.686], or the incidence of major complications (myocardial infarction, stroke, mechanical ventilation≥24 h, dialysis for new-onset renal failure, deep sternal wound infection and atrial fibrillation) (all P>0.05). The rate of reoperation for bleeding in the PCI group was higher than that in the non-PCI group [19 (2.8%) vs. 67 (1.5%), P=0.016; 19 (2.8%) vs. 7 (1.0%), P=0.029]. Both in original cohort and matched cohort, there was no statistical difference in 1-year survival rate between the two groups [613 (93.1%) vs. 4225 (94.6%), P=0.119; 613 (93.1%) vs. 630 (95.2%), P=0.124], while the re-admission rate in the PCI group was significantly higher than that in the non-PCI group [32 (4.9%) vs. 113 (2.5%), P=0.001; 32 (4.9%) vs. 17 (2.6%), P=0.040]. Conclusion This study shows that a history of PCI treatment does not significantly increase the perioperative mortality and major complications of CABG, but increases the rate of cardiogenic re-admission 1 year postoperatively.
ObjectiveTo explore the influencing factors for lost follow-up of diabetic patients, looking for suitable follow-up methods for patients in the region of Central and Western China, in order to help ensure the quality of follow-up, improve the rate of follow-up and provide a basis for improving the quality of patients' continuous nursing outside of the hospital.
MethodsContinuous nursing was carried out for 600 patients discharged from our department by two full-time diabetes education nurses from September 2012 to April 2014. The data of outside hospital patients who were lost in the follow-up were retrospectively analyzed. According to the sequential order of the patients, they were divided into three groups. The difference among the three groups of patients was analyzed and the effect of nursing intervention on patients' follow-up loss was also analyzed.
ResultsThe rate of lost follow-up for the three groups were 29.4%, 20.3%, and 12.2%. Big classroom participation rate was 29.4%, 50.5%, and 57.5%. The lost follow-up rate of group three using team comprehensive management pattern was lower than that in group 1 with traditional supervision intervention. The age of the patients who were lost in the follow-up concentrated under 40 and above 75 years old. The patients with a disease history longer than 10 years with more complications were more likely to be lost in the follow-up. The main reason for lost follow-up was self-conceit and lack of awareness of the follow-up.
ConclusionDiversified ways of follow-up can complement each other which can reduce the rate of lost follow-up.
With the promoting of “the Belt and Road Initiative”, medical assistance to Xinjiang is one ofthe important tasks of public hospitals in China. West China Hospital of Sichuan University actively explores the“Huaxi-Karamay” model of multi-disciplinary group assistance and scientific and technological assistance to Xinjiang, and leverages the technical leadership and leading role of medical experts to improve the medical and health service capabilities of Karamay, especially in chronic diseases management. This article takes the People’s Hospital ofKaramay City in Xinjiang province as an example to discuss the exploration and practice of the new chronic diseasemanagement model of the endocrinology and metabolism center with medical assistance from West China Hospital ofSichuan University, aiming to provide a certain reference for the in-depth development of medical aid to Xinjiang in thefuture.
Objective To review the research progress of intelligent remote follow-up modes in the application after hip and knee arthroplasty. Methods Extensive literature on this topic published in recent years both domestically and internationally was reviewed, and the application of intelligent remote follow-up modes after hip and knee arthroplasty was summarized and analyzed. Results The intelligent remote follow-up mode is a novel follow-up method based on network information technology. Patients who undergo hip and knee arthroplasty require long-term follow-up and rehabilitation guidance after operation. Traditional outpatient follow-up is relatively time-consuming and inconvenient for some patients in terms of travel and transportation, which makes the application of intelligent remote follow-up modes increasingly widespread worldwide. The inherent attributes of remote interaction and instant feedback of this mode make it particularly valued in the field of hip and knee arthroplasty. Artificial intelligence (AI)-based voice follow-up systems and virtual clinics have significant advantages in improving follow-up efficiency, reducing human resource costs, and enhancing patient satisfaction. Conclusion The existing intelligent follow-up system has formed a standardized protocol in remote follow-up and rehabilitation guidance. However, there are still shortcomings in the formulation of personalized rehabilitation plans and the gerontechnological adaptation of human-computer interaction. In the future, it is necessary to construct a multimodal data fusion platform and establish technical application guidelines for different rehabilitation stages.
Esophageal diseases include esophageal malignant diseases and benign diseases, with a high incidence in our country. Along with the development of the endoscopic technique, many of them which required medical treatment or surgery in the past can now be cured by endoscopic surgery. This article is an overview of long-term follow-up of endoscopic surgery for the common esophageal disease, such as early squamous cell carcinoma, esophageal stricture, achalasia and submucosal tumor of the esophagus.
Resection is one of the most important treatments for esophageal squamous cell carcinoma, and routine postoperative follow-up is an effective method for early detection and treatment of recurrent metastases, which can improve patients' quality of life and prognosis. This consensus aims to provide a reference for colleagues responsible for postoperative follow-up of esophageal squamous cell carcinoma patients in China, and further improve the standardization of the diagnosis and treatment of esophageal squamous cell carcinoma.
Objective To explore the construction and application of a new follow-up visit model in the context of Internet hospital consultation, aiming to create a novel follow-up visit model that integrates precise identification of follow-up patients, messages of follow-up reminders, online free follow-up visits, and promotional activities. Methods Satisfaction surveys were conducted among outpatient patients and doctors at Jintang County First People’s Hospital from July 2023 to June 2024. Patients and doctors were divided into two groups based on whether the online free follow-up visit program had been implemented: the pre-implementation group (July to December 2023) and the post-implementation group (January to June 2024). The satisfaction levels of patients and doctors before and after the implementation were compared and analyzed. Results A total of 17 831 patient visits and 801 doctor visits were included. Since its launch, WeChat messages had been pushed to all outpatient patients, and both WeChat and SMS messages had been pushed to patients in surgical departments. The average waiting time for outpatient visits in January-June 2024 was shortened by 2 minutes compared with the same period last year (January-June 2023). The hospital’s Case Mix Index increased by 3.7%, and the surgical volume increased by 7.5%. After the launch of the Internet hospital, both patient and doctor satisfaction improved. Conclusion The new follow-up visit model of the Internet hospital represents an important initiative in the digital transformation of hospitals and holds value and significance for promotion in more county-level medical institutions.
