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BACKGROUND: This study aimed to explore the association between hypertension follow-up management and family doctor contract services, as well as to examine whether socioeconomic status (SES) had an interaction effect on this relationship among older adults in China. METHODS: We used data from the sixth National Health Service Survey of Shandong Province, China, including 3,112 older adults (age ≥ 60 years) with hypertension in 2018. Logistic regression models and a margins plot were used to analyze the role of SES in the relationship between hypertension follow-up management and family doctor contract services. RESULTS: The regular hypertension follow-up management rate and family doctor contracting rate were 81.8% and 70.9%, respectively, among older adults with hypertension. We found that participants with regular hypertension follow-up management were more likely to sign family doctor contract services (OR=1.28, 95%CI: 1.04, 1.58, P=0.018). The interaction effect occurred in the groups who lived in rural areas (OR=1.55, 95%CI: 1.02, 2.35), with high education level (OR=0.53, 95%CI: 0.32, 0.88) and had high incomes (OR=0.53, 95%CI: 0.35, 0.81). CONCLUSIONS: Our findings suggested that regular hypertension follow-up management was associated with family doctor contract services and SES influenced this relationship. Primary health care should improve the contracting rate of family doctors by strengthening follow-up management of chronic diseases. Family doctors should focus on improving services quality and enriching the content of service packages especially for older adults with higher income and education level.
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Serviços Contratados , Hipertensão , Classe Social , Humanos , Hipertensão/terapia , Hipertensão/epidemiologia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , China , Assistência ao Convalescente , Médicos de Família , Idoso de 80 Anos ou maisRESUMO
Objective: This study aimed to assess the diagnostic value of prenatal echocardiography for identifying transposition of the great arteries (TGA) during pregnancy and evaluating the associated outcomes. Methods: We conducted a retrospective analysis of 121 prenatally diagnosed patients with TGA at our hospital between January 2012 and September 2022. This analysis included prenatal ultrasound, prenatal screening, clinical management and follow-up procedures. Results: Among the 103 fetuses considered in the study, 90 (87.4%) were diagnosed with complete transposition of the great arteries (D-TGA), while 13 (12.6%) exhibited corrected transposition of the great arteries (CC-TGA). Diagnoses were distributed across the trimester, with 8 D-TGA and 2 CC-TGA patients identified in the first trimester, 68 D-TGA patients and 9 CC-TGA patients in the second trimester, and 14 D-TGA and 2 CC-TGA patients referred for diagnosis in the third trimester. Induction of labour was pursued for 76 D-TGA patients (84.4%) and 11 CC-TGA patients (84.6%), and 14 D-TGA patients (15.6%) and 2 CC-TGA patients (15.4%) continued pregnancy until delivery. Among the D-TGA patients, 9 fetuses (10.0%) underwent surgery, two of which were inadvertent fatality, while the remaining seven experienced positive outcomes. Additionally, seven TGA patients received palliative care, leading to four fatalities among D-TGA patients (5.2%), whereas 1 D-TGA patients and 2 CC-TGA patients survived. Conclusion: This study underscores the feasibility of achieving an accurate prenatal diagnosis of TGA during early pregnancy. The utility of prenatal ultrasound in the development of personalized perinatal plans and the application of multidisciplinary treatment during delivery are conducive.
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BACKGROUND: Anemia is a global health concern, particularly among the elderly on chronic antithrombotic treatment. Close monitoring of hemoglobin (Hb) levels and achievement of an optimized treatment significantly enhance patients' quality of life. This study aimed to examine the impact of antithrombotic treatment on Hb levels and readmissions in hospitalized patients with anemia. METHODS: This is a prospective cohort study of patients admitted to the Department of Internal Medicine of the University Hospital of Heraklion, Greece, from November 2021 to October 2022 with the diagnosis of anemia while receiving antithrombotic treatment. Data regarding demographics, past medical history, and laboratory and endoscopy findings were recorded. For those receiving inappropriate therapy according to international guidelines, antithrombotic treatment was optimized. Subsequent follow-ups occurred at one and six months post-discharge. Six- and twelve-month anemia-caused readmissions, as well as annual mortality, were evaluated. RESULTS: In total, 104 patients were assessed. Among them, 34.6% were on antiplatelets, 56.7% were on anticoagulants, and 8.7% were on combination treatment. The mean age was 80 ± 8.2 years, and 54.8% were males. On admission, mean Hb levels were 6.86 ± 1.23 g/dL, while 56 (53.8%) patients had severe anemia. Gastroscopy and colonoscopy were performed in 75.0% and 41.4% of patients, respectively, confirming gastrointestinal bleeding in most of the cases. Treatment optimization was carried out for 56 patients. Follow-up revealed elevated Hb levels after one and six months post-discharge, while anemia-related readmissions stayed below 10%. CONCLUSIONS: Most hospitalized anemic patients on antithrombotic treatment had endoscopic findings favoring gastrointestinal bleeding. Half received inappropriate antithrombotic therapy. Treatment optimization and regular follow-up improved Hb levels and reduced readmissions.
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Objective:To summarize the existing problems in the follow-up management of the clinical research project on cerebrovascular diseases at the National Clinical Research Center for Neurological Diseases, Affiliated Beijing Tiantan Hospital, Capital Medical University, and propose solutions and strategies to improve the level of follow-up management in clinical research, this study provided a reference basis.Methods:A comprehensive quality control system was established based on the follow-up management platform, data collection platform, quality control platform, and project management platform.Results:Strategies were proposed for key points in each stage of clinical research follow-up, quality control of the follow-up process, and follow-up progress. Furthermore, a follow-up assistant software management system was established.Conclusions:The follow-up management platform established by this study can timely address the issues encountered during follow-up, help standardize the follow-up management of clinical research, improve the follow-up rate, and ensure the quality of follow-up data.
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The teaching of diabetes has always been the focus and difficulty of clinical internal science teaching. How to skillfully integrate theoretical knowledge into clinical practice and help students deeply master medical knowledge and clinical skills is a topic that clinical teaching teachers are considering. Under the background of analyzing the concept and connotation of deep blended learning, this paper constructed the diabetes "doctor-patient" friendly model teaching process in the perspective of deep blended learning from the three stages of "learning situation analysis and independent learning" in the early stage, "ability improvement and in-depth research" in the middle stage, and "reflection and ability expansion" in the later stage. This paper expounded the positive role of the "doctor-patient" friendly model of diabetes in clinical teaching from three main aspects: improving the integration effect of theory and practice, fully meeting students’ learning needs, and increasing the connection between doctors, patients, and students.
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Se realizó una investigación operativa, de alcance longitudinal, en el periodo comprendido entre abril y noviembre de 2019, con el objetivo determinar indicadores y propuestas de mejora para la gestión de seguimiento a pacientes rurales con parasitosis intestinales, diagnosticados en el laboratorio clínico del Centro de Salud Tipo C Quero (CSQ). El universo del estudio estuvo conformado por 15.842 usuarios potenciales del CSQ. El tipo de muestreo fue por conveniencia; la población consistió en 217 pacientes que acudieron al laboratorio institucional durante el periodo de estudio para realizarse el examen coproparasitario. La muestra estuvo conformada por 184 pacientes con diagnóstico de parasitosis intestinal. Para determinar la gestión de cuidados de los pacientes rurales diagnosticados con parasitosis intestinales, se tuvieron en cuenta 8 variables y 8 indicadores para el período de estudio, las cuales se obtuvieron mediante el seguimiento a los procesos del laboratorio clínico, una vez completado el periodo de la investigación. Un total de 217 pacientes del Centro de Salud Tipo C Quero acudieron al laboratorio institucional durante el periodo de estudio para realizarse el examen coproparasitario, de los cuales 169 (77,89%) mostraron un resultado positivo al examen directo, y 15 (6,91%) fueron diagnosticados mediante la técnica de sedimentación por centrifugación, para un total de 184 pacientes con parasitosis intestinales, es decir el 84,8% de la población de estudio, aiendo Endolimax nana, con 22,94% la especie más frecuente, seguida de Entamoeba coli con el 20,78%, Blastocystis spp. 16,06%. Del grupo de 184 pacientes con diagnóstico de parasitosis intestinal que conformaron la muestra del estudio, 31 y 8 (16,85 y 4,35%) mostraron resultado positivo para coparasitación con 2 y 3 especies diferentes, respectivamente. La implementación de indicadores de gestión de cuidados de los pacientes diagnosticados con parasitosis intestinales puede contribuir a la planeación de estrategias para la prevención e identificación factores de riesgo, en dicha población, así como dirigir campañas de educación sanitaria y promover la conciencia sobre la salud y la higiene como medidas que deben ser consideradas e implementadas para disminuir las prevalencias(AU)
An operative investigation, of longitudinal scope, was carried out in the period between April and November 2019, with the objective of determining indicators and improvement proposals for the follow-up management of rural patients with intestinal parasites, diagnosed in the clinical laboratory of the Center for Health Type C Quero (CSQ). The universe of the study was made up of 15,842 potential users of the CSQ. The type of sampling was for convenience; The population consisted of 217 patients who attended the institutional laboratory during the study period to undergo coproparasitic examination. The sample consisted of 184 patients diagnosed with intestinal parasitosis. To determine the care management of rural patients diagnosed with intestinal parasites, 8 variables and 8 indicators were taken into account for the study period, which were obtained by monitoring the clinical laboratory processes, once the period of study was completed. the investigation. A total of 217 patients from the Quero Type C Health Center attended the institutional laboratory during the study period to undergo coproparasitic examination, of which 169 (77.89%) showed a positive result on direct examination, and 15 (6. 91%) were diagnosed by the centrifugation sedimentation technique, for a total of 184 patients with intestinal parasites, that is, 84.8% of the study population. Being Endolimax nana, with 22.94% the most frequent species, followed by of Entamoeba coli with 20.78%, Blastocystis spp. 16.06%. Of the group of 184 patients diagnosed with intestinal parasitosis that made up the study sample, 31 and 8 (16.85 and 4.35%) showed positive results for co-parasitic infection with 2 and 3 different species, respectively. The implementation of care management indicators for patients diagnosed with intestinal parasites can contribute to the planning of strategies for the prevention and identification of risk factors in said population, as well as directing health education campaigns and promoting awareness about health and hygiene as measures that must be considered and implemented to reduce prevalence(AU)
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , População Rural , Indicadores de Gestão , Laboratórios Clínicos , Enteropatias Parasitárias , Doenças Parasitárias , Pacientes , Centros de Saúde , Monitoramento Ambiental , HigieneRESUMO
Objective:To summarize the experiences of clinical study project management in Peking University Clinical Research Institute, REDCap (Research Electronic Data Capture) data management system was proposed to improve the follow-up process management.Methods:Current clinical study follow-up process management situation were analyzed and methods for utilizing REDCap in follow-up management was proposed.Results:Using REDCap through " direct management" and " system management" data management can improve the follow-up quality and standard level of management in clinical study, at the same time, secured better protection of participants′ privacy and rights during the process.Conclusions:REDCap plays crucial roles in securing follow-up data quality from the source, timely tracking and standardization of follow-up management, it can be adopted more widely in assisting clinical study follow-up management.
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Objective:Proposed suggestions to improve the quality of investigator-initiated trials follow-up management under the normalization of COVID-19.Methods:Analyzed current status and challenges of follow-up management in China investigator initiated trial through a combination of literature review and previous work reflection, in the context of normalization of COVID-19.Results:Follow-up management of investigator initiated trial had shown variations in follow-up contents, methods, personnel and auxiliary tools. The insufficient research funding and lacking of professional clinical research team support have led to the challenges of low follow-up visits, insufficient follow-up personnel, lack of electronic follow-up platforms, and unknown follow-up time windows for investigator-initiated trials, which became more prominent in the context of COVID-19.Conclusions:In order to improve the quality of follow-up management during the normalization of COVID-19, appropriate amendment of the investigator-initiated trials follow up should be carefully considered. For instance, taking into account of the characteristics of the research disease, the main research endpoints, the content of the key indicators of the research key follow-up, follow-up methods, follow-up frequency, and follow-up tools to make sure the scientific validity and feasibility, as well as the mandate of clinical research related laws, regulations and ethical requirement. The possible amendments may include follow content, method, mode, frequency, time window. At the same time, re-consent or sufficient disclosure of information should be carried out with compliance of the updated protocols to assure the quality of clinical research follow up.
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The prevention and control of novel coronavirus pneumonia is the most priority recently, and various measures during the prevention and control period will have varying degrees of impact on the implement of clinical trials. However, various examinations in ophthalmological clinical trials need close contact between operators and patients, which put us at risk of cross-infection. This paper indicated some suggestions based on the criteria of clinical trials under major public health emergencies, the management of clinical trials during epidemic period including the follow-up of subjects, the treatment of epidemic serious adverse event (SAE) and the management requirements of co-sponsors, as well as the requirements and management principles for environment, subjects, examiners and inspection equipment in the process of ophthalmic clinical trials. It may be helpful to the ophthalmic clinical trial researchers and subjects during the period of novel coronavirus infection.
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Objective According to the study of academic clinical research managed by Peking University Clinical Research Institute,identified problems that existed during the follow up in clinical research.Strategies and methods were proposed after analyzed the related problems,to enhance the quality of follow-up in clinical research.Methods Analysis of common follow-up management problems found in project management and on-site monitoring.Results Strategies and suggestions were proposed,table tools and management software were recommended to investigators for strengthening follow-up management.Conclusions Investigators should follow the scientific validity,research strategy and methodologies during the implementation of clinical research,to make sure compliance to increase the follow-up rates and guarantee the data quality.
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Objective To explore the effect of continuous management of cancer pain patients by group follow-up model. Methods A total of 86 cases of cancer pain patients discharged from oncology department from March to May 2016 were selected and grouped according to the number of inpatients. The control group(44 cases)was treated with conventional intervention, and the experimental group(42 cases) was followed by team follow-up. The cancer pain control effect and quality of life were evaluated in the two groups after 1 month. Results The average degree of pain degree within 24 h in the past pain after intervention respectively was (2.90 ± 0.85) (2.56 ± 0.79) points in the experimental group and (4.17 ± 0.92) (4.00 ± 1.18) points in the control group, there was statistically significant difference between the two groups (t=6.618, 6.492, P < 0.01). The quality of life in physical function, cognitive function, social function, general health level was(66.83 ± 20.02),(69.33 ± 15.45),(61.17 ± 16.50),(63.83 ± 17.93)points in the experimental group,(27.83 ± 11.97),(36.17 ± 16.24),(26.14 ± 17.29),(28.23 ± 17.43)points in the control group, there were significant differences(t =4.224-9.727,P<0.05 or 0.01). There was no significant difference in role function and emotion function between the two groups (P>0.05). Conclusions The continuous management of team follow-up can help the patients with cancer pain continue to receive standard treatment and care after discharge, which will help improve the patient's pain control level and improve the quality of life.
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Loss to follow-up (LF), which refers to patients who started care but voluntary stopped it, is a problem for patients with chronic disease. We aimed to estimate the rate of LF among patients seropositive for hepatitis C virus (HCV) and identify possible demographic and lifestyle risk factors associated with LF. From January 2009 through December 2012, 1010 anti-HCV-positive patients were included in the study. Among participants, 223 (22.1%) met the case definition for LF (more than 1-year elapsed since the last clinical appointment). Among 787 patients who remained in follow-up, 372 (47.2%) were discharged after undetectable HCV RNA, 88 (11.1%) were transferred (and remained on regular follow-up at the destination), and 25 (3.1%) died. According to univariate analysis, male gender, absence of a life partner, black race, psychiatric illness, previous alcohol abuse, previous or current recreational drug use, and previous or current smoking were significantly associated with LF. In multivariate analysis, absence of a life partner (adjusted odds ratio (AOR)=1.44; 95% confidence interval (95%CI)=1.03–2.02), black race (AOR=1.81, 95%CI=1.12–2.89), psychiatric illness (AOR=1.77, 95%CI=1.14–2.73), and the presence of at least one lifestyle risk factor (pertaining to substance abuse) (AOR=1.95, 95%CI=1.29–2.94) were independently associated with LF. Our study provides an estimate of the incidence of LF among anti-HCV-positive patients and identifies risk factors associated with this outcome. In addition, these results can help clinicians recognize patients at risk for LF, who require additional support for the continuity of care.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Hepatite C/epidemiologia , Estilo de Vida , Perda de Seguimento , Análise de Variância , Brasil/epidemiologia , Hepacivirus , Transtornos Mentais/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Fumar/epidemiologiaRESUMO
To explore the effect of follow-up management after health examination for the cerebro-cardiovascular disease risk, a survey applied with the KOSHA cerebro-cardiovascular disease risk assessment tool was conducted with 500 workers in small scale enterprise less than 50 employees. They were provided two types of health services; post-examination management and health consultation, and finally compared the cerebro-cardiovascular disease risk changes between 2014 and 2015. In normal group in 2014, only 18.7% of workers who received the follow-up management had elevated risks, while 23.8% of workers who received the health consultation had elevated risks in 2015. In risk group in 2014, only 2.8% of workers who got follow-up management had elevated risks, while 7.7% of workers who got only health consultation had elevated risks in 2015. After adjustment for gender, age, exercise, body mass index, nationality and type of industry, negative correlation was found in association to the follow-up management (odds ratio = 0.87). This study shows that workers with cerebro-cardiovascular disease or who are at high cerebro-cardiovascular risk in small scale enterprise should receive early detection and management using counselling and regular follow-up after periodic health examination. Also the health counselling including preventive education for cerebro-cardiovascular disease is needed for all workers to improve their self-management for health.
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Humanos , Índice de Massa Corporal , Educação , Etnicidade , Seguimentos , Serviços de Saúde , Medição de Risco , AutocuidadoRESUMO
Objective To explore the application effect of the wechat public platform in follow-up management of patients with moderate or severe craniocerebral injury.Methods 98 patients admitted in the craniocerebral department of our hospital from February to November 2014 were selected and divided into two groups by random number table method,with 48 cases in the control group and 50 cases in the observation group;the traditional follow-up management mode using telephone was adopted to patients in the control group,while the follow-up management mode using the wechat public platform was adopted to those in the observation group,with a follow-up period of 3 months;for patients in both groups,their activities of daily living (ADL) and exercise of self-care agency (ESCA) abilities before and after intervention,occurrence of adverse events and complications within the follow-up period,and their degree of satisfaction towards the follow-up management were collected.Results After intervention,ADL score,total scores of ESCA and total scores of satisfaction towards the follow-up management among patients in the observation group were 87.34±15.26,24.36±17.24 and 86.07±14.82,which were significantly higher than that among patients in the control group were 66.72±14.62,99.37±15.29 and 61.14±13.19 (t=7.941,7.982,6.962,all P <0.01);within intervention,the observation group had significantly lower total occurrence rate of adverse events and complications which was16.00% (8/50) compared to the control group 39.58% (19/48) (x2=6.824,P < 0.01).Conclusions By establishing the follow-up management mode for patients with craniocrerbral injury through the wechat public platform,effect of the follow-up management can be effectively promoted,prognosis of patients can be improved and patients' degree of satisfaction can be enhanced;it is worth of being further promoted clinically.
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To evaluate the follow-up management state and related factor of lead battery workers in periodic health examination as part of program of group occupational health service, author studied 293 workers with questionnaire on knowledge of results and follow-up management state and related factors, and compared the responses to their periodic health examination result charts. The results were as follows: 1. 252(86%) workers responsed that they had received the health examination result chart, but only 116(39.6%) workers responsed that they had been educated or explained about the result of health examination, and 11(57.9%) workers among 19 workers with non-occupational disease D, 101(44.3%) workers among 228 workers with non-occupational disease C, and 19(28.4%) workers among 67 workers with occupational disease C knew accurately their health examination results. 2. 78(24.8%) of the workers responsed that they had follow-up management, and contents of follow-up management were follow-up(36.6%), out-patient treatment(31%), change worksite(8.5%), temporary retirement(7.0%) and others(16.9%). 3. Most of the workers responsed that the health examination were necessary, but three-fourths of the workers responsed that the health examination had been superficial or that they didn't know. 4. In this study, follow-up management show significant association with only explanation or education about health examination result chart.