The advent and utility of new endoscopic imaging modalities for predicting the histology of Barrett's esophagus (BE) in real time with high accuracy appear promising and could potentially obviate the need to perform random biopsies where guidelines are poorly adhered to. We embarked on evaluating the performance characteristics of white-light endoscopy with magnification (WLE-z), narrow-band imaging with magnification (NBI-z) and a combination of both modalities.This was a prospective online study with 28 endoscopists from 11 countries (Asia-Pacific region) participating as assessors. In total, 35 patients with BE were assessed using 150 slides from WLE-z and NBI-z randomly arranged using a simple classification with corresponding histology. The overall Accuracy (Acc), Sensitivity (Sn), Specificity (Sp), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of WLE-z, NBI-z and a combination of both were calculated.The overall Acc for WLE-z and NBI-z images was 87.1 % and 88.7 %, respectively. When images from the two modalities were placed side by side, the Acc increased to 90.3 %. The Sn, Sp, PPV, and NPV of WLE-z were 48 %, 92 %, 45 %, and 93 % while with NBI-z, these improved to 89 %, 89 %, 56 %, and 98 %, respectively. When both imaging modalities were viewed together, they improved further to 93 %, 90 %, 61 %, and 99 %.The high NPV (99 %) when both WLE-z and NBI-z were used simultaneously indicates that areas with regular appearance that are diagnosed with confidence can effectively be left alone and not biopsied when performed at a skilled resourced center. This approach could potentially lead to a paradigm shift of how patients with BE are assessed.
It is important for modern hospital management to strengthen medical humanistic care and build a harmonious doctor-patient relationship. Innovative applications of the big data resources of patient experience in modern hospital management facilitate hospital management to realize real-time supervision, dynamic management and scientific decision-making based on patients experiences. It is helping the transformation of hospital management from an administrator's perspective to a patient's perspective, and from experience-driven to data-driven. The technological innovations in hospital management based on patient experience data can assist the optimization and continuous improvement of healthcare quality, therefore help to increase patient satisfaction to the medical services.
Objective To observe the MRI characteristics and the value of prenatal diagnosis for fetal cystic lymphangioma.Methods Conventional MRI of 4 fetus with suspected lymphangioma and complete image data were retrospectively reviewed.Pregnant women aged 24—30 years,with the gestational ages of 31+3 weeks—38+1 weeks.Results All 4 fetus were diagnosed as cystic lymphangioma with MRI,which was then proved pathologically.MRI findings of cervical lymphangioma in fetus were as follows: Single or polycystic with septations mass with low T1 and high T2 signal intensity on unilateral or bilateral neck,tumor size ranging from 1.73 to 10.63 cm in diameter.Conclusion MRI is valuable for prenatal diagnosis of cervical lymphangioma in fetus.
Patient satisfaction is one of the important ways to measure the results of treatment and the quality of medical services. The purpose of the present study was to verify the reliability and validity of the indicator system for evaluating satisfaction of outpatients and inpatients in Chinese hospitals.The study was based on the satisfaction questionnaire program of the national doctor- patient experience research center with data from 99,802 outpatients and 229,215 inpatients, collected in China between 2016 and 2017. We adopted exploratory factor analysis for validity analysis and the method of split-half reliability and Cronbach's α coefficient for reliability analysis.In the validity analysis of the indicator system for outpatients, the factor loading was between 0.438 and 0.919, and the reliability was excellent. In the validity analysis of the indicator system for nonsurgical inpatients, the factor loading of the secondary indicators was between 0.417 and 0.75, and the reliability was excellent. In the validity analysis of the indicator system for surgical inpatients satisfaction, the factor loading of the secondary indicators range was 0.391-0.751, and the reliability was excellent.The indicator systems for evaluating satisfaction of outpatients, surgical inpatients and nonsurgical inpatients all have excellent reliability and good validity. They can be widely used for an outpatient and inpatient satisfaction questionnaire in Chinese hospitals.
BackgroundAcupuncture has long been employed for the treatment of chronic low back pain [CLBP]. The aim of this randomized, controlled study was to validate back-pain-acupoints acupuncture for relieving CLBP compared with standard acupuncture and usual care.MethodsIn total, 236 patients with CLBP participated in this study. Eligible patients were randomized to back-pain-acupoints acupuncture, standard acupuncture, or usual care groups. Fourteen treatments were provided over four weeks. Back-related dysfunction and symptom severity were assessed by Roland–Morris Disability Questionnaire [RMDQ] and visual analog scale [VAS] scores. Repeated-measures analysis of variance [ANOVA] was employed for factorial analyses.ResultsThe back-pain-acupoints acupuncture group improved by RMDQ scores and VAS scores [P < 0.001 for both] compared with the usual care group. The standardized acupuncture group also improved by RMDQ scores and VAS scores [P < 0.001 for both] compared with the usual care group. The back-pain-acupoints group improved by RMDQ scores [four weeks, P < 0.05; 24 weeks, P < 0.001] and VAS scores [P < 0.05 for both] compared with the standardized group. Across the three testing points, significant differences were found in the RMDQ and VAS scores between the usual care group and both treatment groups [P < 0.001]. A significant difference was found between the back-pain-acupoints and standardized acupuncture groups in repeated-measures ANOVA [P < 0.05].ConclusionBoth acupuncture groups have beneficial and persistent effectiveness against CLBP compared with the usual care group. Back-pain-acupoints acupuncture is significantly more effective than standardized acupuncture.
Background: Complete uterine rupture (CUR) is a rare but severe obstetric complication. We explored the characteristics of CUR and compared the maternal and perinatal outcomes of different types of CUR.Methods: This was a hospital-based multicenter retrospective cohort study. We consecutively enrolled women with surgically confirmed CUR from 22 tertiary hospitals in China between January 1, 2004 and January1, 2019. CUR patients were divided into CS (cesarean section)-scarred, non-CS-scarred and unscarred groups. Characteristics and outcomes of CUR patients were compared appropriately.Findings: There were 201 women with CUR. CS-scarred CUR was the most common type (130, 64.7%), followed by unscarred CUR (47, 23.4%) and non-CS-scarred CUR (24, 12%). CUR resulted in 4 maternal deaths (2%).An increase in severe postpartum hemorrhage was observed in the following order: CS-scarred CUR < non-CS-scarred CUR< unscarred CUR. There were 210 fetuses and newborns including 9 twins. The fetal and perinatal mortality rates were 31% and 24.3% respectively. 25 of the newborns had severe neonatal asphyxia, and 74 newborns required NICU admission. 13 infants were diagnosed with hypoxic ischemic encephalopathy. Increases in fetal death, perinatal death and NICU admission were observed in the following order: CS-scarred CUR < non-CS-scarred CUR < unscarred CUR.Interpretation: The maternal and perinatal mortality rates are slightly higher in China than in Western countries. Unscarred CUR and non-CS-scarred CUR are associated with higher risks of adverse maternal and perinatal outcomes than CS-scarred CUR. Identification of the rupture type is helpful for clinical decision-making. Funding: CAMS initiative for Innovative Medicine (CAMS-12 M; 2017-12M-1-002)Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study used only medical records data, and it was approved by the institutional review board of PUMCH.
Objectives: The purpose of this study is to identify the Self-care Agency(SCA) and body Functional Status(FS), and to examine the relationship between SCA and FS of patients with AMI, and to find out the effective nursing that can increase SCA of patients and improve the patients' FS. Method: Three instruments were employed for data collection: the Demographic Information Sheet, the Exercise of Self-Care Agency Scale (ESCA) and the Seattle Angina Questionnaire (SAQ). The statistical software SPSS for windows, version 10.0 is used for data analysis. Spearman's correlation coefficient is used to investigate the relationship between two variables and to test the hypothesis. Results : 73.44% subjects perceived a high level of SCA. 51.56% subjects reached a higher level of FS. The correlation index between the SCA and FS is 0.45 (P0.01). Conclusion: The results of this study indicate that there is a moderate and positive correlation between the self-care agency and the functional status of AMI patients. Nurses can increase self-care knowledge and skill of patients and improve the patients' functionanl status by health education. For instance, the patients'quality of life will be developed by effective nursing.
Introduction The use of retrievable esophageal stents represents a new method to avoid multiple dilations for stenosis recurrence. The aim of this study was to evaluate the efficacy of treatment with a retrievable covered Z-stent for corrosive esophageal stenosis in children. Materials and Methods A total of 15 children were enrolled in this study. All patients had undergone balloon catheter dilatation (BCD) but without significant symptomatic improvement. A retrievable Z-stent was placed, and the dysphagia score was evaluated. After stent removal, healing was considered to have occurred if the score was 0 to 1 for at least 12 continuous months. Results Stents were placed in all children without complications and were later removed successfully. Stents remained in situ for 4 to 8 weeks (mean, 7.4 weeks). Dysphagia scores decreased from 3 to 4 to 0 to 1 in all patients while the stent was in place. During the 12-month follow-up period, seven patients remained free from dysphagia, but eight children had recurrent stenosis and required a subsequent BCD to alleviate symptoms from the stricture. Six of them required placement of a second stent. Conclusions The use of a retrievable Z-stent is an effective method and may become the treatment of choice for corrosive esophageal stenosis in children.
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