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31.
Feng Jiang Huixuan Zhou Linlin Hu Tingfang Liu Shichao Wu Pengyu Zhao Guangyu Hu Huanzhong Liu Yilang Tang Yuanli Liu 《Lancet》2018
Background
China's Mental Health Law was implemented in 2013 to provide a legal foundation to protect patients' rights and provide involuntary treatment for patients at high risk of suicide or self-injury, or of harming others, or both. However, the law has not been thoroughly examined since its implementation. This study aimed to examine compliance of major psychiatric hospitals in China with the criteria of involuntary admission defined in the Mental Health Law.Methods
As part of a national survey, we collected data from discharged inpatients from 32 tertiary psychiatric hospitals across all 31 provinces of China. We manually retrieved patients' admission information from discharge medical records, and calculated the proportion of the patients who met the criteria of involuntary admission.Findings
We included data from 1663 (93%) of 1780 discharged inpatients from all hospitals. 814 (49%) of 1663 patients were admitted to hospital involuntarily. 369 (45%) of these 814 patients were admitted because of risks of suicide or self-injury, or of harming others, or both, as defined in the Mental Health Law. Among the 369 patients, 85 (23%) had risk of suicide or self-injury, 310 (84%) had risk of harming others, and 26 (7%) had both. The rest of the patients who were admitted involuntarily, although needing treatment, did not meet the Mental Health Law-defined criteria for involuntary admission.Interpretation
The number of involuntary admissions in major psychiatric hospitals in China is high. Fewer than half of the patients who were admitted involuntarily met the criteria for involuntary admission, as defined by the Mental Health Law. Psychiatric hospitals and clinicians need to be mindful of balancing the safety of patients or others and avoiding the unnecessary restriction of patients' freedom.Funding
Beijing Medical and Health Foundation. 相似文献32.
目的 观察柴芍六君汤、拉米夫定联合治疗慢性乙型肝炎患者YMDD变异的情况.方法 采用非随机同期对照试验,将405例慢性乙型肝炎患者分为治疗组和对照组,治疗组220例,对照组185例,对照组给予拉米夫定100 mg,每天1次,口服,治疗18个月.治疗组给予柴胡六君汤每日1剂,同时口服拉米夫定100 mg,每天1次,治疗18个月.观察患者临床症状、ALT复常率、HBeAg阴转率,HBeAg血清转换率,HBV DNA阴转率、治疗12个月及18个月的YMDD变异率.率的比较采用χ2检验,均数比较采用t检验或U检验,方差不齐者用秩和检验. 结果治疗3.6、12.18个月时,ALT复常率治疗组分别为69.5%、85.9%、90.5%,82.7%,对照组分别为50.3%、65.4%、78.4%,69.7%,两组比较,χ2值分别为15.70、23.50、11.50.9.50.JD值均<0.01,差异均有统计学意义.治疗组12、18个月HBV DNA阴转率、HBeAg阴转率、HBeAg血清转换率、YMDD变异率分别为77.7%、57.7%、25.5%、6.8%和86.8%、74.1%、33.2%、8.6%,对照组分别为54.6%、36.8%,13.O%,14.6%和69.2%、37.3%、19.5%、20.5%,两组比较,χ2值分别为24.38、17.70、9.88、6.54和18.67、55.60、9.62,11.78,P<0.01或P<0.05,差异有统计学意义. 结论柴芍六君汤联合拉米夫定治疗慢性乙型肝炎,能有效地改善肝功能,提高拉米夫定抑制HBV复制的作用,减少YMDD变异的发生. 相似文献
33.
Background
The shortage of qualified health workers in rural areas is a global concern. The question of how to attract more medical graduates to work in rural areas has drawn considerable attention. However, very few studies have analysed the association between medical graduates' initial intentions and whether they ultimately opt for rural practice, and no related studies have been conducted in China.Methods
The cross-sectional survey was carried out in ten western provinces in China (Gansu, Kweichow, Inner Mongolia, Ningxia, Qinghai, Shaanxi, Sichuan, Tibet, Xinjiang, and Yunnan). No more than six medical schools in each province and no more than 100 medical students in each school were randomly selected. 4517 questionnaires were collected (response rate, 90·3%). However, only medical graduates who had found a job were included. Pearson's chi squared tests and binary logistic regression analyses were performed on data.Findings
Of 482 medical graduates included in the analysis, 61·0% (293) disclosed an initial intention of rural practice when they began to look for a job, and 68·9% (332) ultimately found a job in a rural area. Among these 332 graduates, 213 initially intended to work rurally. An increase of 1·59 times was observed in the odds of ultimately opting for rural practice in the medical graduates who initially intended to work rurally (odds ratio [OR] 1·59, 95% CI 1·08–2·36). However, after adjusting for all of the demographic variables (gender, age, residence, specialty, type of medical school, and rural clinical clerkship), it reduced to an increase of 1.0 times (1·06, 0·57–2·00) and the association became statistically insignificant. A rural background (1·90, 1·01–3·59), majoring in a specialty of non-clinical medicine (4·69, 1·80–12·24), and studying in junior colleges or below (8·87, 3·67–21·45) significantly increased the odds of ultimately opting for rural practice.Interpretation
A univariate association was identified between medical graduates' initial intentions and whether they ultimately opted for rural practice. However, the initial intentions of medical graduates did not guarantee the eventual outcomes, and it could not be concluded that all medical graduates who opted for rural practice had a genuine desire to work in rural areas. Further study is required on how to increase the likelihood that those who intend to work in rural practice fulfil these intentions, and how to ensure that there continue to be those with other intentions who eventually opt to work rurally.Funding
China Medical Board (number 10-029). 相似文献34.
Background
In China, patients increasingly choose to access severely overcrowded higher level hospitals, whereas the lower level facilities often have low frequencies of use. This situation undermines effectiveness and efficiency of the health system. Moreover, the situation tends to worsen despite policy measures aimed at improvement. We therefore aimed to systematically review the factors affecting patient choice of health system access in China to synthesise scientific understanding.Methods
We did a systematic review of peer-reviewed literature that investigated Chinese patients' choice of health-care facilities at different levels. We searched Embase, MEDLINE, Web of Science, and PubMed for English language articles, and three large Chinese databases (CNKI, VIP, and Wanfang) for articles in Chinese between April 1, 2009, and Jan 28, 2016, using search terms related to patients' choice of health-care facility access level, and how these factors affect the choice of level, such as health care access, decision making in health care, and health seeking behaviour. The primary outcome was to identify the factors that influenced patient choices of health system access level in China. Two structured forms were used to extract data from eligible studies, regarding the study characteristics, methodology, and factors. We appraised the methodological quality of the studies using Method Appraisal Tool (MMAT).Findings
We identified and included 45 studies into our analysis. We identified four types of factors related to patient, provider, context, and composite factors from multiple types. Patient factors are mentioned in 31 (69%) of 45 studies, but the evidence on patient factors is mostly inconclusive. Context factors were the least frequently mentioned, and were reported in four (9%) studies. Evidence suggests that the provider factors, such as drug variety and equipment, and composite factor, such as perceived quality, push patients from lower levels towards higher levels. The MMAT quality score was 100% for 13 studies, 75% for 25 studies, 50% for six studies, and 25% for one study.Interpretation
This systematic review provides an evidence base for measures to redirect patient flow from high level health-care facilities to lower level facilities, thus improving effectiveness and efficiency of the Chinese health system. The underuse of primary care facilities in the Chinese health system compromises the effectiveness and efficiency, and are likely to be amplified by current demographic trends. Evidence suggests that improving the drug availability, equipment, and perceived quality of primary care services can improve the situation. Our evidence suggests that further experimental research is needed, which also considers interactions between factors.Funding
This study was partly funded by the China Scholarship Council (grant number 201507720036). 相似文献35.
Background
A longer time in consultation with doctors in ambulatory care has been associated with better quality of care. Patient experience is of great concern to policy makers and is linked with health-care quality. However, the relationship between consultation length and patient experience remains unclear. We aimed to investigate the effect of consultation length on patient experience, based on analysis of a cross-sectional nationwide patient survey data in China.Methods
We obtained patient survey data from a strati?ed nationwide survey sample that covered 136 tertiary hospitals in China. Patient-estimated consultation length and associated patient experience data were collected by questionnaire after each patient attended a face-to-face consultation with a doctor. The consultation experience was rated on a 5-point scale. We applied a two-piecewise linear regression model to examine the saturation effect of the consultation length on patient experience (consultation score), using a smoothing function, while age, sex, education, and profession were adjusted in the model, then estimated the turning point that gave the maximum model likelihood by using trial and error.Findings
Between Dec 18, 2017, and Dec 30, 2017, 27?721 patients, aged 15–85 years, were eligible and selected for inclusion. The median patient-reported duration of face-to-face ambulatory care consultation was 10 min (IQR 5–12), and the mean score of the consultation experience rated by the patient was 4·25 (SD 0·83; 95% CI 4·24–4·26) on the 5-point scale. After adjusting for potential confounders including age, sex, education, and profession, there was a non-linear relationship between consultation length and measure of patient experience after smooth curve fitting. A turning point at 8 min was identified in the modelling process. Below this point, there was a higher probability of rating a consultation score above average with longer consultation length (odds ratio [OR] 1·28, 95% CI 1·26–1·30, p<0·001). After this point, the OR changed to 1·03 (95% CI 1·02–1·04, p<0·001). There was a significant difference in patient experience measure before and after this consultation length turning point (p<0·001).Interpretation
Consultation length was associated with a measure of patient experience in a non-linear pattern. Longer consultations might not be required to achieve better patient experience, but an adequate consultation should not be shorter than 8 min. Future research about the appropriateness of consultation length for varies ambulatory care institutions would be of benefit.Funding
National Natural Science Foundation of China (71532014), National Health Commission of China 相似文献36.
BackgroundOur previous study showed that a single nucleotide polymorphisms (SNP) of 1888 C>T located at promoter region of human PLUNC gene might affect the susceptibility of nasopharyngeal carcinoma (NPC) in a Chinese population. This study aims to analyze the effect of the genetic variant on PLUNC promoter activity.Materials and methodsThe DNA fragments of the PLUNC promoter region including the SNP 1888 C>T were obtained by polymerase chain reaction (PCR). The recombinant plasmid of the fragment and the pGL3-Enhancer firefly luciferase reporter vector were cloned and identified. Relative luciferase activity (RLA) was measured and electrophoretic mobility shift assay (EMSA) was analyzed.ResultsLuciferase reporter assays demonstrated that luciferase activity of the 1888 T-allele was significantly higher, compared with the C-allele. EMSA experiment proved that the PLUNC gene promoter region SNP 1888 TT genotype had the ability to bind the nucleus protein with the human NPC CEN2 cell, whereas the CC genotype had not.ConclusionsSNP 1888 C>T in the promoter region of PLUNC gene might be a functional mutant locus, indicating that individuals carrying SNP 1888 C-C genotype might be more likely to develop NCP due to the reduced expression of the PLUNC gene. Further functional studies on PLUNC genetic variants are warranted to verify our findings. 相似文献
37.
目的 以联合缩唇-腹式呼吸法和六字诀训练为改良的运动处方,探讨其对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)稳定期患者的康复疗效.方法 将100例患者随机分为四组:对照组、缩唇-腹式呼吸组、六字诀组、运动处方组,每组25例,各组分别于锻炼前和坚持锻炼半年后测定肺功能、6分钟步行距离(6MWD)和动脉血气分析.结果 运动处方组较对照组、缩唇-腹式呼吸组、六字诀组的肺功能指标FEV1、FEV1占预计值百分比和6MWD及血气分析等有明显改善,差异有统计学意义.结论 改良运动处方能有效改善COPD稳定期患者的肺功能、提高运动耐力、提高动脉血氧分压(PaO2)及降低动脉二氧化碳分压(PaCO2),且在改善肺功能、提高运动耐力及降低PaCO2等方面的疗效明显优于单独的缩唇-腹式呼吸操和六字诀训练. 相似文献
38.
目的：探讨地塞米松配合云南白药灌肠治疗溃疡性结肠炎（UC）的效果。方法：选择轻中度活动期UC患者68例,随机分为观察组和对照组各34例,观察组应用地塞米松配合云南白药灌肠治疗,对照组应用柳氮磺吡啶口服治疗。观察治疗前后两组腹痛、便血消失时间和总疗效。结果：观察组腹痛、便血消失时间明显短于对照组。观察组总有效率（91．2％）明显高于对照组（73．5％）,两组比较均具有显著性差异（P〈0．05）。结论：地塞米松配合云南白药灌肠治疗UC比口服柳氮磺吡啶效果好。 相似文献
39.
40.
近年来,血清角蛋白18及其裂解片段在肝病诊断方面的应用潜力引起了国内外研究者的强烈兴趣,但其在慢性乙型肝炎方面的应用研究较少。该文总结和探讨了循环血角蛋白18裂解片段M30及M65水平变化在慢性乙型肝炎中的意义以及应用前景。 相似文献