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51.
52.
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53.
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
54.
目的:观察子午流注择时温和灸联合中药敷脐防治胃肠道恶性肿瘤化疗所致胃部不良反应的临床疗效。 方法:将120例胃肠道恶性肿瘤化疗患者随机分为对照组和观察组,每组60例。对照组患者在化疗期间常规给予制酸剂和止吐药物,观察组在对照组干预措施基础上,根据子午流注择时给予温和灸法和中药敷脐;观察两组患者胃部不良反应情况。 结果:化疗期间,观察组、对照组恶心、呕吐及食欲减退等胃部不良反应发生率分别为51.7%和80.0%,观察组胃部不良反应发生率及胃部症状分级均低于对照组(P<0.05)。 结论:子午流注择时温和灸联合中药敷脐能有效防治胃肠道肿瘤化疗所致的恶心、呕吐及食欲不振等胃部反应。 相似文献
55.
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56.
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57.
文章以临床验案为例,分析刘学勤教授活用经方的思路,举隅说明刘学勤教授活用经方治疗肝胆病的临证经验。以逍遥散变方(以丹参易当归、赤芍易白芍、土茯苓易茯苓、生薏仁易白术)拟疏肝健脾汤,治疗慢性肝炎;以血府逐瘀汤去生地、桔梗、川芎、牛膝,加川楝子、香附、郁金拟疏肝化瘀汤,治疗肝硬化;以五苓散去桂枝,加苍术、猪苓、防己、川牛膝、怀牛膝等拟消水汤,治疗肝硬化合并胸腹水;以半夏泻心汤加枳壳、砂仁,以太子参易人参拟胃平汤,治疗脂肪性肝病。在经方原方基础上"取其意、增其效",灵活变通后,更加符合肝胆病特点。经方变方对肝胆病的治疗更具有针对性,在一定程度上提高了临床疗效,这种承古拓今的独特思路值得借鉴。 相似文献
58.
应用苯妥英钠后急性低压缺氧条件下大鼠脑单胺递质的变化 总被引:4,自引:0,他引:4
目的探讨苯妥英钠(Diphenylhydantoin,DPH)在急性缺氧条件下的脑保护作用。方法给大鼠应用DPH,用荧光分光法检测其在低压舱模拟升空7.5km后1h、2h的脑匀浆单胺递质含量,同时观察脑细胞形态学改变。结果DPH实验组在缺氧1h及2h时脑多巴胺和5-羟色胺含量升高(P<0.05),而脑去甲肾上腺素在缺氧1h时降低(P<0.05),缺氧2h恢复正常。电镜形态学观察,低压缺氧条件下对照组大鼠脑细胞水肿,线粒体嵴严重缺失,细胞核明显变形;应用DPH的实验组细胞形态基本正常。结论给大鼠应用苯妥英钠后,在急性缺氧条件下,动物脑单胺递质含量的变化可能与缺氧适应或耐受的形成有关。 相似文献
59.
本文通过考证和调查,证实云南省长期习用的刘寄奴为金丝桃科(Hypericaceae)植物金丝桃Hyperiaum uralum Buct-Ham的干燥地上部分。从而对金丝桃的原植物、药材性状,显微鉴别及理化鉴别进行了研究。 相似文献
60.
谨守病机权衡邪正主次燮理脏腑重视处方配伍--刘平教授治疗肝硬化经验浅析 总被引:2,自引:0,他引:2
总结刘平教授治疗肝硬化的经验。认为临床上注重肝硬化基本病机.治疗上依据邪正主次确立基本治法.处方用药强调配伍。 相似文献