Objective To investigate the attitudes of Chinese doctors towards the difficulties they have concerning the involvement of patients in decision-making about treatment. Method We surveyed 1 088 doctors at different levels (70% internal medicine, 22% general surgery, 8% gynecology) from 20 general hospitals and 5 university hospitals covering 25 provinces and cities in China, using a simple questionnaire, which we had developed. Results A total of 780 doctors returned the questionnaire and of these only 488 (62%) had completed it. The difficulties that doctors were most concerned about focused on lack of time (27%), expressing uncertainties to patients (15%), dealing with patients who have little medical knowledge (13%), eliciting patients’ preferences (12%), and establishing a stable relationship (9%). Conclusion Increasing their knowledge of patient involvement in making treatment decisions may reinforce appropriate attitudes towards this concept among doctors.
ObjectiveTo develop a survey questionnaire on preferences and values regarding perineal injury prevention measures during pregnancy and conduct reliability and validity tests. MethodsCombining literature reviews, qualitative interviews, and expert consultations, we summarized key elements of perineal injury prevention during pregnancy and synthesized the best evidence. Through multiple discussions within the core working group, a survey questionnaire on preferences and values regarding perineal injury prevention measures during pregnancy was formulated. Using convenience sampling, pregnant women were recruited, and a pre-survey was conducted using the questionnaire. Pre-survey results were analyzed using item analysis and reliability and validity testing methods to validate and refine the questionnaire. ResultsThe questionnaire was compiled based on the theory of evidence-based decision-making. The initial version of the questionnaire was developed by combining systematic evaluation, network meta-analysis, and semi-structured interviews. The questionnaire was modified and improved through expert consultation, group discussion, and pre-investigation, which ensured that the questionnaire had good reliability, validity, and practicability. The Cronbach's α coefficient was 0.87, the split-half reliability was 0.71, and the content validity index was 0.97 of the survey questionnaire. ConclusionThe present version of the perineal injury preventive measures preference and values questionnaire has good reliability, validity, and practicability. It can serve as a valuable tool for investigating preferences and values related to perineal injury prevention during pregnancy.
Objective To evaluate the control status and knowledge level about disease in asthmatic patients in region level cities of Shaanxi province for effect appraisal of patient education. Methods Eight hospitals were selected from six region level cities, where questionnaire survey was completed in out-patients with asthma ( ≥14 years old) . Results A total of 523 patients completed the questionnaire with a ratio of male to female of 1∶1. 14, and an average age of ( 44. 3 ±15. 5) years old. The percentage of controlled,partly controlled and uncontrolled by self-evaluation was respectively 26. 4% , 52. 4% and 11. 1% . 48% insisted on using inhaled corticosteroids ( ICS) . The average score was 17. 88 ±4. 43 by asthma control test ( ACT) . The first three medicines used daily were ICS ( 26. 6% ) , sustained-release theophyline ( 25. 2% )and combination ICS/ long-acting β2 -agonists ( 21. 8% ) . 12. 6% had no medicine and 5. 2% used nonorthodox medicines. 68. 6% patients had omen before exacerbation, and those were sneezing, chest distress and cough. 73. 6% knew asthma is a disease of airway inflammation, and 33. 3% selected ICS as the leader medicine. Only 32. 1% attended the lecture about asthma in hospitals and 85. 0% longed for such education. Conclusions The control status and knowledge level about disease in asthmatic patients in cities still need to be improved in Shaanxi province, and too much work need to be done in order to realize the total control in all patients.
Objective To get the information about the cognition and attitude towards organ transplantation and donation in inpatients. Methods The inpatients were investigated by using a self-designed questionnaire，including general data，cognition and attitude towards organ transplantation and donation. The influence factors of organ transplantation and donation were analyzed by SPSS 18.0. Results A total of 1 000 questionnaires were delivered，973 returned，the effective questionnaire was 906，and the effective rate was 93.1%. In 906 valid questionnaires，788 （87.0%） patients knew organ transplantation；189 （20.9%） patients had transplanted relatives；511 （56.4%） patients were willing to accept the organ transplant surgery，226 （24.9%） patients did not want，169 （18.7%） patients did not know；490 （54.1%） patients agreed to donate organ，173 （19.1%） patients disagreed，243 （26.8%） patients did not know. The age，education，occupation，knowing organ transplants，and with organ transplanted relatives or not had significant influences to the willingness towards organ transplantation and donation （P＜0.01）. The gender had no effect on organ transplantation （P=0.727） and donation （P=0.935） concerned issues，but the age，education，knowing organ transplantation，and with organ transplanted relatives or not had significant influences on it （P＜0.01）. Most concerned factors about organ transplantation were as follows：with an available organ for transplantation 〔28.7% （260/906）〕，postoperative quality of life 〔23.0% （208/906）〕，risk of surgery 〔21.5%（195/906）〕，surgery costs 〔19.5% （177/906）〕，and postoperative rejection 〔7.3% （66/906）〕. Most concerned factors about organ donation were as follows：the reasonable usage of donated organs 〔57.4% （520/906）〕，attitude of relatives 〔23.8% （216/906）〕，and donation compensation 〔17.6% （159/906）〕，and others 〔1.2% （11/906）〕. According to the way of organ donation，403 （44.4%） patients were willing to accept donation after cardiac death （DCD），257 （28.4%） patients accept donation after brain death，246 （27.2%） patients accept living organ donation. The gender，education，and occupation had significant influences on the way of organ donation （P＜0.05），but age，knowing organ transplantation，and with organ transplanted relatives or not had no effects on it （P＞0.05）. Conclusions The lack of propaganda and the high costs of transplantation surgery are the main factors restricting the acceptance rate of organ transplantation. Over time，with continuous improvement of universal education and strengthening the publicity of organ transplantation，the acceptance rate will show a constant increase in the trend. By now，the most accepted way of organ donation is DCD in inpatients. The establishment of a reasonable organ allocation and compensation system is a corner stone to promote organ donation.
Objective To investigate the reading habits of authors of articles published in the Chinese Journal of Evidence-Based Medicine (CJEBM) and to compare the findings with those from other surveys. Methods A total of 512 questionnaires were sent to authors who had contributed to CJEBM over the past 7 years. Results A total of 129 questionnaires were returned (response rate 31.6%). The replies showed that the main purpose of reading literature was to keep up with the latest developments in medicine (94% of replies). The main reading material was medical journals (86%). Most respondents (57%) spent more than 3 hours a week reading journals. The biggest problem identified by authors was the lack of full text papers, but the first choice was the electronic versions of the literature. More than half of the authors (57%) said that they spent less time reading than in the past. Conclusion Effective reading of the medical literature is a basic requirement in the practice of evidence-based medicine. It is necessary and important for clinicians and healthcare providers to improve their reading skills and methods.
Objective To investigate the diagnosis and treatment of status epilepticus in hospitals of different levels and the knowledge of status epilepticus in clinical physicians, in order to better guide clinical education in the future. Methods From August 2014 to August 2015, a questionnaire was designed and used to investigate the general situation of the hospital, the diagnosis of status epilepticus and the clinical practice among trainee doctors and students in the epilepsy training class in the Neurological Intensive Care Unit and the Department of Neurology of West China Hospital, Sichuan University. The results of the investigation were statistically analyzed. Results Ninety questionnaires were distributed, and all the questionnaires were retrieved with validity. The number of investigated physicians was 42 (46.7%) from the Department of Neurology, 6 (6.7%) from the Department of Neurosurgery, 30 (33.3%) from the Intensive Care Unit and 12 (13.3%) from other departments. Twenty-seven (30.0%) physicians were from class Ⅲ grade A hospitals, 31 (34.4%) from class Ⅲ grade B hospitals, and 32 (35.6%) from class Ⅱ grade A hospitals. All the class Ⅲ hospitals and 53.1% of class Ⅱ hospitals had electroencephalograph monitoring facilities. The proportion of status epilepticus patients ranged from 0.5% to 10.0% in different hospitals. There were great differences in the identification and treatment of convulsive status epilepticus among different hospitals. Conclusions Status epilepticus is a common emergency. Questionnaire survey is an effective means to reflect the difference in identifying and treating the emergency among different departments and hospitals. It can guide clinical education and promote the identification and treatment of the emergency more accurately in doctors of all levels.
Objective To investigate the decision-making situation of doctors in the township hospitals in Gaolan, Gansu province, and to discuss its scientificity and rationality. Methods Self-designed questionnaire was adopted to investigate the clinical decision-making situation of 108 doctors from 7 township hospitals in Gaolan county. The investigation contained three parts as follows: basic information of respondents, general information of clinical decision-making evidence, and comparison between respondents’ decision-making situation and current best clinical evidence. Results Among the total 108 questionnaires distributed, 89 valid were retrieved. The feedback showed that 79% of the doctors diagnosed and treated patients in accordance with medical textbooks; 53% took curative effect into consideration in the first place; 33% failed to consider patients’ willingness properly when making clinical decisions; and 52% made clinical therapy regimen for common diseases based on the evidence which was different from that in BMJ published Clinical Evidence. Conclusion While making clinical decisions, doctors in the township hospitals do not adequately refer to the best clinical evidence as their decision-making basis, and fail to take patients’ value and willingness into consideration properly. It is necessary to promote the concept of evidence-based medicine and spread the best evidence in the township health departments.
Objective To provide basic data for further application of national essential medicine list (EML) in Chengdu, through a survey of key-workers or persons, who attended the lecture of EML, in charge of village town hospitals or community medical service centers, and to find out their awareness of and attitudes to the essential medicine and requirements and suggestions for EML training. Methods Based on principles and methods of modern cognitive psychology, we designed the questionnaire and carried out the survey face to face. Two people input the data independently and verified them. Proportions were used to analyze the data through the Excel software. Results (1) The proportions ofcorrect answers to the questions of essential medicine conception, use range of EML and the relationship between EML and essential insurance medicines list were 89%, 91% and 87%, respectively. (2) 46% of the persons investigated (117 persons) chose “always consider preferentially using the essential medicine when prescribing”, 31% (81 persons) “consider using the essential medicine in most cases”. (3) 41% of the persons investigated (103 persons) chose “comparatively welcome” for the EML. (4) Problems of implementing EML in village town hospitals or community medical service centers, in the order of importance decreasing, were: “income and compensation”, “awareness of the essential medicine and prescribing habit of the doctor”, “patient’s cognition of essential medicine and preference to drug use”, “safety and effectiveness of the essential medicine”, “the applicability of essential medicine ” and “the purchase and delivery of essential medicine”, respectively. (5) The ways of getting information of essential medicine were 19.6% (187 person-time) through documents, 18.6% (177 persontime) through conferences and 15.3% (146 person-time) through lectures. (6) 60% of the persons investigated (154 persons) attended training of the essential medicine once or twice. (7) 77% of the persons investigated (196 persons) were trained for less than one week for essential medicine. (8) Requirements and suggestions on the training of essential medicine: 42% (71 person-time) enlarging the targeted people, 22% (38 person-time) increasing the training time,16% (27 person-time) improving practicability and specificity of training contents, 11% (18 person-time) diversifying training ways, 9% (15 persontime) requiring “training according to needs ” which addresses specific problems after investigation. Conclusion Training of essential medicine should be strengthened for medical workers in the village town hospitals or community medical service centers, and researches should be carried out on evaluation of EML applicability, performance of EML implementation, financial aiding, income of medical worker, procurement and reimburse, etc.
ObjectiveTo understand the cognition and mediation tendencies of health care workers in terms of third-party mediation for medical disputes, analyze the factors influencing the trust of both doctors and patients on third-party mediation, and propose suggestions on building third-party mediation mechanisms for medical disputes. MethodsBetween August and December 2012, we made the cognition questionnaire on third-party mediation for medical disputes based on the past medical literature, and the knowledge of doctor-patient relationship as well as third-party mediation agency's organizational structure (including locations and management authorities), staffing, mediation basis, validity sources and fund ensuring. We performed the random cluster sampling survey on all health care workers in five hospitals of different levels. The original data were put into the computer for statistical analysis by SPSS 18.0. ResultsThe knowledge of health care workers on third-party mediation was high. They believed that the best place for solving medical disputes should be the court or judicial administrative department, and the management authorities should be health administrative departments. In case of mediation failure, the majority of health care staff chose to continue to solve the dispute through legal channels. For the effectiveness of mediation conclusion, most health care workers tended to believe in the form of arbitration. They thought that mediators should have professional background of medicine and law; the majority of those surveyed doctors tended to accept forensic conclusions as a basis for mediation. For determining the compensation, doctors were in favor of Applicable Regulations for Medical Malpractice. Over 40% of medical staff believed that third-party mediation should be financed by government financial allocation, and more than half of the medical staff believed that it should be paid by the insurance company. ConclusionThird-party mediation should be set in and managed by the court or judicial and administrative departments. Mediator group should be formed by professionals of law and medical sciences. In the mediation process, it is recommended that the focus of controversy should be identified by forensic identification in order to form a clear division of responsibilities and high mediation efficiency. We recommend that the government introduce in financial allocations at all levels on the basis of medical liability insurance system, and force medical institutions to purchase medical liability insurance through the regulations of law, in order to provide funding support for the operation of third-party mediation organizations. Meanwhile, medical liability insurance companies should be operated under strict supervision to avoid their interference on the mediation work.
Objective To evaluate the applicability of the cut-off points of different versions of the Asthma Control Questionnaire (ACQ) in the Chinese population and their consistency with the symptom control criteria of the Global Initiative for Asthma (GINA), so as to provide strategies for cut-off point selection in clinical practice. Methods Based on baseline data from a multicenter prospective cohort study, asthma patients who completed pulmonary function tests, GINA symptom control assessments, and the ACQ-7 questionnaire were included. Taking the GINA symptom control level as the gold standard, the Receiver Operating Characteristic Curve (ROC) was used to determine the optimal cut-off points of the ACQ for discriminating the GINA symptom control levels, and the consistency was analyzed by kappa statistics. Results Among 399 patients (58.9% female; mean age 44.5 ± 12.8 years), asthma symptom control, partial control, and uncontrolled rates were 61.7%, 27.6%, and 10.8%, respectively. ROC analysis revealed the following optimal cutoffs for identifying symptom control: ACQ-5 (0.5), ACQ-6Res (0.42), ACQ-6PFT (0.92), and ACQ-7 (0.93); for identifying uncontrolled symptoms: ACQ-5 (0.9), ACQ-6Res (1.08), ACQ-6PFT (1.42), and ACQ-7 (1.36). All corresponding areas under the ROC curve (AUC) exceeded 0.9. Consistency between ACQ and GINA symptom control levels was moderate (Fleiss’ κ = 0.453–0.531). Performance characteristics varied between traditional (0.75/1.5) and optimized cutoffs. After optimization, ACQ-5 emerged as the only version achieving balanced sensitivity-specificity (Youden index = 0.75) in dual tasks: ACQ-5 ≤ 0.5 demonstrated sensitivity (91%) and specificity (84%) for symptom control, while ACQ-5 ≥ 0.9 showed sensitivity (95%) and specificity (80%) for uncontrolled status. Conclusions Region-specific calibration of ACQ cutoffs enhances clinical utility in the Chinese population. A stratified application strategy is recommended: high-sensitivity cutoffs for initial screening to reduce underdiagnosis, high-specificity cutoffs for resource-constrained settings to minimize overtreatment, and optimized ACQ-5 cutoffs (≤0.5/≥0.9) for comprehensive management to balance sensitivity and specificity. Flexible combination of cutoff protocols tailored to screening objectives may optimize hierarchical asthma management.