3A Hospitals Research Articles

Comments on prescriptions of big data from outpatient and emergency services using R

Abstract. To explore the high-frequency influencing factors of unqualified prescriptions, and promote rational drug use, the author evaluated on prescriptions of 245,352 from outpatient and emergency services using R in a large 3A hospital in 2023. Among the 245,352 prescriptions, 1,327 were evaluated as unreasonable, with a percentage of 0.54%. There were 1,368 issues related to irrational drug usage. Among the irrational prescriptions identified, the most prominent issues were inappropriate indications (59.16%) and incomplete writing in clinical diagnosis (17.78%). The departments with relatively high rates included head and neck surgery (5.94%), general medicine (3.33%), and convenient outpatient service (2.02%). The top five drugs in irrational prescriptions were Atorvastatin calcium tablets, Aspirin enteric-coated tablets, Calcium carbonate D3 tablets, Rabeprazole sodium enteric-coated tablets, and Metformin tablets, which were commonly used in chronic diseases. There was no significant correlation between the irrational rate and the professional title of the prescribing doctor. Overall, the quality of prescriptions in the hospital was satisfied, but there were still cases of irrational drug use. Hospitals should strengthen prescription review and rational drug use management to ensure the safety and effectiveness of patient medication.

Psychological resilience and intention to stay among nurses: the mediating role of perceived organizational support.

This study aims to analyze the relationship between psychological resilience, perceived organizational support, and intention to stay among nurses. Additionally, it explores the mediating role of perceived organizational support in the relationship between psychological resilience and nurses' intention to stay. A cross-sectional survey was conducted between August and September 2023, involving 1,402 nurses from five Grade 3A hospitals in Guangdong. The survey utilized several instruments, including the General Information Questionnaire (GIQ), the Chinese version of the Connor-Davidson Resilience Scale (CD-RISC), the Chinese version of the Perceived Organizational Support Scale (POSS), and the Chinese version of the Intention to Stay Scale (ITSS). The obtained data were analyzed using descriptive statistics and Pearson's correlation coefficient, while the mediating effect of perceived organizational support was assessed using the PROCESS macro mediation model in SPSS. The overall mean score for psychological resilience among nurses in the five Grade 3A hospitals in Guangdong was 60.54 ± 19.17, the overall mean score for perceived organizational support was 45.77 ± 11.49, and the mean score for intention to stay was 20.82 ± 4.65. The results of the statistical analysis revealed positive correlations between psychological resilience and intention to stay (r = 0.388, p < 0.01), between perceived organizational support and psychological resilience (r = 0.570, p < 0.01), and between perceived organizational support and intention to stay (r = 0.550, p < 0.01). Additionally, perceived organizational support was found to mediate the relationship between psychological resilience and intention to stay, with a mediation effect value of 0.067, accounting for 71.28% of the total effect. Psychological resilience of nursing staff directly impacts their intention to stay and indirectly influences their caring behaviors, with perceived organizational support serving as a key mediator in both relationships. Therefore, nursing managers should implement targeted interventions to enhance nurses' psychological resilience and perceived organizational support. Strengthening these factors can significantly increase nurses' intention to stay in their jobs, improve the quality of care, and contribute to building a strong and stable nursing workforce.

Research on Contract Risk Management of Hospital Construction Project based on Fuzzy Analytic Hierarchy Process

With Covid-2019 outbreak in December 2019, the number of medical infrastructure projects in infrastructure projects has increased. Although contract management is an important link of medical infrastructure project management but there is little quantitative research on the risk analysis. in this paper, firstly, three first-level risk indicators of contract risk management evaluation system are extracted by combing literature: contract drafting, contract signing and contract performance. Then, taking the contract management of a 3A hospital in Chengdu as an example, 12 second-level risk indicators are determined by fault tree method. Then, by experts scoring and statistically analyzing the risk points of 100 construction project contracts signed by the hospital from 2016 to 2020, the weight of secondary risk indicators is determined and the risk matrix is established. Then, the evaluation matrix of contract risk management evaluation system is established by 10 experts. Finally, the evaluation index system of contract risk management is obtained by combining the risk matrix with the evaluation matrix through fuzzy analytic hierarchy process, and the maximum membership degree method is adopted to complete the risk assessment. The research results show that there are high risks in the contract drafting stage and medium risks in the contract signing and contract performance stages in the contract management of a Grade A hospital in Chengdu. The author puts forward reasonable suggestions to improve the contract management level of hospital construction projects.

Predictive model of risk factors for 28-day mortality in patients with sepsis or sepsis-associated delirium based on the MIMIC-IV database

Research on the severity and prognosis of sepsis with or without progressive delirium is relatively insufficient. We constructed a prediction model of the risk factors for 28-day mortality in patients who developed sepsis or sepsis-associated delirium. The modeling group of patients diagnosed with Sepsis-3 and patients with progressive delirium of related indicators were selected from the MIMIC-IV database. Relevant independent risk factors were determined and integrated into the prediction model. Receiver operating characteristic (ROC) curves and the Hosmer–Lemeshow (HL) test were used to evaluate the prediction accuracy and goodness-of-fit of the model. Relevant indicators of patients with sepsis or progressive delirium admitted to the intensive care unit (ICU) of a 3A hospital in Xinjiang were collected and included in the verification group for comparative analysis and clinical validation of the prediction model. The total length of stay in the ICU, hemoglobin levels, albumin levels, activated partial thrombin time, and total bilirubin level were the five independent risk factors in constructing a prediction model. The area under the ROC curve of the predictive model (0.904) and the HL test result (χ2 = 8.518) indicate a good fit. This model is valuable for clinical diagnosis and treatment and auxiliary clinical decision-making.

Illness perception and family resilience in gynaecologic cancer patients: A study on the mediating role of hope.

To investigate the level of family resilience among patients with gynaecologic cancer and explore hope as a mediator between perceptions of illness and family resilience. A cross-sectional study. From May to October 2022, researchers used convenience sampling to survey 320 patients with gynaecological cancer at a level 3A hospital in Jinan City. The study instruments included the General Information Questionnaire, Family Hardiness Index, Brief Illness Perception Questionnaire, and Herth Hope Index. SPSS 26.0 was used to analyse the mediation effect of hope. The mean score for family resilience was 55.86 ± 8.62. Illness perception was negatively associated with family resilience, while hope was positively associated with it. Additionally, hope mediated the relationship between illness perception and family resilience. There is considerable room for improvement in family resilience among patients with gynaecologic cancer. Interventions aimed at increasing hope can enhance family resilience. Healthcare providers can boost family resilience by fostering hope in patients, thereby promoting effective coping and adaptation to cancer. Patients primarily completed the questionnaires, providing insights into the factors that hindered and facilitated the development of family resilience. These findings were communicated to caregivers for further understanding and action.

Moral sensitivity and caring behavior in nursing interns: the mediating role of empathy.

The main purpose of this study is to analyze the relationship between moral sensitivity, empathy, and caring behaviors and to explore the mediating effect of empathy on moral sensitivity and caring behaviors of nursing interns. A cross-sectional survey was conducted from August to September 2022 in which 261 nursing interns from two Grade 3A Hospitals in Xi'an participated. The questionnaires used in the survey include the General Information Questionnaire (GIQ), the Moral Sensitivity Questionnaire-Revised Version translated into Chinese (MSQ R-CV), the Chinese version of the Jefferson Empathy Scale (JSE), and the Chinese version of the Caring Behavior Inventory (C-CBI). The obtained data were analyzed through descriptive statistics, a one-way analysis of variance (ANOVA), and Pearson's correlation coefficient, and the mediating effect of empathy was tested through structural equations. The overall mean of moral sensitivity of nursing interns in two Grade 3A Hospitals in Xi'an is 40.84 ± 8.73, the overall mean of empathy is 100.51 ± 21.56, and the overall mean of caring behavior is (113.81 ± 21.05). Statistical analysis showed that there is a positive correlation between moral sensitivity and caring behavior of nursing interns (r = 0.376, p < 0.01), between their empathy and moral sensitivity (r = 0.336, p < 0.01), and between their empathy and caring behavior (r = 0.394, p < 0.01). The empathy of nursing interns has a mediated effect on the relationship between moral sensitivity and caring behavior. The mediated effect value was 0.14, accounting for 31.82% of the total effect. The moral sensitivity of nursing interns can have a direct impact on predicting the caring behavior and indirect influences their caring behaviors mediated by empathy, with the latter effect being mediated by empathy. Therefore, nursing educators and hospital administrators should adopt targeted interventions to improve the moral sensitivity and empathy of nursing interns, which can further prove to be beneficial in improving their caring behaviors, leading to enhanced quality of nursing care and reduced nurse-patient conflicts and finally to a stabilized nursing team.

Knowledge, Attitudes, Willingness, and Associated Factors to Organ Donation Among Intensive Care Unit Health Care Workers: Findings of a Cross-Sectional Study

The lack of donor organs is a major barrier to the advancement of organ transplantation. This study aimed to understand the current status of knowledge, attitudes, and willingness to donate organs among intensive care unit (ICU) health care workers and analyzed the influencing factors to provide a scientific basis for improving the situation of a serious imbalance between the ratio of organ supply and demand. From November 2021 to March 2022, 160 ICU health care workers from 3 level 3A hospitals in Huzhou City, Zhejiang Province, China were chosen as subjects by the cluster sampling method. A cross-sectional study of the participants was carried out using a general information questionnaire, Organ Donation Knowledge Scale, Organ Donation Attitude Scale, and Organ Donation Willingness Scale. The determinants of ICU health care workers' knowledge, attitudes, and willingness toward organ donation were examined using multiple linear regression analysis. A total of 150 ICU health care workers completed the survey within the prescribed time, and the recovery rate of this questionnaire was 93.75%. The score on the Organ Donation Knowledge Scale was 7 (5, 7) points, and the full score was 10 points. The score on the Organ Donation Attitude Scale was (3.87 ± 0.93), and the full score was 7. The Organ Donation Willingness Scale score was 2 (2, 3) out of 5. The results of the multiple linear regression analysis revealed that several factors significantly influenced the score of organ donation knowledge. These factors were identified as the professional title and persuasive experience related to organ donation. Additionally, the score of organ donation attitude was found to be influenced primarily by the persuasive experience of organ donation. Furthermore, the score of organ donation willingness was influenced by 3 main factors: marital status, professional title, and persuasive experience in the context of organ donation. Although the level of ICU health care workers' knowledge and attitudes toward organ donation was above the median level, they still needed to be improved. The current status of ICU health care workers' desire to donate organs is not optimistic; thus, relevant departments should take specific actions to improve the situation.

Latent classes of health-promoting lifestyle in breast cancer patients undergoing chemotherapy in China: A cross-sectional survey.

To identify the latent classes of a health-promoting lifestyle and examine the associations of latent class profile with individual characteristics of breast cancer undergoing chemotherapy in China in order to provide some insights and recommendations for targeted and individualized health education of health-promoting lifestyle. A descriptive cross-sectional survey design was used for this work. A total of 197 patients with breast cancer undergoing chemotherapy recruited from the Breast Cancer Outpatient Chemotherapy Clinic of a Grade 3A hospital were surveyed. Health-promoting lifestyle was measured using the Health Promotion Lifestyle Profile-II: Chinese Version Short (HPLP-IICR). Latent class analysis was used to examine respondents' health-promoting lifestyle patterns. Associations between the latent class membership and individual characteristics were examined using multinomial logistic regression. Four latent classes were identified: Class 1-Good Nutrition and Poor Physical Activity, Class 2-Poor Health Responsibility and Nutrition, Class 3-Active Health-Promoting Lifestyle, and Class 4-Medium Spiritual Growth and Poor Other Dimensions. Younger respondents and respondents with a higher score in anxiety and depression were more likely to be classified in Class 4 rather than Class 1 or 3. Respondents with low exercise self-efficacy were more likely to be classified in Class 4 than the others. Respondents in Class 4 had more chemotherapy symptom severity and interference, and cases of menopause were fewer in Class 4 rather than Class 3. Those in Class 4 were more likely to have been diagnosed with cancer within 3 months than those in Class 1.

Readiness for return-to-work model-based analysis of return-to-work perception of young and middle-aged colorectal cancer patients with stoma in the early postoperative period: a descriptive qualitative study.

With an increase in the number of young and middle-aged colorectal cancer (CRC) patients with stoma, understanding their perception about return to work (RTW) in the early postoperative period can guide medical professionals to provide appropriate rehabilitation strategies, which can eventually improve patients' readiness for return to work (RRTW) and enable them to achieve final rehabilitation. The present study aimed to investigate the RTW-related perceptions and considerations of young and middle-aged CRC patients with stoma after surgery. From 2021 to 2022, we conducted a basic interpretive qualitative study involving semi-structured interviews with 17 CRC patients with stoma in two grade 3A hospitals in China. This study was based on the RRTW model. Data collection was continued until data saturation was reached, and all data were transcribed verbatim and analyzed by Colaizzi's phenomenological method. The following three key themes were identified: (1) self-efficacy; (2) decision balance; and (3) change process. Eight subthemes were formulated that were included within the respective main themes. In light of the current low self-efficacy and unsatisfactory willingness of patients with stoma about RTW, we suggest that medical staff should implement cognitive intervention and supportive interventions to improve self-efficacy, actively enhance the motivation of patients for RTW, and simultaneously resolve the pertinent difficulties; this could help patients to accept the positive change process and enable their successful transition from a change process to RTW.

Virtual emotional gestures to assist in the examination of the mental health of the deaf‐mutes

AbstractThe particular characteristics of deaf‐mutes make them more likely to have mental health problems. Due to their particular way of communication, it is more difficult for them to deal with mental health problems than ordinary people. Nowadays, those psychologists who are good at sign language are in short supply, and remote assistance cannot achieve satisfactory results. Therefore, a library of virtual emotional gestures based on electroencephalogram (EEG) was established and a prototype system for mental health examination of deaf‐mutes was proposed, which help deaf‐mutes identify their psychological problems in time and assist medical staff to examine the psychological problems encountered by deaf‐mutes. In addition, the virtual library of emotional gestures is established with the assistance of the chief physician from a 3A hospital in Henan Province. More importantly, the later experiments demonstrate the applicability of this virtual system.

A Survey of Therapeutic Drug Monitoring Status in China.

To understand the status of therapeutic drug monitoring (TDM) in China Mainland, and thus lay down the foundation for further improvement in TDM. In the present study, a nationwide questionnaire survey was conducted, which was distributed and collected using a mobile-based application. Clinicians, pharmacists, and clinical laboratory physicians belonging to different levels of public hospitals were involved as subjects/objects. The contents of the survey included TDM implementation in their hospital and information regarding their opinions and suggestions on TDM work. Mann-Whitney test was used to compare the difference between top tertiary hospitals and non-top tertiary hospitals. A total of 475 questionnaires were collected, 383 from top tertiary hospitals (3A hospitals) and 92 from non-top tertiary hospitals (other than 3A hospitals). A total of 240 clinicians, TDM pharmacists, and clinical laboratory physicians were involved, with an effective rate of 50.5%. Top tertiary hospitals were associated with certain advantages, such as the number of TDM testing facilities, annual sample size, number of monitoring varieties, and interpretation rate of monitoring reports, compared with non-top tertiary hospitals. In particular, β-lactamase inhibitor, olanzapine, carbamazepine, and glucocorticoids seemed to be the main projects that clinicians wanted to assess. The drugs for which TDM was commonly performed included vancomycin, valproic acid, carbamazepine, phenytoin sodium, and methotrexate. The most commonly used detection methods include high-performance liquid chromatography, immunization, 2D-LC, and LC-MS. The monitoring concentration range was found to be inconsistent for most of the drugs. Currently, no unified regulation exists for TDM charges in China, which is no more than ¥200 in general. Clinicians rely on pharmacists for professional guidance. Importantly, improvement in the interpretation of monitoring reports, proficiency testing, and cooperation with clinical departments may aid in improving the level of TDM service. This survey objectively reflected the current status of TDM work in hospitals in China, and provided a strong reference base for devising strategies for improvement and effective execution of TDM work.

Symptom distress and suicidal ideation among Chinese ovarian cancer patients: A moderated mediation model of depression and suicide resilience.

The aim of this study was to examine whether depression mediates the relationship between symptom distress and suicidal ideation in Chinese patients with ovarian cancer, and whether this mediating effect was moderated by suicide resilience. From March to October 2022, this cross-sectional study was performed in a three Grade 3A hospital and an oncology specialty hospital in Wuhan, Hubei Province, China. Ultimately, 213 ovarian cancer patients completed anonymous self-report. Bootstrapping method was used for regression analysis to test the mediating and moderating effects. Among the 213 participants, 29.58% (n = 63) exhibited significant suicidal ideation. Symptom distress was positively associated with suicidal ideation, and depression partially mediated this relationship. Suicide resilience moderated the relationship between depression and suicidal ideation. In ovarian cancer patients with low suicide resilience, the effect of symptom distress on suicidal ideation through depression was greater, while in patients with high suicide resilience, this effect was attenuated. Our study suggests that symptom distress could be more likely to lead to suicidal ideation as depression levels increase in ovarian cancer patients. Fortunately, suicide resilience could attenuate this negative effect.

Analysing the global and local spatial associations of medical resources across Wuhan city using POI data

BackgroundThere is a sharp contradiction between the supply and demand of medical resources in the provincial capitals of China. Understanding the spatial patterns of medical resources and identifying their spatial association and heterogeneity is a prerequisite to ensuring that limited resources are allocated fairly and optimally, which, along with improvements to urban residents’ quality of life, is a key aim of healthy city planning. However, the existing studies on medical resources pattern mainly focus on their spatial distribution and evolution characteristics, and lack the analyses of the spatial co-location between medical resources from the global and local perspectives. It is worth noting that the research on the spatial relationship between medical resources is an important way to realize the spatial equity and operation efficiency of urban medical resources.MethodsLocalized colocation quotient (LCLQ) analysis has been used successfully to measure directional spatial associations and heterogeneity between categorical point data. Using point of interest (POI) data and the LCLQ method, this paper presents the first analysis of spatial patterns and directional spatial associations between six medical resources across Wuhan city.Results(1) Pharmacies, clinics and community hospitals show “multicentre + multicircle”, “centre + axis + dot” and “banded” distribution characteristics, respectively, but specialized hospitals and general hospitals present “single core” and “double core” modes. (2) Overall, medical resources show agglomeration characteristics. The degrees of spatial agglomeration of the five medical resources, are ranked from high to low as follows: pharmacy, clinic, community hospital, special hospital, general hospital and 3A hospital. (3) Although pharmacies, clinics, and community hospitals of basic medical resources are interdependent, specialized hospitals, general hospitals and 3A hospitals of professional medical resources are also interdependent; furthermore, basic medical resources and professional medical resources are mutually exclusive.ConclusionsGovernment and urban planners should pay great attention to the spatial distribution characteristics and association intensity of medical resources when formulating relevant policies. The findings of this study contribute to health equity and health policy discussions around basic medical services and professional medical services.

Application of Wax Therapy in Pain Care of Patients with Rheumatoid Arthritis

Objective: To investigate the effect of wax therapy in pain care of patients with rheumatoid arthritis. Methods: Convenience sampling method was used to select inpatients with rheumatoid arthritis admitted to the rheumatology and immunology department of a 3A hospital in Jingzhou City. 75 patients from January 2021 to June 2021 were selected as the control group, and 75 patients from January 2022 to June 2022 were selected as the observation group. The control group was given routine nursing, and the observation group was implemented wax therapy nursing on the basis of the control group. The relief of clinical symptoms (morning stiffness time, pain score) and quality of life score of the two groups were observed. Results: After intervention, there was statistical significance between the two groups (P < 0.05). Conclusion: Wax therapy can improve the time of morning stiffness, the degree of pain and the quality of life of patients with rheumatoid arthritis.

Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey

ObjectivesThis study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists.DesignMulti-centre cross-sectional survey.Setting220 medical centres in different regions of China.ParticipantsA total of...

Correlation Between the Number of Fiberoptic Bronchoscopies and Nosocomial Infection/Colonization of Carbapenem-Resistant Enterobacteriaceae.

ObjectiveThe present study aims to explore the effects of different numbers of fiberoptic bronchoscopic examinations on the nosocomial infection/colonization of carbapenem-resistant Enterobacteriaceae (CRE).MethodsThe data of 129 patients admitted to the intensive care unit of a grade 3A hospital were retrospectively analyzed, and CRE nosocomial infection/colonization situations in patients with fiberoptic bronchoscope application times of 1, 2, 3, and ≥4 were statistically analyzed.ResultsThe incidence of nosocomial infection/colonization of CRE increased significantly when the number of fiberoptic bronchoscopic examinations was ≥3.ConclusionNosocomial infection/colonization of CRE is highly correlated with an increased number of fiberoptic bronchoscopic examinations.

Association of Ubiquitin C-Terminal Hydrolase-L1 (Uch-L1) serum levels with cognition and brain energy metabolism.

In recent years, many researchers have taken serum ubiquitin c-terminal hydrolase (Uch-L1) as an indicator of post-traumatic brain injury and associated it with cognitive impairment. Alzheimer's disease is characterized by cognitive impairment and energy metabolism disorders. The purpose of this study was to detect whether serum Uch-L1 is related to cognition and brain energy metabolism in healthy people, and to explore whether it can be used as an early blood marker of Alzheimer's disease. In this prospective cohort study, adult outpatients from a Grade 3A hospital were recruited. They completed the 18F-FDG-PET/CT examination in the nuclear medicine department and were screened by the Mini Mental State scale (MMSE) and the Montreal Cognitive Assessment scale (MoCA). Blood samples were collected from all outpatients to detect the concentration of serum Uch-L1, and the mean standard uptake value (SUVmean) of energy metabolism in the hippocampus during PET/CT examination was collected. A total of 37 participants, 14 participants with cognitive impairment (MMSE score < 27) and 23 controls (MMSE score 27-30) were included. There was a significant difference in the SUVmean of the hippocampus between the cognitive impairment group and the normal control group (p < 0.05). There was a significant correlation between the SUVmean of the hippocampus and the total score of MMSE in all participants [r = 0.439, 95% CI: (0.139-0.668), p = 0.007]. There were also significant correlations between serum Uch-L1 and MMSE. Based on the significant differences of demographic variables between groups, we conducted a multivariate linear regression analysis of MMSE cognitive scores based on age (X1), length of education (X2) and SUVmean of hippocampus (X3). The regression equation is as follows: Y = 25.709-0.072 X1 + 0.422 X2 + 0.232 X3. Brain cognitive ability is closely related to energy metabolism and serum Uch-L1 concentration, so serum Uch-L1 may become a blood marker for extensive screening of dementia in the future. We look forward to the introduction of a more accurate and low-cost method for detecting serum Uch-L1 concentration.

A Cross-Sectional Study of Breast Cancer Surgery and the Cost Based on Data From 77 Chinese 3A Hospitals in 2015.

PurposesWe aimed to clarify the real-world status of breast cancer surgery and the cost in China.MethodsThis cross-sectional survey relied on data obtained from the hospitalization summary reports (HSRs) in 77 top-ranked (grade 3A) hospitals in China to analyze breast cancer patients who underwent surgery between January 2015 and December 2015. The surgery and cost were mainly evaluated.ResultsOverall, 31,900 breast cancer patients underwent surgeries in 77 hospitals. The mean age in our study was 51.5 years (SD, 11.7 years). The primary types of surgical procedures were mastectomy (n = 24,629, 77.2%) and breast-conserving surgery (6,210, 19.5%). The rate of mastectomy was the highest at age band 50–65 years (n = 10,861, 82.1%) and in non-first-tier cities (n = 7,651, 88.4%) as well as in Northeast China (n = 3,107, 93.2%). The rate of breast-conserving surgery was less than 10% in non-first-tier cities (9.8%), Southwest China (6.1%), and Northeast China (5.8%). The median cost was $3,352.4 (interquartile range (IQR), $2,492.6–4,588.0). Mastectomy cost was significantly higher than breast-conserving surgery cost in both different city tiers and regional distribution except Northeast China (p < 0.001).ConclusionsThis study demonstrated that the main breast cancer surgery in Chinese 3A hospitals was mastectomy and that the cost varied both across and within geographic regions and city tiers. This information helps describe the real-world status of breast surgery and the cost in China.

Extracting clinical named entity for pituitary adenomas from Chinese electronic medical records

ObjectivePituitary adenomas are the most common type of pituitary disorders, which usually occur in young adults and often affect the patient’s physical development, labor capacity and fertility. Clinical free texts noted in electronic medical records (EMRs) of pituitary adenomas patients contain abundant diagnosis and treatment information. However, this information has not been well utilized because of the challenge to extract information from unstructured clinical texts. This study aims to enable machines to intelligently process clinical information, and automatically extract clinical named entity for pituitary adenomas from Chinese EMRs.MethodsThe clinical corpus used in this study was from one pituitary adenomas neurosurgery treatment center of a 3A hospital in China. Four types of fine-grained texts of clinical records were selected, which included notes from present illness, past medical history, case characteristics and family history of 500 pituitary adenoma inpatients. The dictionary-based matching, conditional random fields (CRF), bidirectional long short-term memory with CRF (BiLSTM-CRF), and bidirectional encoder representations from transformers with BiLSTM-CRF (BERT-BiLSTM-CRF) were used to extract clinical entities from a Chinese EMRs corpus. A comprehensive dictionary was constructed based on open source vocabularies and a domain dictionary for pituitary adenomas to conduct the dictionary-based matching method. We selected features such as part of speech, radical, document type, and the position of characters to train the CRF-based model. Random character embeddings and the character embeddings pretrained by BERT were used respectively as the input features for the BiLSTM-CRF model and the BERT-BiLSTM-CRF model. Both strict metric and relaxed metric were used to evaluate the performance of these methods.ResultsExperimental results demonstrated that the deep learning and other machine learning methods were able to automatically extract clinical named entities, including symptoms, body regions, diseases, family histories, surgeries, medications, and disease courses of pituitary adenomas from Chinese EMRs. With regard to overall performance, BERT-BiLSTM-CRF has the highest strict F1 value of 91.27% and the highest relaxed F1 value of 95.57% respectively. Additional evaluations showed that BERT-BiLSTM-CRF performed best in almost all entity recognition except surgery and disease course. BiLSTM-CRF performed best in disease course entity recognition, and performed as well as the CRF model for part of speech, radical and document type features, with both strict and relaxed F1 value reaching 96.48%. The CRF model with part of speech, radical and document type features performed best in surgery entity recognition with relaxed F1 value of 95.29%.ConclusionsIn this study, we conducted four entity recognition methods for pituitary adenomas based on Chinese EMRs. It demonstrates that the deep learning methods can effectively extract various types of clinical entities with satisfying performance. This study contributed to the clinical named entity extraction from Chinese neurosurgical EMRs. The findings could also assist in information extraction in other Chinese medical texts.

Analysis of disease composition and outcome of patients in intensive care department of 3A hospitals: analysis of 3 249 cases in the department of Liaocheng People's Hospital from 2019 to 2021

To provide the basis and direction for the establishment of the database of severe patients by analyizing of the disease composition and outcome of patients in the department of critical care medicine of the 3A hospital. The clinical data of 3 249 patients admitted to the department of critical care medicine of Liaocheng People's Hospital from January 1, 2019 to December 31, 2021 were retrospectively analyzed, including gender, age, admission time, admission route, diagnosis, acute physiology and chronic health evaluation II (APACHE II) score 24 hours after admission, outcome and other information. The mean age of 3 249 patients was (61.99±18.29) years old, and the proportion of young and old patients aged 60-74 years accounted the largest (34.01%). There were more males (1 800 cases) than females (1 449 cases). The most patients were admitted in January (119 cases) and the least in March (75 cases). The top eight diseases in the department of critical care medicine were respiratory system diseases (21.88%), multiple injuries (12.65%), cardiovascular system diseases (11.48%), gastrointestinal surgery diseases (9.42%), pathological obstetrics (7.76%), digestive system diseases (7.63%), urinary system diseases (5.69%) and nervous system diseases (5.23%). Among 3 249 critically ill patients, 54.36% (1 766 cases) were transferred to the general ward for treatment after improvement, with APACHE II score was 17.99±5.51. 15.91% (517 cases) returned to local hospital for further treatment after improvement, APACHE II score was 22.48±6.57. 1.51% (49 cases) were transferred to superior hospitals, APACHE II score was 21.71±5.18. 24.22% (787 cases) were discharged automatically, APACHE II score was 25.64±5.45. 4.00% (130 cases) died in intensive care unit (ICU), APACHE II score was 29.08±8.10. The APACHE II score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the differences were statistically significant (all P < 0.001). Among 3 249 patients, a total of 1 265 patients were admitted to ICU for sepsis caused by aggravated infection, and 44.43% (562 cases) of the 1 265 patients improved to the general ward after treatment, with APACHE II score was 18.99±5.46. 19.21% (243 cases) returned to local hospital after treatment with APACHE II score was 22.79±6.74. 1.50% (19 cases) were transferred to superior hospitals for further treatment with APACHE II score was 21.21±4.81. 31.54% (399 cases) were discharged automatically with APACHE II score was 25.55±4.84; 3.32% (42 cases) died in ICU with APACHE II score was 27.69±7.92. The APACHE II score of patients who died in ICU was higher than that of patients who were transferred to another department, another hospital or discharged automatically after their condition improved, and the difference was statistically significant (all P < 0.001). Among the patient admitted to ICU 2019-2021 in Liaocheng People's Hospital, respiratory system diseases accounted for the first, multiple injuries accounted for the second place, followed by cardiovascular system diseases, gastrointestinal surgery diseases, pathological obstetrics, etc. Males and elderly patients aged 60-74 years have a higher proportion of severe cases. APACHE II scores were associated with patients' prognosis.