25 April 2023, Volume 30 Issue 2

    

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  Causal relationship between depression and interstitial lung disease with two-sample Mendelian randomization

  Chen Ming，Liu Jinchan，Tang Tianshu，Xu Dehua，Chen Xiaolin，Rao Shaoqi

  journal1. 2023, 30(2): 81-86. https://doi.org/10.3969/j.issn.1006-5253.2023.02.001

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  Objective To reveal the causal relationship between depression and interstitial lung disease (ILD) by using Mendelian randomization method, and to provide new ideas for the prevention, treatment and prognosis of ILD.Methods The genetic loci closely associated with depression were selected as instrumental variables using pooled data from the Genome-Wide Association Study (GWAS). The inverse variance weighting method was used as the primary analysis method, and the weighted median method and MR-Egger regression were used as auxiliary methods to perform two-sample Mendelian randomization analysis; OR values were used to evaluate the causal relationship between depression and ILD, and heterogeneity tests, gene multiplicity tests and sensitivity analyses were performed to assess the stability and reliability of the results.Results Thirty-seven single nucleotide polymorphism (SNP) loci were included as instrumental variables. MR-Egger regression estimated that the risk of lung cancer in patients with depression was 1.21 times that of healthy people (95%CI: 1.075-1.361, P=0.002). The weighted median method also supported a causal effect between depression and interstitial lung disease (95% CI: 1.118-1.564, P=0.001). The heterogeneity test results of the inverse variance-weighted method and MR-Egger regression showed that there was no heterogeneity; MR-Egger regression intercept term and MR-PRESSO method tests showed that the results were less likely to be affected by gene pleiotropism; no non-specific SNPs were found in leave-one-out analysis.Conclusion There may be a positive causal association between depression and ILD.
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  Signal mining and analysis of vortioxetine adverse event reports based on OpenFDA database

  Wu Xuqi，Ge Chenjie

  journal1. 2023, 30(2): 87-92. https://doi.org/10.3969/j.issn.1006-5253.2023.02.002

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  Objective To evaluate the reports of adverse events of vortioxetine and data analysis to provide reference for drug safety in clinical practice.Methods The data of vortioxetine adverse events from September 2013 to August 2022 were retrieved from OpenFDA database, and risk signals were mined using the Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR) methods of the Ratio Imbalance Method. Statistical classification and analysis of the mined signals were performed using the preferred system organ class (SOC) of the Medical Dictionary for Regulatory Activities (MedDRA).Results Totally 16 569 reports of vortioxetine related adverse events were retrieved, with a predominantly adult population and a higher proportion of female patients (62.2%). The top 3 reporting countries were USA, France and Canada. The reporting population was mainly consumers or nonhealth professionals, accounting for 47.8%. The main indication was depression. The proportion of serious adverse events was 45.1%. Fifty suspicious signals were screened according to the positive criteria, involving a total of 10 SOC classifications, with psychiatric disorders having the highest number of signals (20), followed by systemic disorders and various reactions at the site of administration (9). Twenty-five of the 50 suspicious signals were consistent with the instructions. Among the 50 suspicious signals, the top 3 signals in terms of intensity were feeling guilty (ROR=171.616, PRR=169.288), decreased appetite (ROR=92.452, PRR=91.141) and apathy (ROR=38.309, PRR=37.404).Conclusion Based on the OpenFDA database, the adverse event data of vortioxetine can help to identify the potential risk signals of vortioxetine in the real world, suggesting that clinics should pay attention to these potential risk signals not mentioned in the instructions, in addition to those included in the instructions, and take timely interventions to ensure the drug safety of patients.
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  Survival benefit analysis of postoperative adjuvant chemotherapy for early-stage NSCLC

  Xu Lingyan，Li Qianni，Li Jian，Liu Meina

  journal1. 2023, 30(2): 93-100. https://doi.org/10.3969/j.issn.1006-5253.2023.02.003

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  Objective To calculate the median survival time and survival rate of patients with early-stage non-small cell lung cancer (NSCLC), and analyze the survival difference of patients with different clinical characteristics after postoperative adjuvant chemotherapy, so as to provide a basis for doctors to screen patients with possible survival benefit of postoperative adjuvant chemotherapy.Methods The data of early-stage NSCLC patients undergoing surgical treatment were extracted from SEER database. Propensity score matching (PSM) was used to control confounding factors to obtain the postoperative adjuvant chemotherapy group and the control group. The main clinical characteristics were selected to test the interaction between these clinical characteristics and postoperative adjuvant chemotherapy. Kaplan-meier method was used to compare the median survival time, 3-year survival rate and 5-year survival rate of the adjuvant chemotherapy group and the control group with different clinical characteristics.Results There were 25 791 patients with early stage NSCLC who underwent surgical treatment. The propensity score model included 11 confounding factors, and 3 336 pairs of patient samples were obtained after matching, with good balance between groups. The interaction between postoperative adjuvant chemotherapy and TNM stage, N stage, histological type, differentiation degree, and age had statistical significance on the survival of patients(P<0.05). The clinical characteristics of patients with postoperative adjuvant chemotherapy survival benefit were: stage-II, stage-T2, stage-T3, stage-N1, poorly-differentiated tumor, histological type of squamous cell carcinoma, age＞60 years old. The median survival time of patients with survival benefit wassignificantly prolonged, and the 3-year and 5-year survival rates were higher than those of the control group(P<0.05). The patients with stage-II, stage-N1 and histological type squamous cell carcinoma had the most significant benefit: the HR of the postoperative adjuvant chemotherapy group with stage-II was 0.70(95%CI: 0.63-0.77); the HR of the postoperative adjuvant chemotherapy group with stage-N1 was 0.68(95%CI:0.59-0.77); the HR of the postoperative adjuvant chemotherapy group with squamous cell carcinoma was 0.68(95%CI:0.59-0.78). The 3-year and 5-year survival rates of stage-IA and well-differentiated patients in the chemotherapy group were lower than those in the control group. The HR of the postoperative adjuvant chemotherapy group with stage-IA was 2.33(95%CI:1.58-3.42); the HR of the postoperative adjuvant chemotherapy group with well-differentation was 1.76(95%CI:1.27-2.42).Conclusion Postoperative adjuvant chemotherapy can greatly improve the lung cancer-specific survival rate of patients with high TNM staging, poorly differentiation and pathological type of squamous cell carcinoma, so postoperative adjuvant chemotherapy is recommended; elderly patients should be careful to use postoperative adjuvant chemotherapy after strict evaluation of various indicators; postoperative adjuvant chemotherapy has adverse effects on the survival of stage-IA and well-differentiated patients. Doctors should be wary of overtreatment in clinical therapeutics.
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  DRG index analysis of chemotherapy in the surgery department of a tertiary comprehensive hospital

  He Liping，Liu Yuanting，Huang Weijuan

  journal1. 2023, 30(2): 101-105. https://doi.org/10.3969/j.issn.1006-5253.2023.02.004

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  Objective To evaluate the current status of chemotherapy for malignant tumors in the surgical department in a tertiary hospital in southern Guangzhou with Diagnosis Related Groups indicators, and to provide reference for the hospital to formulate treatment strategies for chemotherapy patients.Methods The first page data of medical records of the patients in RU14 group classified by CN-DRG (version 2019) were collected in a hospital discharged from the surgical department and the oncology department in 2019. Total weight, time consumption index, and cost consumption index were used to describe the development of the surgery department. Multiple linear regression was used to analyze the relationship between the time consumption index and cost consumption index and different departments.Results In this hospital, 64.5% of RU14 group patients were admitted to the surgery department, mainly with postoperative chemotherapy. The number of patients admitted to the RU14 group ranked first in the surgical department, but the weight output was low. The time consumption index of the surgery department was 0.77, and that of oncology department was 1.05. By multiple linear regression analysis, the time consumption index of the surgery department was lower than that of the oncology department (t=-9.650, P<0.001). The cost consumption index of the surgery department was 1.14, and that of the oncology department was 1.09. According to multiple linear regression analysis, the relationship between the cost consumption index and the departments was not statistically significant (t=1.117, P=0.264).Conclusion The application of DRG index to analyze the current situation of patients treated with chemotherapy for malignant tumors in the surgery department can provide important guidance for the development of the department.
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  Evolutionary game and empirical analysis of DRG system on the difficulty of diseases diagnosis and treatment in tertiary hospitals

  Fang Jinming，Tao Hongbing

  journal1. 2023, 30(2): 106-113. https://doi.org/10.3969/j.issn.1006-5253.2023.02.005

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  Objective To analyze the influence of DRG system on the difficulty of diagnosis and treatment of diseases in tertiary hospitals with the evolutionary game theory.Methods Through theoretical analysis of strategies and behavioral benefits of medical institutions, an evolutionary game model was constructed, the influence of various factors on the difficulty of diagnosis and treatment of hospital diseases was analyzed by software simulation, and the correctness of the model was verified by empirical analysis.Results Under normal circumstances, even if the initial proportion of departments who choose the strategy of improving the difficulty of diagnosis and treatment of diseases is only 1%, after only 6.13 simulation cycles, the strategy of improving the difficulty of diagnosis and treatment of diseases can quickly cover more than 95% of the groups. When the medical insurance rate is too low, hospitals will choose not to improve the difficulty of disease diagnosis and treatment. Empirical data prove the correctness of the evolutionary game model constructed in this study.Conclusion DRG will promote the difficulty of diagnosis and treatment of diseases in tertiary hospitals. The model constructed in this study has strong practicability in prediction, adjustment and control. The proportion of individuals adopting different initial strategies in hospital group has a great influence on evolutionary equilibrium time. It must be noted that when the medical insurance rate is too low, the hospital will choose not to the difficulty of disease diagnosis and treatment.
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  Evaluation of performance allocation based on DIP in hospitals based on efficiency coefficient method

  Zhang Huacui, Tang Ji, Yu Huajun, Zhang Jingbo, Zhang Ensi

  journal1. 2023, 30(2): 114-118. https://doi.org/10.3969/j.issn.1006-5253.2023.02.006

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  Objective To comprehensively evaluate the effect of the inpatient performance distribution scheme based on DIP in a hospital, so as to find the existing defects in the current performance distribution scheme and explore the rationality and feasibility of the performance distribution scheme based on DIP.Methods Thirteen data from 10 surgical departments in a tertiary general hospital in Qingyuan City in 2021 were selected as comprehensive evaluation indexes. Delphi expert consultation method was used to determine the weights of evaluation indexes, and the efficacy coefficient method was used to calculate the total efficacy coefficient and rank it.Results Except for obstetrics with simple disease types, the results of comprehensive evaluation of other surgical departments were consistent or basically consistent with the actual allocation results.Conclusion The current performance allocation scheme based on DIP can relatively reasonably reflect the service quality and medical value of the departments. It is of practical guiding significance to comprehensively evaluate the results of performance distribution of the hospital with the efficiency coefficient method.
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  Application of disease risk adjustment in medical quality management 

  Ma Shangyin，Tian Wei

  journal1. 2023, 30(2): 119-122. https://doi.org/10.3969/j.issn.1006-5253.2023.02.007

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  Objective To explore the application of disease risk adjustment method in medical quality management. Methods The disease risk adjustment model was used to analyze and compare the medical quality, efficiency and cost of some cases in the same population with the DRGs method.Results In the four indicators of hospitalization days, total hospitalization cost, drug cost and consumable cost, the predicted values provided by the disease risk adjustment model modeled separately for different management objectives were closer to the actual values than the reference values of DRGs, and the difference was statistically significant (P<0.05). In fatality management, it is possible to provide predictions of fatality in disease groups that cannot be given by DRGs.Conclusions Compared with the DRGs method, the disease risk adjustment model has better representativeness and application value in multiple quality management dimensions such as hospitalization days, costs, and fatality. It can provide the predictive value of indicators such as expenses and hospitalization days for individual cases, which is more instructive in specific management practices.
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   Grey correlation analysis of personal health expenditure in Shandong Province from 2010 to 2019

  Wang Xiubin，Su Yong，Li Huibo

  journal1. 2023, 30(2): 123-127. https://doi.org/10.3969/j.issn.1006-5253.2023.02.008

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  Objective To analyze the influencing factors of personal health expenditure in Shandong Province from 2010 to 2019.Methods The data were obtained from China Health Statistical Yearbook (2011-2021) and Shandong Statistical Yearbook (2011-2021), and analyzed by grey correlation analysis method.Results All indicators of health expenditure in Shandong Province showed an increasing trend from 2010 to 2019. The three indicators with the highest correlation with personal health expenditure were disposable income of rural residents, per capita GDP, and number fo surgeries for hospitalized patients. The three indicators with the lowest correlation were social health expenditure, government health expenditure, and price index of Chinese and Western medicine and health products.Conclusion The economic development factors represented by urban and rural residents′ disposable income and per capita GDP have a strong correlation with personal health expenditure in Shandong Province. Medical service factors such as the number of inpatient operations, the average medical cost per inpatient and the average medical cost per outpatient have a certain correlation with personal health expenditure. The correlation between health resource factors and population status factors and personal health expenditure is relatively low. It is suggested to take comprehensive measures from the aspects of policy, medical service and residents to slow down the growth of personal health expenditure.
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  Application of the DEA method based on DRGs indicators in the efficiency evaluation of clinical departments

  Luo Qin， Wang Mingju，Ming Xingchen，Luo Yongzhong，Li Jialin，Zhang Jin，Fu Ping，Deng Qiong，Yang Xiao

  journal1. 2023, 30(2): 128-132. https://doi.org/10.3969/j.issn.1006-5253.2023.02.009

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  Objective To measure and evaluate the operational efficiency of clinical departments in a general hospital and optimize the allocation of medical resources.Methods Data envelopment analysis (DEA) was used to comprehensively evaluate the input and output efficiency of the hospital's clinical departments by combining the indicators related to Diagnosis Related Groups (DRGs). The improvement direction and degree were obtained by analyzing the slackness of input and output indicators of non-technical effective clinical departments.Results Among 41 clinical departments, 48.78% of the clinical departments were effective in DEA, 12.20% were purely technically effective, and 39.02% were ineffective in terms of pure technical efficiency and scale efficiency.Conclusion Hospitals should do a good job of differentiated management, supplement and improve the hospital performance assessment system by combining DEA methods and DRGs-related indicators, optimize the allocation of health resources within the hospital, improve quality and efficiency, and take the path of high-quality development.
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  Multidimensional analysis of inpatient death cases in a tertiary hospital in Guiyang from 2017 to 2021

  Qin Xinyun，Luo Dan

  journal1. 2023, 30(2): 133-138. https://doi.org/10.3969/j.issn.1006-5253.2023.02.010

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  Objective To research the distribution characteristics of inpatient death cases, and to provide theoretical basis for disease prevention and treatment measures in hospitals.Methods The first page information of inpatient death records from a tertiary hospital in Guiyang from 2017 to 2021 was collected, and the cause of death was classified according to the International Classification of Diseases (ICD-10). The distribution characteristics of several factors such as sex, age, season and cause of death were statistically analyzed by T-test and chi square test.Results There were 4 452 cases of inpatient death in the hospital in the past five years, which showed a decreasing trend overall (χ2=113.45, P<0.001). The male mortality rate was 0.51%, higher than that of the female 0.29%. There were statistically significant differences in mortality among different age groups (χ2=6 133.08, P<0.001), among which the proportion of death over 65 years old was higher than that in other age groups (60.27%). The proportion of death in winter was 26.44%, higher than that in other seasons. The top three causes of death were circulatory diseases, respiratory diseases and tumors.Conclusion It is necessary to strengthen the medical prevention and management for male and elderly patients, and strengthen the prevention and treatment of key diseases such as cerebrovascular diseases, so as to reduce the mortality in hospitals.
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  Analysis on influencing factors of hospitalization expenses of systemic lupus erythematosus patients in a tertiary general hospital from 2017 to 2021 

  Wu Dongyan，He Zhenbo

  journal1. 2023, 30(2): 139-143. https://doi.org/10.3969/j.issn.1006-5253.2023.02.011

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  Objective To determine the main factors affecting the hospitalization expenses of patients with systemic lupus erythematosus patients and to provide scientific basis for reducing the hospitalization expenses of patients with systemic lupus erythematosus.Methods The medical records of patients discharged from a tertiary hospital in Qinzhou from 2017 to 2021 who were mainly diagnosed with systemic lupus erythematosus patients were collected. In this study, multiple regression analysis and path analysis models were used to analyze the direct and indirect influencing factors that determine the hospitalization expenses of systemic lupus erythematosus patients.Results The average hospitalization days of patients with systemic lupus erythematosus patients were 9.36 days, the average hospitalization cost was 12 429.96 yuan, and the median was 7 182.65 yuan. Path analysis results showed that gender, age, year, blood transfusion or not, and the proportion of drugs not only have direct effects, but also have indirect effects. The above factors indirectly affect the hospitalization expenses through the number of days in hospital.Conclusion The number of days in hospital has the most important impact on the hospitalization expenses of patients with systemic lupus erythematosus, followed by age, and then the proportion of drugs. The hospital should adopt more scientific and effective measures to deal with the high economic burden of hospitalized patients with systemic lupus erythematosus, such as reasonable arrangement of hospital stay.
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  Path analysis of influencers of hospitalization expenses for patients with malignant tumors in a tertiary hospital

  Cao Bingyan

  journal1. 2023, 30(2): 144-147. https://doi.org/10.3969/j.issn.1006-5253.2023.02.012

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  Objective To explore the factors influencing hospitalization expenses of malignant tumor patients, and to provide scientific basis for reducing the economic burden of malignant tumor patients.Methods A retrospective analysis approach was used for path analysis on the influencing factors of hospitalization expenses of patients with 5 kinds of malignant tumors in a tertiary hospital from January 1, 2021 to December 31, 2021.Results The surgery level was the main factor affecting the hospitalization expenses of patients with malignant tumor (direct effect 0.50 and indirect effect 0.21); length of hospital stay was in the second place by influence on hospitalization expenses of malignant tumor patients (direct effect 0.58), followed by malignant bronchus and lung tumors (direct effect 0.27, and indirect effect 0.30), malignant esophagus tumors (direct effect 0.17, and indirect effect 0.32), malignant stomach tumors (direct effect 0.21 and indirect effect 0.22), malignant breast tumors (direct effect 0.15 and indirect effect 0.28), whether first-class or special nursing or not (direct effect 0.04 and indirect effect 0.15), whether transferred between departments (indirect effect 0.15), whether critical or severe (direct effect 0.08), age(direct effect-0.08), drug proportion (direct effect -0.03 and indirect effect 0.10), whether with medical insurance (direct effect 0.03).Conclusion The main factors affecting the hospitalization expenses of malignant tumor patients are the surgery level and hospitalization days, so it is necessary to reduce the hospitalization expenses of patients with malignant tumors by shortening the average hospitalization days and strengthening perioperative management.
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  Research on the present situation of the first page data filling of medical records in public hospitals under the background of performance appraisal

  Jing Yuan，Huang Qi，Zhou Fengfei

  journal1. 2023, 30(2): 148-151. https://doi.org/10.3969/j.issn.1006-5253.2023.02.013

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  Objective To analyze the management and data quality of the first page of medical records of public hospitals in Leshan, and put forward some suggestions for the existing problems.Methods Fifty medical records of discharged patients in 2021 were randomly selected from 14 hospitals, and quality control was carried out one by one according to the "data quality scoring standards for the first page of inpatient medical records", data defects of the first page of medical records were analyzed, and the data filling process and management of medical records on the first page of medical records were investigated by combining quantitative and qualitative methods.Results Defects in quality control medical records accounted for 45.3%; among the data on the first page of medical records that affected performance assessment monitoring indicators, the defects of admission condition, diagnosis and code, surgical operation and code, and incision healing grade accounted for a relatively high proportion. There were weak points in data collection, quality control and interface reporting on the first page of medical records.Conclusion All medical institutions should further sort out the problems in all links of data filling on the home page and strengthen quality control assessment and construction management for data defects and weak links.
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  Implementation of Stata for random sampling of medical records

  Yi Wei，Huang Zhenyu，Niu Yadan，Zhou Yuqin

  journal1. 2023, 30(2): 152-156. https://doi.org/10.3969/j.issn.1006-5253.2023.02.014

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  Objective To introduce the method of simple random sampling and stratified sampling of medical records with Stata, in order to carry out the quality control of medical records.Methods Taking the statistical analysis software Stata as an example, the process of importing, viewing, random sampling, and exporting medical record data was shown, and the Stata command of random sampling required in the management of medical record quality control was provided.Results Compared with random number table method, lottery and subjective sampling, Stata sampling is more convenient, scientific and efficient. Compared with SAS and R language, Stata commands are more concise and easier for beginners to master. Conclusion Stata sampling is practical and efficient in the quality control of medical records, and it is worth learning and mastering by the relevant personnel of medical records.
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  Application of Excel VBA in data statistics of rehabilitation therapists

  Mao Xiaoliang，Cai Naixin，Yuan Jieyang，Wu Xiaoqing

  journal1. 2023, 30(2): 157-160. https://doi.org/10.3969/j.issn.1006-5253.2023.02.015

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  Objective To explore the application of Excel VBA in data statistics of rehabilitation therapists.Methods The Excel VBA program embedded in Microsoft office was used to compile the code, and the corresponding forms, engineering files and modules were designed to enable the computer to complete the statistics of rehabilitation assessment, rehabilitation treatment, clinical examination and other data by the rehabilitation therapists.Results Through Excel VBA programming, we designed a data statistics program that met the clinical work needs of rehabilitation therapists. In this study, we recorded the complete basic information and treatment process of 534 rehabilitation patients. It provided a window interface for query and patient information input, which was automatically saved in a format that occupied less memory, enabling the rehabilitation therapists to quickly query the patients′ treatment process data and quickly accumulate the basic data of rehabilitation clinical research.Conclusion Using Excel VBA programming can improve the data statistics efficiency of rehabilitation therapists, reduce the error rate, improve the reliability of data, so as to improve the daily work efficiency and provide strong support for clinical research.