Impact of adverse media reporting on public perceptions of the doctor-patient relationship in China: an analysis with propensity score matching method

Nursing staff and supervisors perceptions on stress and resilience: a qualitative study

BACKGROUND

Supervisor-subordinate relationship is high relevant in dealing with work-related stress and providing a compassionate, high-quality, and safe nursing care while meeting the needs of the hospital. Our aim was to assess the predisposing risk and resilience factors of the stress of nursing staff as well as to explore the common and distinctive perceptions of these factors between nurses without a managerial position (nursing staff) and employees in a supervising position (nurse managers, ward nurses).

DESIGN

Generic qualitative study using half-standardized interviews.

METHODS

Fifty nurses and supervisors from different departments from a German hospital of maximum medical care participated in this study between August and November 2018. Nineteen face-to-face interviews and five focus groups were conducted. Transcripts were subjected to structured qualitative content analysis.

RESULTS

Systematised in Lazarus's transactional model, nurses, and supervisors mentioned similar risk and resilience factors of stress. Disagreement in suggested responsibility for nurses' stress or health and an evaluation of implemented measures meeting the nurses' needs are discussed.

CONCLUSION

Nursing staff and supervisors should enforce exchange to reduce disagreements in perceptions and to improve mutual understanding. Furthermore, measures to meet nurses' needs to minimize stress and to improve collaboration and job satisfaction should be developed in close coordination with the target group. The focus should be placed on restructuring training and education programs with supplementation of self-responsibility promotion.

TRAIL REGISTRATION

The study was registered with the German Register for Clinical Studies (DRKS 00013482) on 09 March 2018.

Toward stakeholders' understanding of media reporting on doctor-patient relationship issues: trust, unfamiliarity and uncertainty in the Chinese context

Introduction

This study explores doctors' and patients' understandings of citizen journalism on doctor-patient relationship issues. It also examines the communication effect of citizen journalism as a communication platform on doctors and patients who are taking part in the doctor-patient relationship in contemporary China.

Method

This study draws on the analysis of 24 semi-structured interviews with doctors from both publicly funded and privately operated hospital, and nine focus groups which included 36 patients with different socio-economic backgrounds.

Result

The empirical research present the following results: (1) authority and witness are the two key factors to construct the stakeholders'(doctors' and patients') awareness and trust of citizen journalist reporting on the doctor-patient relationship issues. (2) stakeholders' perception on citizen journalism will construct them concern on the uncertain and unfamiliar knowledge during the hospital activities.

Discussion

The interpretation of doctor-patient relationship reports by doctors and patients affects their mutual trust. Authority and witnessing are two key factors that citizen journalists should consider when reporting on doctor-patient relationship news. Doctors from different types of hospitals and patients with different income levels have different understandings of the authority and witnessing of the reported content. Reading the content of doctor-patient conflicts reflected in citizen journalist reports can exacerbate the emotional fluctuations of doctors and patients. After reading these reports, doctors and patients may experience increased anxiety about uncertainty and unfamiliarity in doctor-patient communication.

Contribution

This study provides a framework for public health research from the relationship between communication content and audience. It also provides answers from the perspectives of media and stakeholders to investigate the tension in doctor-patient relationships in China.

Internet usage time and trust in doctors: evidence from China

BACKGROUND

The growth of internet use has greatly impacted many societal sectors, including healthcare. However, current evidence about the relationship between internet usage time and public trust on doctors is insufficient.

OBJECTIVE

To examine the relationship between the time spent on the internet and the level of trust in doctors, and explore its mechanism.

METHODS

Multiple regression models are employed, utilizing a sample of 19,193 observations from the China Family Panel Studies (CFPS) in 2020. First, we regress the relative trust in doctors compared to trust in strangers on internet usage time. Subsample results across distinct population groups are explored. Second, we examine the mechanism of using the internet as an information channel through the mediation method, and further investigate the role of the internet as a communication platform by analyzing the moderation effects of socializing activity as well as social media engagement.

RESULTS

We find a significant negative relationship between increased internet usage time and trust in doctors. This correlation remains robust across different model specifications and variable measurements. The negative correlation is more pronounced among population groups who are elderly, male, married, with low educational levels, insured and residing in urban areas. The role of the internet as a source of information is validated as a mechanism producing the negative influence. The role of the internet as a communication platform tends to mitigate the negative consequences of internet usage, as engaging in online socializing activity can have a positive moderation effect. However, for social media engagement, its overall effect on trust in doctors is negative, potentially due to social media's dual function as a communication platform and an information source.

CONCLUSIONS

Although individual-focused literature tends to demonstrate a positive impact of the internet on trust in doctors in China, our study, which focuses on the general public, reveals contrasting results. Our findings imply that the primary manner in which internet usage, encompassing social media usage, influences public trust in doctors is by molding a collective perception of them. Consequently, the medical community may need to take a more proactive approach in expanding online communication channels for interacting with patients and the wider public.

"I feel like I'm walking on eggshells": a qualitative study of moral distress among Chinese emergency doctors

BACKGROUND

While the number of emergency patients worldwide continues to increase, emergency doctors often face moral distress. It hampers the overall efficiency of the emergency department, even leading to a reduction in human resources.

AIM

This study explored the experience of moral distress among emergency department doctors and analyzed the causes of its occurrence and the strategies for addressing it.

METHOD

Purposive and snowball sampling strategies were used in this study. Data were collected through in-depth, semi-structured interviews with 10 doctors working in the emergency department of a tertiary general hospital in southwest China. The interview data underwent processing using the Nvivo 14 software. The data analysis was guided by Colaizzi's phenomenological analysis method.

STUDY FINDINGS

This study yielded five themes: (1) imbalance between Limited Medical Resources and High-Quality Treatment Needs; (2) Ineffective Communication with Patients; (3) Rescuing Patients With no prospect of treatment; (4) Challenges in Sustaining Optimal Treatment Measures; and (5) Strategies for Addressing Moral Distress.

CONCLUSION

The moral distress faced by emergency doctors stems from various aspects. Clinical management and policymakers can alleviate this distress by enhancing the dissemination of emergency medical knowledge to the general public, improving the social and economic support systems, and strengthening multidisciplinary collaboration and doctors' communication skills.

Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) in Healthcare

Our professional activity is constantly under pressure from a multitude of elements and factors that can be classified into the four components of the VUCA phenomenon-volatility, uncertainty, complexity, and ambiguity-components that define the turbulence and challenges of the external environment. Considering the general elements of this phenomenon, we designed a new VUCA dimension specific to the healthcare field within which we have identified and analyzed all the factors that can influence the main actors of the doctor-patient relationship and the effects that can occur within the healthcare system in which this relationship is born. In this context, we generated the VUCA treatment in healthcare capable of mitigating the impact of this phenomenon; this treatment involves essential elements in overcoming possible crises and vulnerabilities of the medical profession. The VUCA treatment in healthcare requires combating volatility, uncertainty, complexity, and ambiguity through vision, understanding, clarity, and agility, which are grounded in the doctor's need to acquire cross-functional competencies (soft skills). These competencies are applicable by using functional mechanisms and techniques that support the doctor in developing adaptability and anticipation skills, understanding the patient's needs and addressing them, and ensuring the functionality and efficiency of the healthcare system by transferring these elements from micro-management to macro-management levels.

Roles of doctor-patient relationship perception and job satisfaction in the impact of workplace violence on medical professionals' turnover intentions in the early phase of COVID-19: a cross-sectional study in China

OBJECTIVE

This study aimed to explore the role of the doctor-patient relationship (DPR) perception from the perspective of medical professionals in the association between workplace violence (WPV), job satisfaction and turnover intention in the early stages of the COVID-19 pandemic based on the affective events theory (AET).

DESIGN

A cross-sectional study.

SETTING

Nine medical institutions in Beijing were enrolled in this study.

PARTICIPANTS

In total, 792 medical professionals participated in the study, excluding administrators and logisticians.

RESULTS

The structural equation model was well adapted (comparative fit index (CFI) = 0.933; root mean square error of approximation (RMSEA) = 0.060). DPR mediated the association between WPV and job satisfaction, with an indirect effect of 0.247 (p<0.001). DPR perception mediated the effect of WPV on turnover intention, with an indirect effect of 0.090 (p<0.001). It also played a chain-mediating role in job satisfaction between WPV and turnover intention, with a mediation value of 0.117 (p<0.001), accounting for 53.42% of the total effect.

CONCLUSIONS

This study developed a stable model using AET. DPR perception plays an important role in the relationship between WPV and job satisfaction and turnover intention, suggesting the key impact of emotional factors. This has strong practical implications for maintaining the stability of medical teams. Therefore, medical institutions should improve the level of DPR perception from the perspective of medical professionals to effectively prevent mental health problems following WPV.

How does patient-centered hospital culture affect clinical physicians' medical professional attitudes and behaviours in chinese public hospitals: a cross-sectional study?

BACKGROUND

An increasing number of studies on physicians' professionalism have been done since the 2002 publication of Medical Professionalism in the New Millennium: A Physician Charter. The Charter proposed three fundamental principles and ten responsibilities. However, most studies were done in developed countries, and few have been done in China. Additionally, few studies have examined the effect of patient-centered hospital culture (PCHC) on physicians' professionalism. We aimed to investigate physicians' medical professionalism in public hospitals in China, and to assess mediating effect of professional attitudes in the relationship of PCHC with professional behaviours.

METHODS

Self-administered questionnaires including professional attitudes (20 items) and behaviours (10 items) survey and PCHC scale (22 items) were given to clinical physicians in five public hospitals, China. The mediating effect of professional attitudes in the relationship of PCHC with professional behaviours was tested.

RESULT

232 valid questionnaires were collected. More than 90% (208) respondents agreed with 15 of 20 specific statements on medical professionalism. As for the responsibility of improving quality of care, 54 (23%) respondents disagreed with reporting of incompetent colleagues and as for the responsibility of maintaining professional competence, 49 (21%) disagreed with recertification. More than 185 (83%) respondents reported that they sometimes, usually, or always showed the four positive behaviours on the questionnaire, and 173 (77%) reported that they never showed the six negative behaviours. Mediating effect analysis revealed that two dimensions of PCHC (i.e. value/institution culture and behaviour/material culture) had a significant positive impact on physicians' professional behaviour, and professional attitude played a complete mediation role between them, but another dimension of PCHC (i.e. negative evaluation of hospital) directly affected professional behaviour without influencing professional attitude.

CONCLUSION

Chinese physicians showed positive professional attitudes and behaviours. Different dimensions of PCHC affected physicians' attitudes and behaviours in different ways.

Exploring Older Adults' Perceived Affordability and Accessibility of the Healthcare System: Empirical Evidence from the Chinese Social Survey 2021

The difficulties in accessibility and affordability of healthcare services have posed persistent challenges to the Chinese government ever since the 1990s. This research aimed to explore the perceived accessibility and affordability of the healthcare system, which is also referred to as the social problem of Kan Bing Nan, Kan Bing Gui among older Chinese adults. The research, based on 2169 sample data points from the Chinese Social Survey (CSS) 2021 database, explored the objective and subjective factors in constructing the public perceptions of accessibility and affordability of the healthcare system among both older adult users and older adult non-users of healthcare services, including healthcare expenditure variables, patient experience variables, financial protection variables, and social evaluation variables. The study utilized binary logistic regression analysis to investigate how four different sets of independent variables impact the perceived affordability and accessibility of the healthcare system by older adults. The research found that Kan Bing Nan, Kan Bing Gui was considered the most pressing issue among the older adults in China. Self-reported medical burdens, the cost of healthcare services, and the perceived fairness of public healthcare services were significantly associated with older adults' perceived affordability and accessibility of the healthcare system.

Exploring the Relationship Between Intolerance of Uncertainty and Trust in Physicians from Spousal and Parent-Child Perspectives

OBJECTIVE

The present study aimed to probe the intergenerational transmission of intolerance of uncertainty (IU) and trust in physicians. Besides, through the actor-partner interdependence model (APIM), the predictive effect of parents' IU on their own and their spouses' trust in physicians was examined. A mediation model was further constructed to probe the mechanisms by which parents' IU affects children's trust in physicians.

METHODS

The Intolerance of Uncertainty Scale-12 (IUS-12) and the Wake Forest Physician Trust Scale (WFPTS) were employed to conduct the questionnaire survey among 384 families (each family with a father, mother, and one child).

RESULTS

IU and trust in physicians were found to be intergenerationally transmitted. The results of the APIM analyses showed that fathers' total IUS-12 scores negatively predicted their own (β = -0.419, p < 0.01) and mothers' (β = -0.235, p < 0.01) total WFPTS scores. Mothers' total IUS-12 scores negatively predicted their own (β = -0.353, p < 0.01) and fathers' (β = -0.138, p = 0.017) total WFPTS scores. The results of mediation analyses indicated that parents' total WFPTS scores and children's total IUS-12 scores mediated the effect of parents' total IUS-12 scores on children's total WFPTS scores.

CONCLUSION

The public's IU is a crucial influencing factor of their trust in physicians. Besides, the IU between couples and between parents and children could be mutually affected. On the one hand, husbands' IU could affect their own and their wives' trust in physicians, and vice versa. On the other hand, parents' IU and trust in physicians could affect their children's IU and trust in physicians, respectively.

Analysis of factors influencing the job satisfaction of medical staff in tertiary public hospitals, China: A cross-sectional study

Introduction

Since the outbreak of the novel coronavirus pneumonia (COVID-19), China has entered normalization phase of its epidemic prevention and control measures that emphasizes 'precise prevention and control,' 'dynamic zeroing', and 'universal vaccination'. However, medical staff continue to face physical and mental stress. The present study aimed to investigate the job satisfaction of medical staff in China, as well as any associated factors.

Methods

2,258 medical staff completed a questionnaire specially designed for this study. Independent samples t-tests, one-way analysis of variance, and binary logistic regression were used to analyze associated factors.

Results

Overall, 48.4% of the participants expressed satisfaction with their job; the highest-scoring dimension was interpersonal relationships (3.83 ± 0.73), while the lowest scoring dimension was salary and benefits (3.13 ± 0.94). The logistic regression model indicated that job satisfaction among medical staff is associated with being aged 40-49 years [odds ratio (OR) = 2.416] or > 50 years (OR = 2.440), having an above-undergraduate education level (OR = 1.857), holding a position other than doctor [i.e., nurse (OR = 3.696) or 'other' (OR = 2.423)], having a higher income (OR = 1.369), and having fewer monthly overtime shifts (OR = 0.735-0.543). Less than half of the medical staff expressed satisfaction with their job, indicating that the overall level is not high.

Discussion

This research enriches the study of medical workers' job satisfaction during periods when epidemic prevention and control has become familiar and routine. To improve medical workers' job satisfaction, administrators should seek to enhance medical staff's remuneration, reduce their work pressure, and meet their needs (where reasonable).

Exploring Chinese Elderly's Trust in the Healthcare System: Empirical Evidence from a Population-Based Survey in China

This research aims to investigate how much the Chinese elderly trust the healthcare system and the critical factors that influence their trust. We use data from the China Social Survey (CSS) collected by the Chinese Academy of Social Sciences in the year 2019 to examine how demographic factors, social-economic status, internet access, and perceptions of the healthcare system impact the Chinese elderly's trust in the healthcare system. Our research finds male gender, high educational level, and having internet access are negatively related to the elderly's trust in the healthcare system. Our research also reveals that the elderly's trust in the healthcare system was significantly related to their subjective perception of their social-economic status, upward mobility, and perception of accessibility and affordability rather than other objective indicators such as income and financial protection. The results imply that the elderly have a pessimistic expectation of their subjective social status and future possibilities of upward mobility in their later life, which deepens their distrust of the health system. Additionally, the accessibility and affordability of the healthcare system have remained problematic among the Chinese elderly. The study provides important theoretical and practical implications to enhance the elderly's trust in the healthcare system.

High prevalence and risk factors of dropout intention among Chinese medical postgraduates

BACKGROUND

A high attrition rate in medical students has exacerbated the physician shortage in China. However, few studies have explored the risk factors of dropout intention in medical postgraduates. This study compared the prevalence of dropout intention and mental distress between medical and non-medical postgraduates in China and investigated risk factors for dropout intention. This study also explored the impact of medical postgraduates' perception of the Chinese healthcare environment on their mental status and dropout intention.

METHODS

This cross-sectional study was conducted using online questionnaires from October 2020 to April 2021. Convenience sampling was used to recruit postgraduates in different majors. Outcomes included dropout intention and potential risk factors, including mental distress, quality of life, and fatigue. Medical postgraduates were additionally assessed for healthcare environment satisfaction, burnout, career choice regret, and experiences of workplace violence. A logistic regression model was constructed to evaluate the association between dissatisfaction, mental distress, and turnover intention.

RESULTS

A total of 740 medical and 670 non-medical postgraduates participated in the survey. The rates of depression symptoms (33.8% vs. 39.0%, p < 0.001), anxiety symptoms (22.2% vs. 32.4%, p < 0.001), and somatic symptoms (34.7% vs. 42.4%, p = 0.004) were lower in medical postgraduates, while more medical postgraduates (58.4% vs. 48.4%, p < 0.001) reported dropout intention. Dissatisfaction with the healthcare environment (odds ratio [OR]: 1.65; 95% confidence interval [CI]: 1.17-2.34, p = 0.005), career choice regret (OR: 6.23; 95% CI: 4.42-8.78, p < 0.001), and high perceived stress (OR: 2.74; 95%CI: 1.90-3.94, p < 0.001) remained independently associated with turnover intention.

CONCLUSIONS

Mental distress is common among postgraduates, calling for timely interventions. Medical postgraduates reported higher turnover intention. Healthcare environment perception also affected the mental health and dropout intentions of medical students. A decent future income, reduced workload, shorter duration medical training, and better doctor-patient relationships are urgently needed.

Effect of doctor-patient news-induced moral judgments on pain empathy for doctors and patients in China

Objective

Pain empathy's preferential nature tends to trigger prejudice and intergroup conflicts. Given the current degree of proliferation of doctor-patient conflict news in China, this study aims to determine whether readers of doctor-patient news-initiated moral judgments prefer pain empathy for doctors or patients.

Materials and methods

This study utilized localized doctor-patient news with high or low moral performance (based on morality ratings of patients' behaviors) as moral-judgment-eliciting materials, and painful pictures as pain empathy-eliciting materials. The event-related potential (ERP) technique was utilized to assess moral judgment's effect on the cognitive empathy component and to investigate electroencephalogram signals' accuracy in classifying four brain response patterns when facing doctor or patient is experiencing or not experiencing pain.

Results

Under low moral text material, participants exhibited smaller mean wave amplitude of positive 300 (P3) and late positive potential (LPP) to painful pictures than non-painful pictures when facing patients; under high moral text material, participants exhibited larger mean wave amplitude of P3 and LPP to painful pictures than non-painful pictures when facing doctors. Electroencephalogram (EEG) signals' classification accuracy was significant in 0-1,000 ms in both high and low moral judgments, but the classification accuracy was higher in low moral judgments in some cognitive empathy stages (0.51, 0.53-0.55, 0.66-0.79, and 0.88-1 s).

Conclusion

Under low moral judgment, individuals pay less attention to the patient's (perpetrator's) pain; under high moral judgment, individuals empathize with the doctor (the person praised), showing that news-induced moral judgment can sway readers' empathy for different social groups. In cognitive empathy, individuals' brain representations are more discriminatory under low than high moral judgments when confronted with pain by doctors and patients, which provides insight into objectively recognizing group bias.

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis

BACKGROUND

China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017.

OBJECTIVE

This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives.

METHODS

This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective.

RESULTS

The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04).

DISCUSSION

The policy might reduce overprescription in public hospitals from the patient's perspective. The patient's attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.

Barriers of physician-patient relationships in professionalism: A qualitative study

INTRODUCTION

Undoubtedly, there are several obstacles in the path of medical professionalism. This study examines these obstacles in the relationship between physician and patient. Therefore, this study was conducted to explore the barriers of physician-patient relationships in professionalism based on physician experiences.

METHODS

It was a qualitative study with a conventional content analysis approach. Our participants were 14 patients and 11 physicians. The sampling method was purposive, and data was collected through semi-structured interviews and field notes. Interviews continued until data saturation.

RESULTS

Findings of the study regarding barriers of patient-physician relationship were classified into five main categories: misperception of the physician's identity, unprofessional behavior of the physician, physician's sense of self-superiority, patients' cultural differences, and lack of supportive services in the health care system.

CONCLUSION

The results of this study showed that the communication challenges between physician and patient were not limited to the physicians' education. Part of these challenges depends on the patients and their culture. Another part of these challenges is directly related to the medical and management system structure.

What are the Bad Habits and Behaviors of Inconsiderate Doctors in Chinese Inhabitants’ Mind? A Cross-Sectional Study

Purpose

This study aims to 1) investigate inhabitants’ perceptions of doctors’ inconsiderate behaviors during diagnosis and treatment, 2) explore the factors influencing inhabitants’ attitudes toward doctors’ professional reputation, and 3) examine the status of doctors’ inconsiderate behaviors and inhabitants’ attitudes and behaviors toward these doctors in China.

Patients and Methods

A cross-sectional online survey was conducted with 2050 participants from over 30 Chinese cities, from March to June 2018. In total, 1598 valid questionnaires were obtained (with an effective response rate of 77.95%). Data were analyzed using descriptive statistics, exploratory factor analysis, and logistic linear regression analysis.

Results

We developed a questionnaire comprising of 15 items regarding doctors’ inconsiderate behaviors based on inhabitants’ perspectives (Cronbach’s alpha was 0.944). Additionally, we identified the factors that influence the attitudes of inhabitants regarding doctors’ professional reputation, such as frequency of medical consultations, medical expenses, education catalog, and type of medical insurance. A majority of the participants highly valued Chinese doctors’ professional reputation (87.55%), and trusted them (86.29%). However, about 60.27% of the participants reported a pessimistic-like judgment on the current doctor–patient relationship (DPR) in China. Participants believed that Chinese doctors received a high income (20.47%), maintained a high social status (23.46%), and had a heavy workload (59.95%). Furthermore, about 54.88% of participants reported that they would not engage in aggressive behaviors against doctors during a dispute. Lastly, about 26.66% of participants reported that they would act rationally when they were dissatisfied with their doctors.

Conclusion

Impassive emotions and improper actions of doctors toward patients jointly contributed to the disrepute of Chinese doctors. Although DPR was becoming tense, Chinese inhabitants held a positive evaluation of doctors’ professional reputation. While an improvement in the economic situation and reputation of doctors enhanced the DPR, there remains an urgent need to improve the working environment in regard to future Chinese health reforms.

Effect of Patient-Centered Communication on Physician-Patient Conflicts from the Physicians' Perspective: A Moderated Mediation Model

Physician-patient conflicts are detrimental to doctor-patient relationship and sustainable healthcare delivery. In China, the status quo of the doctor-patient relationship is in great tension. Based on the uncertainty reduction theory (URT), the present study examined the relationship between patient-centered communication (PCC) and medical conflict, as well as the roles of perceived patients' trust, doctors' empathy, and expertise from physicians' perspectives. In March 2020, 509 physicians in China were recruited to participate in an online survey. The results revealed that PCC was negatively associated with physician-patient conflicts and that patient trust mediated the relationship. Additionally, doctors' empathy moderated PCC on patient trust, while expertise positively predicted physician-patient conflicts. Theoretical and practical implications for improving doctor-patient relationships were discussed.

Trust in the Doctor-Patient Relationship in Chinese Public Hospitals: Evidence for Hope

PURPOSE

Trust is an essential component in a successful health care relationship. Doctor-patient trust involves the subjects of both sides, including the direction of patients' trust in physicians (patients' perception) and physicians' trust in patients (physicians' perception). This study aims to assess the status quo and explore suggestions for improving trust between doctors and patients.

PATIENTS AND METHODS

In May 2018, we collected data from six representative hospitals in Beijing, China, including 610 questionnaires (310 physicians and 300 patients). Participants were Chinese-speaking, age 14 and older, who expressed their opinions clearly. Kruskal-Wallis H-test and Wilcoxon rank sum test were used to analyze the difference in the trust scores of the responses.

RESULTS

Based on the doctor and patient characteristics, the data show that inpatients are trusted more than outpatients, and patients who often visit the clinic are more doubtful of doctors. The family trust is the highest, and social trust is the lowest. In general, the degree of trust between doctors and patients is good, but the score of physicians (Mean=3.87; SD=0.79) is lower than that of patients (Mean=4.05; SD=0.76). Physicians' evaluation of the degree of trust tends to be more negative than patients'.

CONCLUSION

In spite of recent negative press reports, there remains a high degree of trust between patients and doctors in Beijing. Despite this, one should not be complacent. We need to explore the root cause of the trust between doctors and patients from a deeper perspective to promote better medical services to meet the health needs of patients.

Mediating Effect of Work Stress on the Associations Between Psychological Job Demands, Social Approval, and Workplace Violence Among Health Care Workers in Sichuan Province of China

Objective: The aim of this study was to investigate the prevalence of workplace violence against health care workers, to explore the combined association of work stress, psychological job demands, and social approval with workplace violence and their respective mechanisms among health care workers. Methods: Using data from the Chinese Sixth National Health Service Survey (NHSS) in 2018 conducted among 1,371 health care workers in Sichuan province of China. A self-administered structured questionnaire was used to collect data on health care workers' socio-demographic and work-related characteristics, work stress, psychological job demands, social approval, and workplace violence. We used structural equation modeling (SEM) to test the hypothesized relationship among the variables. Results: The results showed that a total of 77.0% health care workers were exposed to workplace violence. Work stress was directly related to workplace violence (β = 2.167, 95%CI: 1.707, 2.627), while psychological job demands and social approval had indirect associations with workplace violence via work stress [β = 0.427, 95%CI: 0.297, 0.557; β = -0.787, 95%CI: (-0.941)-(-0.633)]. Both psychological job demands (β = 0.197, 95%CI: 0.139, 0.255) and social approval [β = -0.346, 95%CI: (-0.399)-(-0.294)] had direct associations with work stress, while social approval had direct association with psychological job demands [β = -0.085, 95%CI: (-0.136)-(-0.034)]. Psychological job demands mediated the relationship between social approval and work stress. Conclusion: Overall, decreasing workplace violence among health care workers requires to promote interventions to reduce work stress and psychological job demands by improving social approval.

Judicial judgment and media sensation of violence against medical staff in China: A fuzzy set qualitative comparative analysis (fsQCA)

INTRODUCTION

Violence against medical staff has been prevalent in China over the past two decades. Although Chinese authorities have released many laws and regulations to protect medical staff from violence since 2011, the legal approach alone is unlikely to resolve this complex issue. In particular, several cases of violence against medical staff in China have caused great media sensation.

METHOD

This paper proposes an integrated model that combines the environmental stimuli theory, broken windows theory, and rational choice theory. It adopts the fuzzy set qualitative comparative analysis (fsQCA) to untangle the causal relationship between violence against medical staff, media sensation, and judicial judgment. We examined reports of medical violence on media and news websites from January 1, 2010, to January 31, 2020, and selected 50 cases with detailed information for this study.

RESULTS

The results show that each condition is not sufficient for the absence of judicial judgment, but when combined, they are conducive to the outcome. The conditions of hospital level, medical cost, and media sensation play important roles. The providers, patients, and environmental factors are indicators of inadequate or lack of judicial judgment, which corresponds to previous expectations.

CONCLUSIONS

The integrated model greatly enriches the extant theories and literature, and also yields implications for preventing violence against medical staff in China. We suggest that sustainable and innovative healthcare reform should be initiated. For example, public hospitals should remain the cornerstone of national public health security. Medical staff in public hospitals must be regarded as "civil servants". Therefore, the current legal system should be improved. The media should objectively report events concerning medical staff and improve public healthcare knowledge.

Improvement of the management of mental well-being and empathy in Chinese medical students: a randomized controlled study

BACKGROUND

Among Chinese medical students, there is a high prevalence of mental health-related issues and low empathy. Effective strategies to improve this situation are lacking. This study aims to investigate the efficacy of the intervention courses designed to enhance the mental health and empathy of senior Chinese medical students.

METHODS

A total of 146 3rd - and 4th -year medical students were randomized to an intervention group (n = 74) and a control group (n = 72). A pilot study including 5 pre-clinical students and 5 interns was first carried out to determine the themes and content of the intervention courses. The designed courses were delivered in the intervention group once a month three times, while the control group had no specific intervention. Five self-assessment questionnaires, including the General Self-Efficacy (GSE) scale, Medical Outcomes Study Short Form 8 (SF-8), Patient Health Questionnaire-9 (PHQ-9), Maslach Burnout Inventory (MBI), and Jefferson Scale of Empathy-Health Care Provider Student version (JSE-HPS), were completed by the students before and one month after the courses to evaluate their levels of self-efficacy (SE), quality of life (QoL), depression, burnout, and empathy, respectively. Qualitative data were collected via e-mail two years after the intervention.

RESULTS

Compared to the control group, the intervention group showed significantly higher scores for empathy (111.0 [IQR 102.0, 118.0] vs. 106.0 [IQR 93.0, 111.5]; P = .01) and QoL (32.0 [IQR 28.0, 35.0] vs. 29.5 [IQR 26.0, 34.0]; P = .04). The rate of depression was significantly lower in the intervention group than in the control group (13.5 % vs. 29.2 %; chi-square test, P = .02). However, no significant differences in self-efficacy (25.6 ± 4.8 vs. 24.3 ± 6.3; P = .16) or burnout (27.0 % vs. 34.7 %; Chi-square test, P = .31) were observed between the two groups.

CONCLUSIONS

The intervention courses had a positive impact on mental well-being and empathy in senior Chinese medical students, which might help provide novel information for their incorporation into the medical school curriculum.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02645643; Date of registration: 05/01/2016.

General Perception of Doctor-Patient Relationship From Patients During the COVID-19 Pandemic in China: A Cross-Sectional Study

The doctor–patient relationship (DPR) is essential in the process of medical consultations and treatments. Poor DPR may lead to poor medical outcomes, medical violence against doctors, and a negative perception of the healthcare system. Little is known about how DPR is affected during this novel coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study aimed to explore the DPR during the COVID-19 pandemic. There were 1,903 participants in China (95% response rate) who were recruited during the pandemic online via convenience and snowball sampling. Several questionnaires were used to evaluate participants' attitudes toward DPR, including the Patient–Doctor Relationship Questionnaire (PDRQ-9), Chinese Wake Forest Physician Trust Scale (C-WFPTS), a survey on medical violence against doctors, factors that affect and improve DPR, and general trust in medical services. Results revealed that DPR improved, and doctor–patient trust increased compared to participants' retrospective attitude before the pandemic. In addition, patients' violence against doctors decreased during the pandemic. Better doctor–patient trust and lower violence toward doctors are related to better DPR. Furthermore, we found that the main factors that could improve DPR include communication between doctors and patients, medical technology and services, and medical knowledge for patients. This study helped to better understand DPR in China, which may contribute to future health policies and medical practices in order to improve DPR and doctor–patient trust.

An investigation of the intention and reasons of senior high school students in China to choose medical school

BACKGROUND

Shortages of qualified health workers have been a global concern, especially in developing countries. China also faces this dilemma, which hinders the development of public health services. Senior high school students are a group who are considering their college majors and careers after graduation. They are also a potential and basic talent reserve for the health sector. This survey focused on senior high school students' intention to learn clinical medicine and explored potential influencing factors.

METHODS

An anonymous questionnaire containing 20 items was distributed to 5344 senior high school students. The questions covered the following topics: students' intention to learn clinical medicine, personal and family information, understanding of medical education, cognition of doctors' working conditions, and doctor-patient relationships. Logistic regression and the chi-square test were used to compare students with and without a clear intention to learn clinical medicine to explore influencing factors.

RESULTS

Only 5.6% of senior high school students had a clear intention to learn medicine (CILCM). Personal and family information had distinct impacts. Interest and anatomy course were also associated with students' choice. There was a positive correlation between understanding of medical education and students' intention Meanwhile, students' cognition of doctors, career prospects, and social status had significant impacts. The more optimistic students were about doctors' working conditions and doctor-patient relationships, the more likely they were to have a CILCM.

CONCLUSION

To some extent, this survey reflects the shortage of medical talent in China and provides possible clues for solving this problem. In addition, these findings may provide a perspective for understanding the development of health services in developing countries.

Doctor-Patient Relationship in the Eyes of Medical Professionals in China During the COVID-19 Pandemic: A Cross-Sectional Study

Background: Doctor-patient relationship (DPR) is very important for patient outcomes, especially during a public health emergency like the COVID-19 pandemic. However, few studies have evaluated DPR and related sentiments from medical professionals' perspectives. Thus, the aim of the study is to provide a better understanding of DPR from medical professionals' perspectives during the COVID-19 pandemic in China. Methods: A total of 979 medical professionals, including doctors, nurses, technicians, and other workers have completed a series of questionnaires to evaluate their attitudes toward DPR, trust, violence against doctors, factors that affected and improved DPR, and the importance of these factors on DPR. Analyses of variances (ANOVA) and linear regressions were used to analyze the effects of the pandemic, demographic variables, and various elements on DPR. Results: One-way ANOVA revealed a significant effect of education on recent DPR [F _{(2, 976)} = 6.17, p < 0.001 and trust at F _{(2, 976)} = 9.54, p < 0.001], indicating that individuals with higher level of education (bachelor's degree, Master's degree and above) showed poorer recent DPR and lower level of trust. The level of hospital also showed a significant effect on trust [F _{(5, 973)} = 3.79, p = 0.0021]. Cochran's Q test revealed a significant difference in factors that affected [Q₍₁₁₎ = 3,997.83, p < 0.001] and improved [Q₍₈₎ = 3,304.53, p < 0.001] DPR. Backward stepwise linear regressions revealed predictors for changes during [F _{(9, 969)} = 21.17, p < 0.001, R ² = 0.16], shortly after [F _{(7, 971)} = 54.98, p < 0.001, R ² = 0.28], and long after [F _{(10, 968)} = 37.83, p < 0.001, R ² = 0.29] the pandemic. Conclusions: Medical professionals' perceptions of DPR is important as they provide basis for the improvement in working environment of medical professionals and hospital visiting experience of patients, as well as healthcare policy making and preparation for future public health emergencies.

Prevalence and Influencing Factors of Medical Dissatisfaction Experiences in Chinese Hospitals: A Cross-Sectional Study

PURPOSE

To explore the influencing factors of medical dissatisfaction experiences from the perspectives of patients, and provide corresponding strategies for its prevention.

PATIENTS AND METHODS

Using multistage random sampling, 43 hospitals in three provinces of China were surveyed using a self-designed questionnaire. There were 2065 valid questionnaires analyzed in our study.

RESULTS

46.9% (n = 934) of participants had experienced medical dissatisfaction in the past year, mainly due to poor service quality, cumbersome procedures and high medical costs. There were statistically significant differences in the medical dissatisfaction experiences for these patients with different ages, marital status and levels of education (P<0.05). According to structural equation modelling, health education and media reports had a positive and indirect influence (standardized coefficient = 0.046) on medical dissatisfaction experiences, while there was a negative correlation (standardized coefficient = -0.399) between patients' social recognition and medical dissatisfaction experiences. Also, our results also found that social relationships had a negative and indirect impact (standardized coefficient = -0.166) on medical dissatisfaction experiences. Besides, health education and media reports had a negative impact (standardized coefficient = -0.115) on patients' social recognition, while social relationships have a positive effect (standardized coefficient = 0.416) on patients' social recognition.

CONCLUSION

Health education and media reports and social relationships, as antecedent variables, have an indirect effect on inducing the medical dissatisfaction experiences of patients. In addition, patients' social recognition was an intermediate variable in inducing the medical dissatisfaction of patients.

Medicine, media and the law: The effect on training in obstetrics and gynaecology

The inextricable link between medicine and the legal profession has flourished in the 21st century, with countless newspaper articles and social media content on medical cases visible at every juncture. This is particularly true in the speciality of obstetrics and gynaecology, with one of the highest rates of litigation of all medical specialities. We aimed to evaluate the influence of media and the legal environment on the career of trainees in obstetrics and gynaecology. Under the auspices of the Irish national training body, we distributed a 26-item questionnaire to doctors-in-training (DIT) working in obstetrics and gynaecology in the Republic of Ireland. Descriptive statistics and Chi-squared analyses were performed on the anonymised data. 151 DIT responded to the questionnaire, with a response rate of 86.2 % (sample size = 175). The majority were female (79.9 %, n = 121), Irish (85.5 %, n = 106) and had no children (67.0 %, n = 83). 86.7 % (n = 131) felt that the media did not have a positive impact on patients receiving care, and, further, unfairly represented the speciality (94.1 %; n = 142). Additionally, DIT felt that medico-legal issues had a negative impact on issues such as retention and recruitment. These two areas were implicated in over three quarters of DIT considering leaving the speciality. This study demonstrates that DIT perceive media scrutiny and litigation to have a negative effect on the speciality of obstetrics and gynaecology. Further support integrated into specialist training, is needed to ensure that trainees are adequately equipped to deal with both mainstream and social media as well as interactions they may have with the legal profession as they progress through their career.

Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits

OBJECTIVE

Despite the rising trend of medicolegal challenges in India, there is an absolute dearth of literature from India on this issue. The authors conducted a survey, to their knowledge a first of its kind, to assess the perceptions of Indian neurosurgeons about the medicolegal challenges faced in everyday practice.

METHODS

An anonymous online survey performed using Google Forms was widely circulated among neurosurgeons practicing in India via email and social media platforms. The questionnaire consisted of 38 questions covering the various aspects of medicolegal issues involved in neurosurgery practice.

RESULTS

A total of 221 survey responses were received, out of which 214 responses were included in the final analysis, barring 7 responders who had no work experience in India. The respondents were categorized according to their working arrangements and work experience. Out of all of the respondents, 20 (9.3%) had ≥ 1 malpractice suits filed against them. More than 90% of the respondents believed that malpractice suits are on the rise in India. Almost half of the respondents believed the advent of teleconsultation is further compounding the risk of malpractice suits, and 66.4% of respondents felt that they were inadequately trained during residency to deal with medicolegal issues. Most respondents (88.8%) felt that neurosurgeons working in the government sector had lesser chances of facing litigations in comparison to those working in the private sector. The practice of obtaining video proof of consent was more commonly reported by respondents working in freelancing and private settings (45.1%) and those with multiple affiliations (61.3%) compared to respondents practicing in government settings (22.8%) (p < 0.001). Neurosurgeons working in the private sector were more likely to alter management and refer sick patients to higher-volume treatment centers to avoid malpractice suits than their government counterparts (p = 0.043 and 0.006, respectively). The practices pertaining to legal preparedness were also found to be significantly higher among the respondents from the private sector (p < 0.001).

CONCLUSIONS

This survey highlights the apprehensions of neurosurgeons in India with regard to rising malpractice suits and the subsequent increase of defensive neurosurgical practices, especially in the private sector. A stronger legal framework for providing for quick redress of patient complaints, while deterring frivolous malpractice suits, can go a long way to allay these fears. There is a dire need for systematic training of neurosurgeons regarding legal preparedness, which should begin during residency.

Investigation of the differences between the medical personnel's and general population's view on the doctor-patient relationship in China by a cross-sectional survey

Background

Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP).

Methods

This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon’s Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data.

Results

Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children’s practice (p < 0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR.

Conclusion

The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.

The Awareness of Violence Reporting System Among Healthcare Providers and the Impact of New Ministry of Health Violence Penalties in Saudi Arabia

Purpose

Healthcare professionals are one of the most vulnerable groups subjected to verbal and physical violence daily while carrying out their duties; such violence is a worldwide concern. This study aimed to explore the awareness of a violence reporting system among healthcare providers and the impact of the new Ministry of Health (MOH) violence regulations at one of the Eastern Region hospitals in Saudi Arabia.

Methods

A cross-sectional study was conducted from January to February 2020. The study included 210 healthcare providers from different specialties working in critical care units. A sample of 137 healthcare providers was selected randomly, and a self-administered questionnaire was distributed accordingly.

Results

In this study, 31.4% of participants were not aware of whether they had a specific system for reporting violent incidents, while 68.6% had no training on these systems. Experiences of violence among the staff decreased from 78.6% before the MOH regulations to almost 20% after the MOH regulations.

Conclusion

The majority of victims did not report incidents because there is a lack of system privacy, and the workers felt that the incidents of violence were a part of their daily jobs. In addition, this study revealed that the majority of healthcare workers did not receive training on the reporting system, which explains their lack of knowledge about the formal reporting system. Finally, the MOH initiative and penalties for controlling workplace violence have resulted in a significant drop in the prevalence of violence among healthcare workers.

Current prevalence of perioperative early venous thromboembolism and risk factors in Chinese adult patients with inguinal hernia (CHAT-1)

Venous thromboembolism (VTE) is an important postoperative complication. We investigated and analyzed the current inguinal hernia treatment methods and occurrence of early postoperative VTE in Chinese adults. This study involved data for patients with inguinal hernia hospitalized in 58 general hospitals in mainland China from January 1st, 2017 to December 31st, 2017. Data were retrospectively analyzed using a questionnaire. After data inputting and cleaning, we stratified and statistically analyzed patients' data using Caprini scores to create a high-, middle-, and low-risk group. A total of 14,322 patients with inguinal hernia were admitted to the 58 participating hospitals. After data collation and cleaning, 13,886 patients (97.0%) met our inclusion and exclusion criteria. The percentages of laparoscopic surgery and open surgery were 51.2% and 48.8%, respectively. 16 VTEs occurred during the hospitalization, accounting for 0.1% of all adverse events (95% confidence interval (CI) 0.11-0.13). The incidence of VTE was 0.2% (95% CI 0.18-0.2) in the high-risk group and 0.02% (95% CI 0.01-0.03) in the middle-risk group, based on Caprini scoring, with a significant difference (p < 0.0001). No VTE occurred in the low-risk group. Only 3,250 (23.4%) patients underwent Caprini risk assessment regarding treatment, with 13.2% receiving any prevention and only 1.2% receiving appropriate prevention. The treatment of inguinal hernia in Chinese adults has progressed somewhat; however, the evaluation and prevention of perioperative VTE was seriously neglected, in our study, and the incidence of postoperative VTE was underestimated postoperatively. Risk factors continue to be inadequately considered.

Health care reform in China from the perspective of physicians

Health care reform is a worldwide problem. To address the problems of costs, access, quality, efficiency, and equity, China initiated healthcare reform in 2009. The progress of China's healthcare reform has been internationally recognized as the reform has expanded insurance coverage and improved access to and reduced the costs of care over the ten-year period from 2008 to 2018. To achieve sustainable goals, attention must be focused on whether and how the reform encourages physicians. This paper highlights the role of physicians, the challenges that need to be addressed, and the direction in which to advance health reform in China from the perspective of physicians. The slow-growing and aging physician population cannot meet the ever-increasing medical demand. Physicians have a heavy workload, work long hours, have unsatisfactory income, and have a fraught relationship with patients. The situation calls for rethinking the value of physicians and rebuilding trust between physicians and patients. Further healthcare reform is needed to equitably allocate physicians with adequate training, time, and resources to deliver evidence-based practices and patient-centered care.

Violence against healthcare workers and other serious responses to medical disputes in China: surveys of patients at 12 public hospitals

BACKGROUND

Workplace violence against healthcare workers is a global issue that is on the rise, with Chinese healthcare workers facing growing challenges with hospital violence. Attacks on medical staff have increased in recent years with no clear resolution. Prior research focused on policies to improve the doctor-patient relationship and better protect clinicians, but few studies addressed the patient perspective. This paper examines patients' choices when facing a medical dispute and identifies groups who are more likely to respond to conflict with violence or other serious actions.

METHODS

Patient survey responses were collected in 12 leading public hospitals in five Chinese provinces with 5556 participants. The survey asked sociodemographic information, patients' attitudes (e.g., general optimism, trust in their physicians, perceived healthcare quality), and their primary response to a medical dispute. From least to most severe, the options range from "complaining within the family" to "violence." We used t-tests and Chi-square tests to explore the relationships between reactions and patient characteristics. We also performed multivariable logistic regressions to determine the impact of sociodemographics and provider trust on the seriousness of responses.

RESULTS

The primary response of a third of respondents was complaining to hospital or health department officials (32.5%). Seeking legal help (26.3%) and direct negotiation with doctors (19.6%) were other frequent responses. More serious responses included 83 stating violence (1.5%), 9.7% expressing a desire to expose the issue to the news media, and 7.4% resorting to seeking third-party assistance. Patients who were more likely to report "violence" were male (OR = 1.81, p < .05), high-income earners (OR = 3.71, p < .05), or reported lower life satisfaction (OR = 1.40, p < .05). Higher trust scores were associated with a lower likelihood of a serious response, including violence (OR = 0.80, p < .01).

CONCLUSION

Most respondents reported mild reactions when facing a medical dispute. Among those who reported the intent of serious reactions, some sociodemographic characteristics and the trust of physicians could be predictive. To prevent future hospital violence, this work helps identify the characteristics of patients who are more likely to seek severe approaches to medical dispute resolution, including resorting to violence. From these results, hospitals will be better able to target specific groups for interventions that build patient-provider trust and improve general patient satisfaction.

The effects of job satisfaction and psychological resilience on job performance among residents of the standardized residency training: a nationwide study in China

High resident job performance is essential for effective medical professionalism. To date, few studies have investigated the potential predictors of job performance among residents in standardized residency training (SRT) program in China. Therefore, a nationwide survey among Chinese residents in SRT program was conducted to evaluate the impact of job satisfaction and psychological resilience on job performance. A total of 1146 residents from 9 hospitals were recruited in this study. Demographic and work-related information, job satisfaction, psychological resilience and job performance were collected through questionnaires. Hierarchical regression analyses indicated that, "work pressure", "doctor-patient conflict", "intrinsic job satisfaction" and "psychological resilience" were significant predictors of job performance for residents in SRT programs and explained 61.3% of variance, while the three dimensions of psychological resilience (tenacity, strength and optimism) accounted for 27.2% of variance. The area under curve (AUC) of the receiver operating characteristic (ROC) curve showed that resilience had the highest predictive accuracy than another three subscales. This study indicated that intrinsic job satisfaction and psychological resilience had a significant influence on job performance. Strategies and measures to improve residents' intrinsic job satisfaction and psychological resilience may be efficacious ways to enhance their job performance.

The Effect of an Innovative Financing and Payment Model for Tuberculosis Patients on Health Service Utilization in China: Evidence from Hubei Province of China

Background: Tuberculosis (TB) remains a major social and public health problem in China. The "China-Gates TB Project" started in 2012, and one of its objectives was to reduce the financial burden on TB patients and to improve access to quality TB care. The aims of this study were to determine if the project had positive impacts on improving health service utilization. Methods: The 'China-Gates TB Project' was launched in Yichang City (YC), Hubei Province in April 2014 and ended in March 2015, lasting for one year. A series of questionnaire surveys of 540 patients were conducted in three counties of YC at baseline and final evaluations. Inpatient and outpatient service utilization were assessed before and after the program, with descriptive statistics. Propensity score matching was used to evaluate the impact of the China-Gates TB Project on health service utilization by minimizing the differences in the other characteristics of baseline and final stage groups. Focus group discussions (FGDs) were held to further enrich the results. Results: A total of 530 patients were included in this study. Inpatient rates significantly increased from 33.5% to 75.9% overall (p < 0.001), with the largest increase occurring for low income patients. Outpatient visits increased from 4.6 to 5.6 (p < 0.001), and this increase was also greatest for the poorest patients. Compared with those who lived in developed counties, the overall increase in outpatient visits for illness in the remote Wufeng county was higher. Conclusions: The China-Gates TB Project has effectively improved health service utilization in YC, and poor patients benefited more from it. TB patients in remote underdeveloped counties are more likely to increase the use of outpatient services rather than inpatient services. There is a need to tilt policy towards the poor, and various measures need to be in place in order to ensure health services utilization in undeveloped areas.

Nomograms to predict survival of stage IV tongue squamous cell carcinoma after surgery

To develop clinical nomograms for prediction of overall survival (OS) and cancer-specific survival (CSS) in patients with stage IV tongue squamous cell carcinoma (TSCC) after surgery based on the Surveillance, Epidemiology, and End Results (SEER) program database.We collected data of resected stage IV TSCC patients from the SEER database, and divided them into the training set and validation set by 7:3 randomly. Kaplan-Meier analysis and Cox regression analysis were adopted to distinguish independent risk factors for OS and CSS. Clinical nomograms were constructed to predict the 3-year and 5-year probabilities of OS and CSS for individual patients. Calibration curves and Harrell C-indices were used for internal and external validation.A total of 1550 patients with resected stage IV TSCC were identified. No statistical differences were detected between the training and validation sets. Age, race, marital status, tumor site, AJCC T/N/M status, and radiotherapy were recognized as independent prognostic factors associated with OS as well as CSS. Then nomograms were developed based on these variables. The calibration curves displayed a good agreement between the predicted and actual values of 3-year and 5-year probabilities for OS and CSS. The C-indices predicting OS were corrected as 0.705 in the training set, and 0.664 in the validation set. As for CSS, corrected C-indices were 0.708 in the training set and 0.663 in the validation set.The established nomograms in this study exhibited good accuracy and effectiveness to predict 3-year and 5-year probabilities of OS and CSS in resected stage IV TSCC patients. They are useful tools to evaluate survival outcomes and helped choose appropriate treatment strategies.