How to evaluate surgical tourism service organizations in China: indicators system development and a pilot application.

BACKGROUND: Surgical tourism is an emerging economic sector, with the most growth potential demonstrated in China's health industry before the COVID-19 pandemic. Surgical tourism accounts for a large part of medical tourism services in China, with high requirements in terms of quality and safety. By contrast, China suffers from insufficient measurement tools and theoretical research. The aim of this study was to develop a set of reliable and feasible indicators by augmenting the Donabedian model to evaluate the quality of surgical tourism services. METHODS: A literature review and focus group interview were used to generate indicators for the quality of surgical tourism services. The basic framework of the evaluation system was based on the structure-process-outcome Donabedian model. The screening and weight setting were conducted through an analytical hierarchy process (AHP) and a two-round Delphi consultation with 13 panelists. The validity and reliability of experts were tested by the experts' positive coefficient, authority coefficient, and coordination coefficient. The reliability of the questionnaire was assessed by a pre-test distributed within an International Medical Department of a public hospital in China. RESULTS: Based on the Donabedian quality theory, a novel evaluation system of surgical tourism service institutions was constructed with three dimensions, nine first-level items and 39 second-level items. The three dimensions consisted of the structure (0.315), process (0.287), and outcome (0.398), with several indicators for each dimension and each indicator was given a weight. Of the two rounds of Delphi consultation, the response rates were 86.67% and 100%. The coordination coefficient of expert opinions in the two rounds of consultation were 0.49 and 0.65 (p < 0.05). For the empirical study, the self-evaluation score of a public hospital was 86, which could rate as a two-star institution. CONCLUSIONS: Our evaluation system identified three suitable quality dimensions of surgical tourism services to improve the safety and quality of practical healthcare. It reflects the access criterion of surgical tourism institutions, provides references for the best choice of surgical services for tourists, and can be applied by healthcare managers and policy makers to allocate resources more efficiently and promote more surgical tourism services with international standards.

Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge Prevalencia y predictores de TEPT en pacientes recuperados de COVID-19 un mes después del alta 新型冠状病毒肺炎患者 (COVID-19) 出院一个月后创伤后应激障碍的患病率和预测因素

Background: Coronavirus disease 2019 (COVID-19) can place an immense psychological strain on the infected patient. The psychological distress can linger after the initial recovery from the infection. Objective: This study aimed to evaluate the prevalence and predictors of provisional post-traumatic stress disorder (PTSD) in patients with cured COVID-2019. Methods: The baseline survey was conducted from 10 to 25 February 2020 in patients with COVID-19 in a designated hospital. Demographic and clinical characteristics were acquired, and depression and anxiety levels were assessed, using the 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale, respectively. A follow-up survey was conducted 1 month post-discharge. PTSD symptoms were measured by the Impact of Event Scale-6 (IES-6) and patients’ perception of supportive care during hospitalization was investigated using a self-developed questionnaire. Results: In total, 114 patients completed both the baseline and follow-up surveys. Of these, 41 (36.0%) met the cut-off score for provisional PTSD diagnosis according to the IES-6. Female gender [odds ratio (OR) = 4.69, 95% confidence interval (CI) 1.54–14.37], educational level of high school or below (OR = 15.49, 95% CI 1.13–212.71), higher anxiety levels (OR = 1.34, 95% CI 1.12–1.61) and lower perceptions of emotional support during hospitalization (OR = 0.41, 95% CI 0.17–0.96) predicted a higher risk for provisional PTSD. Conclusions: PTSD is commonly seen in patients with COVID-19 1 month post-discharge. Female patients, and patients with lower educational levels, higher anxiety levels and lower perceptions of emotional support during hospitalization may be more likely to develop PTSD in the near future. Enhancing emotional support during hospitalization could help to prevent PTSD in patients with COVID-19. HIGHLIGHTS More than one-third ofpatients met the diagnostic criteria of probable PTSD 1 month post-discharge. Providing timely emotional support during hospitaliza-tion may be one of the key measures for preventing PTSD in patients with COVID-19.

Prevalence and predictors of post-traumatic stress disorder in patients with cured coronavirus disease 2019 (COVID-19) one month post-discharge.

Background: Coronavirus disease 2019 (COVID-19) can place an immense psychological strain on the infected patient. The psychological distress can linger after the initial recovery from the infection. Objective: This study aimed to evaluate the prevalence and predictors of provisional post-traumatic stress disorder (PTSD) in patients with cured COVID-2019. Methods: The baseline survey was conducted from 10 to 25 February 2020 in patients with COVID-19 in a designated hospital. Demographic and clinical characteristics were acquired, and depression and anxiety levels were assessed, using the 9-item Patient Health Questionnaire and 7-item Generalized Anxiety Disorder scale, respectively. A follow-up survey was conducted 1 month post-discharge. PTSD symptoms were measured by the Impact of Event Scale-6 (IES-6) and patients' perception of supportive care during hospitalization was investigated using a self-developed questionnaire. Results: In total, 114 patients completed both the baseline and follow-up surveys. Of these, 41 (36.0%) met the cut-off score for provisional PTSD diagnosis according to the IES-6. Female gender [odds ratio (OR) = 4.69, 95% confidence interval (CI) 1.54-14.37], educational level of high school or below (OR = 15.49, 95% CI 1.13-212.71), higher anxiety levels (OR = 1.34, 95% CI 1.12-1.61) and lower perceptions of emotional support during hospitalization (OR = 0.41, 95% CI 0.17-0.96) predicted a higher risk for provisional PTSD. Conclusions: PTSD is commonly seen in patients with COVID-19 1 month post-discharge. Female patients, and patients with lower educational levels, higher anxiety levels and lower perceptions of emotional support during hospitalization may be more likely to develop PTSD in the near future. Enhancing emotional support during hospitalization could help to prevent PTSD in patients with COVID-19.

Antecedentes: El COVID-19 ha supuesto una inmensa carga psicológica para el paciente infectado. El malestar psicológico puede persistir aún después de la recuperación inicial de la infección.Objetivos: Este estudio tuvo como objetivo evaluar la prevalencia y los factores predictores del trastorno de estrés postraumático (TEPT) provisional en pacientes recuperados de COVID-2019.Métodos: El cuestionario inicial se realizó en pacientes con el COVID-19 desde el 10 de febrero del 2020 hasta el 25 de febrero del 2020 en un hospital designado. Se consideraron las variables demográficas y clínicas, además, se evaluaron los niveles de depresión y ansiedad mediante el cuestionario de salud del paciente de 9 elementos y el cuestionario del trastorno de ansiedad generalizada de 7 elementos, respectivamente. Un cuestionario de seguimiento fue realizado un mes después del alta. Los síntomas de TEPT fueron medidos por el Cuestionario de Eventos de Impacto 6 (IES-6 por sus siglas en ingles) y el nivel de percepción de los pacientes sobre el cuidado de soporte durante la hospitalización fue investigado utilizando un cuestionario auto-administrado.Resultados: Ciento catorce pacientes completaron tanto el cuestionario inicial como el de seguimiento. Cuarenta y un (36.0%) pacientes cumplieron con el punto de corte para el diagnóstico provisional de TEPT según el IES-6. El sexo femenino (OR = 4.69, 95% CI: 1.54-14.37), un nivel de educación secundaria o inferior (OR = 15.49, 95% CI: 1.13-212.71), niveles elevados de ansiedad (OR = 1.34, 95% CI: 1.12-1.61) y una menor percepción de soporte emocional durante la hospitalización (OR = 0.41, 95% CI: 0.17-0.96) fueron factores predictores de riesgo elevado para el desarrollo provisional de TEPT.Conclusiones: El TEPT es observado con frecuencia en pacientes con COVID-19 un mes después del alta. Las pacientes de sexo femenino, los pacientes con un nivel de educación bajo, los pacientes con un nivel elevado de ansiedad y una menor percepción de apoyo emocional durante la hospitalización podrían tener mayor probabilidad de desarrollar TEPT en el futuro cercano. El reforzamiento del apoyo emocional durante la hospitalización podría ayudar a prevenir el TEPT en pacientes con COVID-19.

Identification of COVID-19 B-cell epitopes with phage-displayed peptide library.

BACKGROUND: Coronavirus disease 19 (COVID-19) first appeared in the city of Wuhan, in the Hubei province of China. Since its emergence, the COVID-19-causing virus, SARS-CoV-2, has been rapidly transmitted around the globe, overwhelming the medical care systems in many countries and leading to more than 3.3 million deaths. Identification of immunological epitopes on the virus would be highly useful for the development of diagnostic tools and vaccines that will be critical to limiting further spread of COVID-19. METHODS: To find disease-specific B-cell epitopes that correspond to or mimic natural epitopes, we used phage display technology to determine the targets of specific antibodies present in the sera of immune-responsive COVID-19 patients. Enzyme-linked immunosorbent assays were further applied to assess competitive antibody binding and serological detection. VaxiJen, BepiPred-2.0 and DiscoTope 2.0 were utilized for B-cell epitope prediction. PyMOL was used for protein structural analysis. RESULTS: 36 enriched peptides were identified by biopanning with antibodies from two COVID-19 patients; the peptides 4 motifs with consensus residues corresponding to two potential B-cell epitopes on SARS-CoV-2 viral proteins. The putative epitopes and hit peptides were then synthesized for validation by competitive antibody binding and serological detection. CONCLUSIONS: The identified B-cell epitopes on SARS-CoV-2 may aid investigations into COVID-19 pathogenesis and facilitate the development of epitope-based serological diagnostics and vaccines.

Negative Appraisals of the COVID-19 Social Impact Associated With the Improvement of Depression and Anxiety in Patients After COVID-19 Recovery.

Objective: Little is known about the factors affecting the recovery of mental health in COVID-19 patients. The purpose of this study is to look into the change of psychological distress and to explore the role of negative appraisals in the improvement of psychological distress in COVID-19 patients after they recovered from the infection. Methods: We conducted a longitudinal survey on patients with COVID-19 infection in Changsha. The 9-item Patient Health scale, the 7-item Generalized Anxiety Disorder scale, and a newly developed measure, the COVID-19 Impact Scale (CIS) were applied to assess patients' depression, anxiety, and negative appraisal toward COVID-19 infection during their hospitalization and 1 month post-discharge. Results: Seventy-two patients were included in the analysis. A significant decrease in anxiety and depression levels was observed after patients were discharged from hospital. Two meaningful factors of the CIS were extracted based on factor analysis, namely "health impact," and "social impact." The change of social impact explained the 12.7 and 10.5% variance in the depression and anxiety symptom improvement, respectively. Conclusions: Change in negative appraisals, especially the appraisals related to COVID-19 social impact may play a vital role in the relief of psychological distress of infected patients. Therefore, a cognitive and social care perspective might be considered when promoting the mental health recovery and readjustment to society among COVID-19 patients.

Functional Connectome Prediction of Anxiety Related to the COVID-19 Pandemic.

OBJECTIVE: Increased anxiety in response to the COVID-19 pandemic has been widely noted. The purpose of this study was to test whether the prepandemic functional connectome predicted individual anxiety induced by the pandemic. METHODS: Anxiety scores from healthy undergraduate students were collected during the severe and remission periods of the pandemic (first survey, February 22-28, 2020, N=589; second survey, April 24 to May 1, 2020, N=486). Brain imaging data and baseline (daily) anxiety ratings were acquired before the pandemic. The predictive performance of the functional connectome on individual anxiety was examined using machine learning and was validated in two external undergraduate student samples (N=149 and N=474). The clinical relevance of the findings was further explored by applying the connectome-based neuromarkers of pandemic-related anxiety to distinguish between individuals with specific mental disorders and matched healthy control subjects (generalized anxiety disorder, N=43; major depression, N=536; schizophrenia, N=72). RESULTS: Anxiety scores increased from the prepandemic baseline to the severe stage of the pandemic and remained high in the remission stage. The prepandemic functional connectome predicted pandemic-related anxiety and generalized to the external sample but showed poor performance for predicting daily anxiety. The connectome-based neuromarkers of pandemic-related anxiety further distinguished between participants with generalized anxiety and healthy control subjects but were not useful for diagnostic classification in major depression and schizophrenia. CONCLUSIONS: These findings demonstrate the feasibility of using the functional connectome to predict individual anxiety induced by major stressful events (e.g., the current global health crisis), which advances our understanding of the neurobiological basis of anxiety susceptibility and may have implications for developing targeted psychological and clinical interventions that promote the reduction of stress and anxiety.

Effects of centralized isolation vs. home isolation on psychological distress in patients with COVID-19.

OBJECTIVE: This study aimed to evaluate the impact of isolation form on the recovery of psychological distress in patients with coronavirus disease 2019 (COVID-19) after being discharged from hospital. METHODS: Baseline survey was conducted from February 10, 2020 to February 25, 2020 in patients with COVID-19 in a designated hospital on the discharge day. After discharge, patients were free to choose whether isolate in a centralized isolation site (i.e. designated hotel) or their own home for another two weeks. A follow-up survey was conducted at the end of the 2-week post-discharge isolation. Depression, anxiety as well as self-rated health were assessed at both time points using the 9-item patient health questionnaire, 7-item generalized anxiety disorder scale and self-rated health scores, respectively. RESULTS: Fifty centrally isolated and 45 home isolated patients completed both the baseline and the follow-up assessments. Significant effects of time and time by isolation form were found on depression and anxiety levels, with a significant decrease in depression and anxiety shown in home isolated but not in centrally isolated patients. Besides, a significant time effect was identified on self-rated health with significant improvement found in home isolated but not in centrally isolated patients. CONCLUSIONS: Home isolation is superior to centralized isolation in the recovery of COVID-19-associated depression, anxiety as well as self-rated health. More attention needs to be paid to the psychological well-being of centrally isolated patients. A sustained and integrated rehabilitation plan is warranted for patients with COVID-19 to achieve both physical and psychological recovery.