[Effect of Sijunzi Decoction on intestinal barrier of type 2 diabetic mice].

This study aims to explore the improvement effect of Sijunzi Decoction on intestinal barrier in diabetic mice. A type 2 diabetes mellitus(T2DM) model was established in C57BL/6J mice by feeding them with high-sugar and high-fat diet combined with streptozotocin(STZ). The T2DM mice were randomly divided into a control group, a T2DM group, a donepezil(DON) group, a rosiglitazone(RGZ) group, and Sijunzi Decoction groups(7. 5, 15, and 30 g·kg~(-1)), and orally administered for six weeks. The body weight and fasting plasma glucose(FBG) of mice were recorded. Fasting plasma insulin(FINS) and insulin resistance index(HOMA-IR) were observed to assess insulin resistance(IR). Intestinal flora and levels of serotonin(5-HT), lipopolysaccharide(LPS), and short-chain fatty acids(SCFAs) in serum were analyzed. Changes in colonic structure and tight junction proteins occludin, claudin-1,and ZO-1 were observed through HE staining and immunohistochemistry. Spontaneous alternation test was conducted to observe the effect on spatial memory ability. Compared with the results in the control group, FBG and HOMA-IR in the T2DM group were significantly increased(P< 0. 01); species richness index(Sobs index), Shannon diversity index(Shannon index), and species abundance estimate index(Chao index) were decreased; LPS was significantly increased(P< 0. 001), while the levels of 5-HT,SCFAs, occludin, claudin-1, and ZO-1 were significantly decreased(P< 0. 01), indicating impaired colonic barrier function;spontaneous alternation accuracy was significantly decreased(P<0. 05). After 6 weeks of Sijunzi Decoction treatment, compared with the results in the T2DM group, FBG and HOMA-IR in the Sijunzi Decoction 15 g·kg~(-1) group were significantly decreased(P<0. 01);Sobs index, Shannon index, and Chao index were increased; LPS was significantly decreased(P<0. 01), while the levels of 5-HT,SCFAs, occludin, claudin-1, and ZO-1 were significantly increased(P< 0. 05), indicating improved colonic barrier function;spontaneous alternation accuracy was increased(P<0. 001). In conclusion, Sijunzi Decoction has the effect of improving intestinal barrier in diabetic mice.

Evaluating perceived value and expected value gaps based on patient experience during outpatient encounters: An empirical study in China.

Background: Improving the quality of care relies on understanding patients' perceptions and expectations based on their experiences. The study aimed to determine the gaps between patients' perceived value and expected value, and to identify critical areas for outpatient service improvement. Method: This cross-sectional study was conducted in China from November 2020 to February 2021. A sample of 572 outpatients, randomly selected from a comprehensive tertiary public hospital, was surveyed using a validated patient perceived value questionnaire. Importance-performance analysis was used to evaluate the differences between patients' perceived and expected value. Results: The scores of patients' expected value for outpatient services were significantly higher than their perceived value in all 29 items and 8 dimensions. The items with the highest and lowest gaps were "short waiting time" (-1.52) and "hospital reputation and popularity" (-0.24) respectively, and the dimensions of price and efficiency (functional value) were located in the quadrant of high expectation and low perception. Conclusion: Our findings are useful for hospital administrators and policymakers to identify strategic focus areas and allocate resources rationally and effectively. We suggest healthcare providers should take measures to narrow the gaps, especially in terms of service efficiency and price.

Satisfaction with Public Hospital Reform and Associated Factors Among Medical Staff: A Cross-Sectional Survey in Wuhan, China.

PURPOSE: To assess whether medical staff are satisfied with public hospital reform and its influencing factors. METHODS: A sample of 2000 medical staff from 13 public hospitals in Wuhan were surveyed with a self-administered questionnaire. Descriptive analysis and binary logistic regression were conducted to identify the status of the medical staff's attitude to the reform and the influencing factors. RESULTS: A total of 61.4% of medical staff satisfied with the reform and the main reason was the promotion of their practice environment and social status brought by the reform. The logistic regression model indicated that the attitude to the reform of medical staff was positively associated with 9-11 hours of daily working time (OR = 2.373, as compared with less than 8 hours), higher income (OR = 1.966), the occupation of the nurse and medical technician (OR = 2.196-1.464 as compared with the doctor) as well as negative attitude towards the effectiveness of reform (OR = 3.676). CONCLUSION: More than half of medical staff are satisfied with the public hospital reform, while some still hold negative attitude to the reform because of the extra working hours, low salary and high expectations due to professional characteristics and high input costs (education and time). Thus, in the current epidemic of prevention and control, more attention should be paid to the work pressure and enthusiasm of medical personnel. Administrators should pay attention to increasing income and improving the practicing environment and social status to prevent medical staff from treating reforms negatively.

Physician Mental Workload Scale in China: Development and Psychometric Evaluation.

OBJECTIVE: The purpose of our study is to develop a mental workload scale for physicians in China and assess the scale's reliability and validity. DESIGN: The instrument was developed over three phases involving 396 physicians from different tiers of comprehensive public hospitals in China. In the first phase, an initial item pool was developed through a systematic literature review. The second phase consisted of two rounds of Delphi expert consultations and a pilot survey. The third phase tested the reliability and validity of the instrument. SETTING: Public hospitals in China. PARTICIPANTS: A total of 396 physicians from different tiers of comprehensive public hospitals in China participated in this study in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Cronbach's α, content validity index, item-total score correlation coefficient, dimension-total score correlation coefficient and indices of confirmatory factor analysis. RESULTS: Six dimensions (mental demands, physical demands, temporal demands, perceived risk, frustration level and performance) and 12 items were identified in the instrument. For reliability, Cronbach's α for the whole scale was 0.81. For validity, the corrected item-content validity index of each item ranged from 0.85 to 1, item-total score correlation coefficients ranged from 0.31 to 0.75, and the correlation coefficients between the dimensions and total score ranged from 0.37 to 0.72. The results of the confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory. CONCLUSION: The instrument showed good reliability and validity, and it is useful for diagnosing the mental workload of physicians.

What Are the Risk Factors of Negative Patient Experience? A Cross-Sectional Study in Chinese Public Hospitals.

Hospitals are struggling to involve patients and learn from their experience. The risk factor of patient experience is increasingly recognized as a critical component in improving patient experience. Our study explored risk factors of negative patient experience in order to improve the health-service quality of public hospitals. We conducted a cross-sectional study in Hubei province, China. A total of 583 respondents were surveyed by the Outpatient Experience Questionnaire with good validity and reliability in July 2015. T-tests were conducted to compare the experience scores among different outpatient groups. Multiple linear regression was performed to determine the significant factors that influenced the outpatient experience. Outpatients between 18 and 44 years old had the lowest experience scores (65.89 ± 0.79), whereas outpatients completely paying out-of-pocket had the lowest experience scores (64.68 ± 0.81) among all participants. Outpatients with poor self-rated health status had the lowest experience scores (66.14 ± 1.61) among different self-rated health status groups. While age, type of payment, and self-rated health status were significantly risk factors that influenced outpatient experience in the multiple linear regression. Thus, health-care providers should pay more attention to outpatients who are young (age <45), completely out-of-pocket and poor health status, and provide precision health care to improve outpatient experience.

The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals.

BACKGROUND: The proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits. OBJECTIVE: The purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps. METHODS: We used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience. RESULTS: The users and nonusers differed in age (χ22=12.2, P=.002), education (χ23=9.3, P=.03), living place (χ21=7.7, P=.006), and the need for specialists (χ24=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t298=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t298=2.93, P=.004), health information (t298=3.556, P<.001), medical service fees (t298=3.991, P<.001), short-term outcome (t298=4.533, P<.001), and general satisfaction (t298=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t289=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t289=3.746, P<.001) and monthly income of patients (t289=2.416, P=.02) influenced the patient experience as well. CONCLUSIONS: The use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience.

The Outpatient Experience Questionnaire of comprehensive public hospital in China: development, validity and reliability.

OBJECTIVE: The objective of this study is to describe the development of the Outpatient Experience Questionnaire (OPEQ) and to assess the validity and reliability of the scale. DESIGN: Literature review, patient interviews, Delphi method and Cross-sectional validation survey. SETTING: Six comprehensive public hospitals in China. PARTICIPANTS: The survey was carried out on a sample of 600 outpatients. MAIN OUTCOME MEASURE(S): Acceptability of the questionnaire was assessed according to the overall response rate, item non-response rate and the average completion time. Correlation coefficients and confirmatory factor analysis were used to test construct validity. Delphi method was used to assess the content validity of the questionnaire. Cronbach's coefficient alpha and split-half reliability coefficient were used to estimate the internal reliability of the questionnaire. RESULTS: The overall response rate was 97.2% and the item non-response rate ranged from 0% to 0.3%. The mean completion time was 6 min. The Spearman correlations of item-total score ranged from 0.466 to 0.765. The results of confirmatory factor analysis showed that all items had factor loadings above 0.40 and the dimension intercorrelation ranged from 0.449 to 0.773, the goodness of fit of the questionnaire was reasonable. The overall authority grade of expert consultation was 0.80 and Kendall's coefficient of concordance W was 0.186. The Cronbach's coefficients alpha of six dimensions ranged from 0.708 to 0.895, the split-half reliability coefficient (Spearman-Brown coefficient) was 0.969. CONCLUSIONS: The OPEQ is a promising instrument covering the most important aspects which influence outpatient experiences of comprehensive public hospital in China. It has good evidence for acceptability, validity and reliability.