{"paper_id":"d6bc3e75-4ad5-42d9-bf27-088190d7205f","body_text":"Frontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-23- \nLong-Term Management of Endometriosis Based on \nThird Party Platform \nJialan Chen1, Zhuo Deng1, Xin Shen1, Qinfeng Liu2,*, Lihong Chen1 \n1Department of Gynecology, Shaanxi Provincial People's Hospital, Xi’an, Shaanxi, China  \n2Medical Equipment Management Department , Shaanxi Provincial People's Hospital, Xi’an , Shaanxi, \nChina \n*Corresponding author \nAbstract: Objective: To explore the effect of long -term management of endometriosis (EMs) patients \nbased on third-party platform. Methods: From June 2019 to December 2020, 200 endometriosis patients \nwho were admitted to the gynecology clinic and ward of Shaanxi Provincial Peo ple’s Hospital were \nselected. Among them, 100 patients who voluntarily used the third -party platform and regularly visited \nthe hospital were selected as the experimental group, and 100 patients who were followed up for routine \noutpatient service were selected as the control group. The pain numerical rating scale (NRS), self-rating \ndepression scale (SDS), self-rating anxiety scale (SAS), cyst diameter and EMS disease cognition were \ncompared between the two groups, which were collected every three months. Results: The data at each \ntime point (NRS score, SDS score, SAS score, cyst diameter, EMS disease cognition) of experimental \ngroup and control group after management were significantly decreased compared with those before \nmanagement and at the previous time point,  and the difference was statistically significant (P < 0.05), \nhowever, there was significant difference in the on -time follow-up rate between the two groups (P < \n0.05). Conclusion: The use of third-party platforms can significantly improve the long-term management \neffect of EMs patients. \nKeywords: Endometriosis, Management mode, Third-party platform \n1. Introduction \nWith the in-depth understanding of the occurrence and development of endometriosis, endometriosis \nhas become a social problem that endangers the health of world's women. Because of unclear etiology, \ndifficult to remove, biological behavior similar to malignant tumors and the mental, psychological and \nphysiological harm to women, it has become another chronic disease in the field of gynecology, whic h \nneeds long-term and even lifelong management. However, there is no mature, effective and standardized \nlong-term management scheme at home and abroad [1, 2]. In this study, the long -term follow-up of \npatients with endometriosis was established and impleme nted on a third -party platform, which can \nsignificantly improve patients’ awareness of the disease and increase patients’ participation in their own \ndisease diagnosis and treatment and long-term management. It also can increase the trust between doctors \nand patients, and saved the cost of disease management for doctors. \n2. Object and methods \n2.1. Object \nPatients with endometriosis who were admitted to the gynecological clinic and ward of Shaanxi \nProvincial People's Hospital from June 2019 to December 2020 were selected as subjects.  \n(1) Inclusion criteria: Consistent with the items of 1), 2) and any item from 3) to 6). 1) The woman \nwas in adolescence, childbearing age and perimenopausal period. 2) The patients can use the smart \nphones pay attention to the third party platform voluntarily, which can be used to learn the relevant \nscientific knowledge published by doctors and communicate with doctors about disease management. 3) \nEndometrial implantati on cyst was showed by B -ultrasound or MRI. 4) The woman was with \ndysmenorrhea and painful nodules of posterior vaginal vault. 5) The woman was with sexual intercourse \npain or post-sexual intercourse pain with painful tubercle of posterior vaginal dome. 6) Endometriosis is \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-24- \nconfirmed by laparoscopic exploration.  \n(2) Exclusion criteria: 1) Endometriosis was ruled out after repeated examinations by B -ultrasound \nor MRI. 2) The woman was suspected of tumor malignancy with the elevation of marker CA125 and \nHE4. 3) The patients were unable to cooperate with dynamic communication due to various reasons. \n2.2. Methods \nA prospective study was conducted to enlist the endometriosis patients diagnosed by clinical \ndiagnosis and postoperative diagnosis. Control group strengthene d hospital education, and an internet \nconnection of doctor-patient was established by the third-party medical platform on the basis of education \nin the experimental group. Both groups were evaluated comprehensively from the aspects of symptoms \nand signs, psychological conditions and disease cognition every three months for a year.  \n1) Grouping method: 100 women who voluntarily paid attention to third -party platforms, used the \nthird-party platforms to learn doctors to relevant scientific knowledge from docto rs, communicate \ndynamically with doctors about disease management and came to the hospital for regular check-ups were \nselected as the experimental group. And 100 patients followed up routinely were selected as control \ngroup. \n2) Intervention method: Both groups were given a systematic education of the disease by the disease \nadministrator at the first diagnosis, including the concept, symptoms, risk factors, hazard and careful \nprecautions of endometriosis, the purpose and necessity of each inspection, and the objectives, principles \nand necessities of long -term management. Besides, the time and content of follow -up, psychological \ncounseling and corresponding counseling measures were also told to patients. \nExperimental group: An online management group composed of senior doctors and nurses who are \ngood at diagnosis and management of endometriosis was established. After that, the patients are taught \nthe use of the third-party platform by nurse, which includes learning of science knowledge and consulting \nonline. Then the patients were asked to complete the relevant questionnaire and record relevant data \nbefore the experiment. The doctor’s task is to improve the content of online science, solve the problems \nonline, provide outpatient office visits and manage the patients.  \nControl group: The related questionnaire before experiment was completed after the education, and \nit was recorded by the nurses. Then an approximate follow-up time was arranged.  \n3) Data collection and analysis \n(1) The basic information of both grou ps was collected, such as age, educational level, diagnostic \nmethods, pre -treatment pain score, cyst diameter, depression score and anxiety score. And the \ninformation differences between both groups of the disease questionnaire after education were evaluated. \n(2) The follow-up information of pain score, cyst maximum diameter, anxiety and depression self-scores \nof the two groups after treatment were collected every three months. Further, the information of disease \ncognition questionnaire of the patients was collec ted one year later. The comparison between the two \ngroups was carried out to evaluate the effect of patient management methods in the long -term \nmanagement of endometriosis. \n3. Statistical method \nThe research data was processed by SPSS 25.0 software. The measurement data were represented by \npaired-samples T-tests (\nx ± s), and the count data were represented by (%). The comparison between \ngroups was performed by χ2 test, and P < 0.05 indicated that the difference was statistically significant. \n4. Results \n4.1. General data \nThe data before management were compared between the two groups (including age, educational \nlevel, diagnostic method, pain score before treatment, cyst diameter, depression score, anxiety score and \nEM’s disease cognition). The results showed that there was no statistically significant difference in the \ndata between the two groups (P > 0.05), as shown in Table 1.  \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-25- \nTable 1: Comparison of basic data of two groups \nItem Experimental group(n=100) Control group(n=100) T/χ2 value P value \nAge (year, \nx ±s) 33.72± 7.738 34.57± 7.567 -0.735 0.464 \nEducational level (number, %)   0.730 0.981 \nPrimary school 5(5) 7(7)   \nJunior high school 12(12) 13(13)   \nHigh school 24(24) 21(21)   \nUndergraduate (including college) 39(39) 37(37)   \nMaster 13(13) 14(14)   \nDoctor 7(7) 8(8)   \nDiagnostic method (number, %)   0.960 0.327 \npathological diagnosis 28(28) 22(22)   \nclinical diagnosis 72(72) 78(78)   \nPain NRS score before (score, \nx ±s) 5.00± 2.701 5.06± 2.719 -0.145 0.885 \nCyst diameter (score, \nx ±s) 44.09± 7.382 42.81± 7.000 1.327 0.188 \nDepression score (score, \nx ±s) 51.90± 11.413 50.59± 7.669 1.044 0.299 \nAnxiety core (score, \nx ±s) 51.51± 8.898 53.49± 8.556 -1.682 0.096 \nEM’s disease cognition (score, \nx ±s) 31.30± 13.681 31.93± 15.293 -0.305 0.761 \n4.2. Pain numerical rating scale (NRS) score  \nAs shown in Table 2, the NRS score of control group was 5.06 ±  2.719 before management. It was \nscored every three months after management; the latter score was significantly lower than the previous \ntime and the difference was statistically significant (P < 0.05). The NRS score of the experimental group \nwas 5.00± 2.701 before management. It was also scored every three months after management, the latter \nscore was significantly lower than those before management and the previous time, and the difference \nwas also statistically significant (P < 0.05). However, there was no significant difference in pain scores \nbetween the two groups before and after 12 months of intervention (P>0.05). \nTable 2: Comparison of NRS score \nGroup Number \nx ±s P value Group Number \nx ±s P value \nEGp before management \n100 \n5.00± 2.701 \n0.885 \nEGp after 12 months \nmanagement 61 \n2.69± 1.689 0.801 \nCGp before management 5.06± 2.719 CGp after 12 months \nmanagement 2.77± 1.657  \nEGp before management \n81 \n4.80± 2.813 \n0.000 \nCGp before management \n61 \n5.08± 2.801 \n0.000 EGp after 12 months \nmanagement 2.58± 1.604 CGp after 12 months \nmanagement 2.77± 1.657 \nEGp before management \n84 \n4.87± 2.793 \n0.000 \nCGp before management \n70 \n5.04± 2.721 \n0.000 EGp after 3 months \nmanagement 4.24± 2.383 CGp after 3 months \nmanagement 4.36± 2.396 \nEGp after 3 months \nmanagement 82 \n4.23± 2.410 \n0.000 \nCGp after 3 months \nmanagement 60 \n4.35± 2.510 \n0.000 EGp after 6 months \nmanagement 3.30± 1.877 CGp after 6 months \nmanagement 3.48± 1.996 \nEGp after 6 months \nmanagement 85 \n3.35± 1.863 \n0.000 \nCGp after 6 months \nmanagement 57 \n3.42± 1.973 \n0.000 EGp after 9 months \nmanagement 2.66± 1.659 CGp after 9 months \nmanagement 2.89± 1.749 \nEGp after 9 months \nmanagement 81 \n2.73± 1.666 \n0.001 \nCGp after 9 months \nmanagement 58 \n2.88± 1.748 \n0.006 EGp after 12 months \nmanagement 2.58± 1.604 CGp after 12 months \nmanagement 2.72± 1.631 \nRemarks: EGp: experimental group, CGp: Control group \n4.3. Self-rating depression scale (SDS) \nAs shown in Table 3, the SDS score of experimental groups before management was 51.90± 11.413. \nAfter management, the SDS scores of patients at each time node were significantly lower than those \nbefore management and the previous time node, and the difference was statistically significant, P<0.05. \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-26- \nThe SDS score of experimental groups before management was 50.59± 7.669. The SDS scores of patients \nafter management at each time node were significantly lower than those before management and the \nprevious time node,  and the difference was statistically significant, P<0.05. Further, there was no \nsignificant difference between the two groups before the intervention (P>0.05), however, the difference \nhad statistical significance after the intervention (P<0.05). \nTable 3: Comparison of SDS score \nGroup Number \nx ±s P \nvalue Group Number \nx ±s P \nvalue \nEGp before management \n100 \n51.90± 11.413 \n0.299 \nEGp after 12 months \nmanagement 64 \n33.75± 6.643 0.005 \nCGp before management 50.59± 7.669 CGp after 12 months \nmanagement 36.63± 4.627  \nEGp before management \n81 \n51.69± 11.671 \n0.000 \nCGp before management \n64 \n49.47± 7.580 \n0.000 EGp after 12 months \nmanagement 33.17± 6.475 CGp after 12 months \nmanagement 36.63± 4.627 \nEGp before management \n83 \n51.76± 11.549 \n0.000 \nCGp before management \n70 \n49.67± 7.358 \n0.000 EGp after 3 months \nmanagement 48.54± 8.971 CGp after 3 months \nmanagement 46.07± 5.754 \nEGp after 3 months \nmanagement 81 \n48.52± 9.064 \n0.000 \nCGp after 3 months \nmanagement 61 \n46.26± 5.924 \n0.000 EGp after 6 months \nmanagement 44.20± 7.398 CGp after 6 months \nmanagement 43.62± 5.791 \nEGp after 6 months \nmanagement 85 \n44.33± 7.259 \n0.000 \nCGp after 6 months \nmanagement 59 \n43.75± 5.646 \n0.000 EGp after 9 months \nmanagement 39.14± 6.167 CGp after 9 months \nmanagement 40.69± 5.509 \nEGp after 9 months \nmanagement 81 \n39.12± 6.270 \n0.000 \nCGp after 9 months \nmanagement 62 \n40.58± 5.385 \n0.000 EGp after 12 months \nmanagement 33.17± 6.475 CGp after 12 months \nmanagement 36.73± 4.406 \nRemarks: EGp: experimental group, CGp: Control group \n4.4. Self-rating anxiety scale (SAS) \nTable 4: Comparison of SAS score \nGroup Number \nx ±s P \nvalue Group Number \nx ±s P \nvalueE \nEGp before management \n100 \n51.51± 8.898 \n0.096 \nEGp after 12 months \nmanagement 64 \n36.33± 5.936 \n0.000 \nCGp before management 53.49± 8.556 CGp after 12 months \nmanagement 40.56± 5.580 \nEGp before management \n81 \n51.91± 9.527 \n0.000 \nCGp before management \n64 \n53.89± 8.720 \n0.000 EGp after 12 months \nmanagement 36.14± 5.533 CGp after 12 months \nmanagement 40.56± 5.580 \nEGp before management \n83 \n51.98± 9.421 \n0.000 \nCGp before management \n70 \n53.74± 8.731 \n0.000 EGp after 3 months \nmanagement 49.10± 8.417 CGp after 3 months \nmanagement 50.41± 7.662 \nEGp after 3 months \nmanagement 81 \n49.07± 8.519 \n0.000 \nCGp after 3 months \nmanagement 62 \n50.63± 7.629 \n0.000 EGp after 6 months \nmanagement 44.73± 6.325 CGp after 6 months \nmanagement 47.87± 6.674 \nEGp after 6 months \nmanagement 85 \n44.60± 6.243 \n0.000 \nCGp after 6 months \nmanagement 60 \n47.90± 6.516 \n0.000 EGp after 9 months \nmanagement 40.31± 5.860 CGp after 9 months \nmanagement 44.60± 6.040 \nEGp after 9 months \nmanagement 81 \n40.49± 5.910 \n0.000 \nCGp after 9 months \nmanagement 62 \n44.82± 6.208 \n0.000 EGp after 12 months \nmanagement 36.14± 5.533 CGp after 12 months \nmanagement 40.60± 5.609 \nRemarks: EGp: experimental group, CGp: Control group \nAs shown in Table 4, the SAS score of experimental groups before management was 51.51± 8.898 \npoints. After management, the scores of patients at each time node were significantly lower than those \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-27- \nbefore management and the previous time node, and the difference was statistically significant, P<0.05. \nThe SAS score of experimental groups before management was 53.49± 8.556 points. And the scores of \npatients at each time node after management were significantly lower than those before management and \nthe previous time node, and the difference was statistically significant P<0.05. Moreover, there was no \nsignificant difference in the scores between the two groups before the intervention (P>0.05), while the \nscores of the two groups decreased after intervention, and the difference was statistically significant (P < \n0.05). \n4.5. Cyst diameter before and after treatment \nAs shown in Table 5, the cyst diameter of experimental group before management was 44.09 ±  7.382 \nmm, and the value after management was significantly lower than that before management and the \nprevious time point with statistical significance ( P ＜0.05 ). While the cyst diameter of control group \nwas 42.81 ±  7.000 mm before management, and the cyst diameter after management was significantly \nlower than that before ma nagement and the previous time point, and the difference was statistically \nsignificant, P < 0.05. Further, the scores of two groups after intervention were lower than those before, \nhowever the difference was not statistically significant (P > 0.05). \nTable 5: Comparison of cyst diameter \nGroup Number \nx ±s P value Group Number \nx ±s P value \nEGp before management 100 44.09± 7.382 0.188 EGp after 12 months management 64 23.33± 11.448 0.145 CGp before management 42.81± 7.000 CGp after 12 months management 26.56± 13.720 \nEGp before management \n81 \n44.30± 7.286 \n0.000 \nCGp before management \n64 \n43.16± 7.167 \n0.000 EGp after 12 months \nmanagement 22.09± 12.175 CGp after 12 months management 26.56± 13.720 \nEGp before management \n83 \n44.35± 7.208 \n0.000 \nCGp before management \n70 \n43.11± 6.952 \n0.000 EGp after 3 months \nmanagement 34.33± 17.314 CGp after 3 months management 34.06± 16.520 \nEGp after 3 months \nmanagement 81 \n34.09± 17.460 \n0.000 \nCGp after 3 months management \n61 \n33.74± 16.944 \n0.000 EGp after 6 months \nmanagement 31.49± 16.233 CGp after 6 months management 32.38± 16.066 \nEGp after 6 months \nmanagement 85 \n31.78± 15.928 \n0.000 \nCGp after 6 months management \n59 \n32.29± 16.260 \n0.000 EGp after 9 months \nmanagement 28.48± 14.392 CGp after 9 months management 29.25± 14.951 \nEGp after 9 months \nmanagement 81 \n28.25± 14.646 \n0.001 \nCGp after 9 months management \n62 \n29.19± 15.194 \n0.000 EGp after 12 months \nmanagement 22.09± 12.175 CGp after 12 months management 26.44± 13.901 \nRemarks: EGp: experimental group, CGp: Control group \n4.6. EMS disease cognition \nIt can be seen from Table 6 that there was no significant difference in EMS disease cognition between \nthe two groups before intervention (P > 0.05). After the intervention, the scores of the two groups were \nlower than those before intervention. There were significant differences in both groups before and after \nintervention and the two groups after intervention (P < 0.05).  \nTable 6: Comparison of disease cognition \nGroup Number \nx ±s P value Group Number \nx ±s P value \nEGp before \nmanagement 81 \n30.370± 13.556 \n0.000 \nCGp before management \n66 \n33.379± 15.103 \n0.000 EGp after 12 months \nmanagement 61.204± 25.078 CGp after 12 months \nmanagement 56.212± 23.077 \nEGp before \nmanagement 100 \n31.300± 13.681 \n0.761 \nEGp after 12 months \nmanagement 66 \n66.174± 23.371 \n0.000 CGp before \nmanagement 31.930± 15.294 CGp after 12 months \nmanagement 56.212± 23.077 \n4.7. Overall management effect \nWe can see from Table 7 that the follow-up rates of 100 patients in experimental group at 0, 3, 6, 9 \nand 12 months were 100 %, 83 %, 85 %, 87 % and 81 %, respectively. While the follow-up rates of 100 \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-28- \npatients in the control group at 0, 3, 6, 9 and 12 months were 100 %, 70 %, 66 %, 66 % and 61%, \nrespectively. Obviously, the follow-up rate between the two groups had significant difference, and there \nwas statistical significance (P<0.05). \nTable 7: Comparison of follow-up rate \nGroup Number Mean standard deviation P value \nExperiment group 5 87.20 7.497 0.020 Control group 5 72.60 15.646 \n5. Discussion \nEndometriosis has the following features: extensive lesion, diverse form, unknown etiology, and it is \ndefined as a refractory disease for its high recurrence rate and difficult to cure, and with the characteristics \nsimilar to malignant tumors such as invasiveness, metastasis and recurrence [3 -6]. In recent years, with \nthe in -depth understanding of endometriosis, it has risen from a common disease in women of \nchildbearing age to a worldwide health problem. It not only increases the burden of health resources, but \nalso seriously endangers the health life of patients. The daily work of obstetrics and gynecology doctors \nin China is relatively busy. How to  effectively manage patients in working leisure is one of the urgent \nproblems to be solved. Due to the wide application of smart phones, and related third-party platforms are \nmore and more widely used [7]. Based on the third -party platform, this study expl ores a long -term \nmanagement model for endometriosis patients, which is suitable for national situation. \nIn this study, 200 patients with endometriosis diagnosed by clinic or surgery were taken as the \nresearch object, and the long-term management lasted for one year. Taking 3 months as a time node, the \nrelevant data of patients were collected regularly, and the data of experimental group and control group \nwere statistically analyzed. The results showed that the data (including NRS score, SDS score, SAS score, \ncyst diameter and EMS disease cognition) of the two groups after management were significantly \ndecreased compared with those before management, the data of latter time node was also significantly \ndecreased compared with the previous time node, and all th e difference were statistically significant (P \n< 0.05). Further, the subjective evaluation (such as SDS score, SAS score and EMS disease cognition) \nafter one year intervention of the two groups were significantly different, and the difference showed \nstatistical significance. For example, the scores of depressions and anxiety in experimental group were \nlower than those in control group, meanwhile, the scores of disease cognition questionnaire in the \nexperimental group were higher. The objective evaluation data showed that (RS score and cyst diameter) \nin both groups decreased significantly, but there was no significant difference of the 12th month. It is \nthus clear that no matter what kind of management method is used, if patients can adhere to the treatment, \nthe treatment effect is objectively equivalent. Moreover, from the overall management effect, the follow-\nup rate at each time point in experimental group was significantly higher than that in control group, and \nthe difference between the two groups was statistically significant. It can be seen that the method used in \nexperimental group can better realize the management of patients. \nIn addition, the difference of management effect between the two groups was considered to be related \nto the fluctuation of new coronary pneumonia epidemic. Many patients who need offline treatment have \ndelayed the treatment or referral due to the epidemic control and other reasons. Patients who use third -\nparty platforms can freely communicate with doctors online during the epidemi c period, and learn the \nscientific knowledge released online, which helps improve the patient compliance. Moreover, patients \nlearn more knowledge and benefit from the treatment (such as significant pain relief), which helps reduce \ndepression and anxiety ps ychologically, forming a positive cycle and promoting each other, so that a \nvirtuous cycle will be formed and promoted. \nReferences \n[1] Leng JH, Dai Y, Li XY. New concept of diagnosis and treatment of endometriosis [J]. Chinese Journal \nof Obstetrics and Gynecology, 2021, 56(12): 831-835. \n[2] Chinese Obstetricians and Gynecologists Association. Guideline for the diagnosis and treatment of \nendometriosis (Third edition) [J]. Chinese Journal of Obstetrics and Gynecology, 2021, 56(12): 812 -\n824. \n[3] Sun WW, Yu B, Liu Y, et al. Long-term management plan and principles of endometriosis [J]. Chinese \nJournal of Health Management, 2019, (03): 262-264. \n[4] Ji MM, Yuan M, Wang GY. Importance of patient education in the long -term management of \n\nFrontiers in Medical Science Research \nISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 \nPublished by Francis Academic Press, UK \n-29- \nendometriosis [J]. Chinese Journal of Practical Gynecology and Obstetrics, 2021, 37(03): 292-296. \n[5] Xu CJ, Yi XF, Zheng YX. Long -term management strategy of endometriosis  [J]. Shanghai Medical \nJournal, 2019, 42(6): 340-343. \n[6] Zhou YF. Necessity of long -term management of endometriosis patients [J]. Chinese Journal of \nObstetrics and Gynecology, 2017, 52(3): 145-146. \n[7] Wang JY, Chen Y, Gu LL, et al. Analysis of the integrated management model of doctors, nurses and \npatients in patients with endometriosis [J]. International Journal of Nursing, 2018, 37(4): 512-514.","source_license":"CC0","license_restricted":false}