Long-Term Management of Endometriosis Based on Third Party Platform

Objective: To explore the effect of long -term management of endometriosis (EMs) patients based on third-party platform. Methods: From June 2019 to December 2020, 200 endometriosis patients who were admitted to the gynecology clinic and ward of Shaanxi Provincial Peo ple’s Hospital were selected. Among them, 100 patients who voluntarily used the third -party platform and regularly visited the hospital were selected as the experimental group, and 100 patients who were followed up for routine outpatient service were selected as the control group. The pain numerical rating scale (NRS), self-rating depression scale (SDS), self-rating anxiety scale (SAS), cyst diameter and EMS disease cognition were compared between the two groups, which were collected every three months. Results: The data at each time point (NRS score, SDS score, SAS score, cyst diameter, EMS disease cognition) of experimental group and control group after management were significantly decreased compared with those before management and at the previous time point, and the difference was statistically significant (P < 0.05), however, there was significant difference in the on -time follow-up rate between the two groups (P < 0.05). Conclusion: The use of third-party platforms can significantly improve the long-term management effect of EMs patients.

Endometriosis, Management mode, Third-party platform 1. Introduction With the in-depth understanding of the occurrence and development of endometriosis, endometriosis has become a social problem that endangers the health of world's women. Because of unclear etiology, difficult to remove, biological behavior similar to malignant tumors and the mental, psychological and physiological harm to women, it has become another chronic disease in the field of gynecology, whic h needs long-term and even lifelong management. However, there is no mature, effective and standardized long-term management scheme at home and abroad [1, 2]. In this study, the long -term follow-up of patients with endometriosis was established and impleme nted on a third -party platform, which can significantly improve patients’ awareness of the disease and increase patients’ participation in their own disease diagnosis and treatment and long-term management. It also can increase the trust between doctors and patients, and saved the cost of disease management for doctors. 2. Object and methods 2.1. Object Patients with endometriosis who were admitted to the gynecological clinic and ward of Shaanxi Provincial People's Hospital from June 2019 to December 2020 were selected as subjects. (1) Inclusion criteria: Consistent with the items of 1), 2) and any item from 3) to 6). 1) The woman was in adolescence, childbearing age and perimenopausal period. 2) The patients can use the smart phones pay attention to the third party platform voluntarily, which can be used to learn the relevant scientific knowledge published by doctors and communicate with doctors about disease management. 3) Endometrial implantati on cyst was showed by B -ultrasound or MRI. 4) The woman was with dysmenorrhea and painful nodules of posterior vaginal vault. 5) The woman was with sexual intercourse pain or post-sexual intercourse pain with painful tubercle of posterior vaginal dome. 6) Endometriosis is Frontiers in Medical Science Research ISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 Published by Francis Academic Press, UK -24- confirmed by laparoscopic exploration. (2) Exclusion criteria: 1) Endometriosis was ruled out after repeated examinations by B -ultrasound or MRI. 2) The woman was suspected of tumor malignancy with the elevation of marker CA125 and HE4. 3) The patients were unable to cooperate with dynamic communication due to various reasons. 2.2. Methods A prospective study was conducted to enlist the endometriosis patients diagnosed by clinical diagnosis and postoperative diagnosis. Control group strengthene d hospital education, and an internet connection of doctor-patient was established by the third-party medical platform on the basis of education in the experimental group. Both groups were evaluated comprehensively from the aspects of symptoms and signs, psychological conditions and disease cognition every three months for a year. 1) Grouping method: 100 women who voluntarily paid attention to third -party platforms, used the third-party platforms to learn doctors to relevant scientific knowledge from docto rs, communicate dynamically with doctors about disease management and came to the hospital for regular check-ups were selected as the experimental group. And 100 patients followed up routinely were selected as control group. 2) Intervention method: Both groups were given a systematic education of the disease by the disease administrator at the first diagnosis, including the concept, symptoms, risk factors, hazard and careful precautions of endometriosis, the purpose and necessity of each inspection, and the objectives, principles and necessities of long -term management. Besides, the time and content of follow -up, psychological counseling and corresponding counseling measures were also told to patients. Experimental group: An online management group composed of senior doctors and nurses who are good at diagnosis and management of endometriosis was established. After that, the patients are taught the use of the third-party platform by nurse, which includes learning of science knowledge and consulting online. Then the patients were asked to complete the relevant questionnaire and record relevant data before the experiment. The doctor’s task is to improve the content of online science, solve the problems online, provide outpatient office visits and manage the patients. Control group: The related questionnaire before experiment was completed after the education, and it was recorded by the nurses. Then an approximate follow-up time was arranged. 3) Data collection and analysis (1) The basic information of both grou ps was collected, such as age, educational level, diagnostic methods, pre -treatment pain score, cyst diameter, depression score and anxiety score. And the information differences between both groups of the disease questionnaire after education were evaluated. (2) The follow-up information of pain score, cyst maximum diameter, anxiety and depression self-scores of the two groups after treatment were collected every three months. Further, the information of disease cognition questionnaire of the patients was collec ted one year later. The comparison between the two groups was carried out to evaluate the effect of patient management methods in the long -term management of endometriosis. 3. Statistical method The research data was processed by SPSS 25.0 software. The measurement data were represented by paired-samples T-tests ( x ± s), and the count data were represented by (%). The comparison between groups was performed by χ2 test, and P < 0.05 indicated that the difference was statistically significant. 4. Results 4.1. General data The data before management were compared between the two groups (including age, educational level, diagnostic method, pain score before treatment, cyst diameter, depression score, anxiety score and EM’s disease cognition). The results showed that there was no statistically significant difference in the data between the two groups (P > 0.05), as shown in Table 1. Frontiers in Medical Science Research ISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 Published by Francis Academic Press, UK -25- Table 1: Comparison of basic data of two groups Item Experimental group(n=100) Control group(n=100) T/χ2 value P value Age (year, x ±s) 33.72± 7.738 34.57± 7.567 -0.735 0.464 Educational level (number, %) 0.730 0.981 Primary school 5(5) 7(7) Junior high school 12(12) 13(13) High school 24(24) 21(21) Undergraduate (including college) 39(39) 37(37) Master 13(13) 14(14) Doctor 7(7) 8(8) Diagnostic method (number, %) 0.960 0.327 pathological diagnosis 28(28) 22(22) clinical diagnosis 72(72) 78(78) Pain NRS score before (score, x ±s) 5.00± 2.701 5.06± 2.719 -0.145 0.885 Cyst diameter (score, x ±s) 44.09± 7.382 42.81± 7.000 1.327 0.188 Depression score (score, x ±s) 51.90± 11.413 50.59± 7.669 1.044 0.299 Anxiety core (score, x ±s) 51.51± 8.898 53.49± 8.556 -1.682 0.096 EM’s disease cognition (score, x ±s) 31.30± 13.681 31.93± 15.293 -0.305 0.761 4.2. Pain numerical rating scale (NRS) score As shown in Table 2, the NRS score of control group was 5.06 ± 2.719 before management. It was scored every three months after management; the latter score was significantly lower than the previous time and the difference was statistically significant (P < 0.05). The NRS score of the experimental group was 5.00± 2.701 before management. It was also scored every three months after management, the latter score was significantly lower than those before management and the previous time, and the difference was also statistically significant (P 0.05). Table 2: Comparison of NRS score Group Number x ±s P value Group Number x ±s P value EGp before management 100 5.00± 2.701 0.885 EGp after 12 months management 61 2.69± 1.689 0.801 CGp before management 5.06± 2.719 CGp after 12 months management 2.77± 1.657 EGp before management 81 4.80± 2.813 0.000 CGp before management 61 5.08± 2.801 0.000 EGp after 12 months management 2.58± 1.604 CGp after 12 months management 2.77± 1.657 EGp before management 84 4.87± 2.793 0.000 CGp before management 70 5.04± 2.721 0.000 EGp after 3 months management 4.24± 2.383 CGp after 3 months management 4.36± 2.396 EGp after 3 months management 82 4.23± 2.410 0.000 CGp after 3 months management 60 4.35± 2.510 0.000 EGp after 6 months management 3.30± 1.877 CGp after 6 months management 3.48± 1.996 EGp after 6 months management 85 3.35± 1.863 0.000 CGp after 6 months management 57 3.42± 1.973 0.000 EGp after 9 months management 2.66± 1.659 CGp after 9 months management 2.89± 1.749 EGp after 9 months management 81 2.73± 1.666 0.001 CGp after 9 months management 58 2.88± 1.748 0.006 EGp after 12 months management 2.58± 1.604 CGp after 12 months management 2.72± 1.631 Remarks: EGp: experimental group, CGp: Control group 4.3. Self-rating depression scale (SDS) As shown in Table 3, the SDS score of experimental groups before management was 51.90± 11.413. After management, the SDS scores of patients at each time node were significantly lower than those before management and the previous time node, and the difference was statistically significant, P<0.05. Frontiers in Medical Science Research ISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 Published by Francis Academic Press, UK -26- The SDS score of experimental groups before management was 50.59± 7.669. The SDS scores of patients after management at each time node were significantly lower than those before management and the previous time node, and the difference was statistically significant, P0.05), however, the difference had statistical significance after the intervention (P<0.05). Table 3: Comparison of SDS score Group Number x ±s P value Group Number x ±s P value EGp before management 100 51.90± 11.413 0.299 EGp after 12 months management 64 33.75± 6.643 0.005 CGp before management 50.59± 7.669 CGp after 12 months management 36.63± 4.627 EGp before management 81 51.69± 11.671 0.000 CGp before management 64 49.47± 7.580 0.000 EGp after 12 months management 33.17± 6.475 CGp after 12 months management 36.63± 4.627 EGp before management 83 51.76± 11.549 0.000 CGp before management 70 49.67± 7.358 0.000 EGp after 3 months management 48.54± 8.971 CGp after 3 months management 46.07± 5.754 EGp after 3 months management 81 48.52± 9.064 0.000 CGp after 3 months management 61 46.26± 5.924 0.000 EGp after 6 months management 44.20± 7.398 CGp after 6 months management 43.62± 5.791 EGp after 6 months management 85 44.33± 7.259 0.000 CGp after 6 months management 59 43.75± 5.646 0.000 EGp after 9 months management 39.14± 6.167 CGp after 9 months management 40.69± 5.509 EGp after 9 months management 81 39.12± 6.270 0.000 CGp after 9 months management 62 40.58± 5.385 0.000 EGp after 12 months management 33.17± 6.475 CGp after 12 months management 36.73± 4.406 Remarks: EGp: experimental group, CGp: Control group 4.4. Self-rating anxiety scale (SAS) Table 4: Comparison of SAS score Group Number x ±s P value Group Number x ±s P valueE EGp before management 100 51.51± 8.898 0.096 EGp after 12 months management 64 36.33± 5.936 0.000 CGp before management 53.49± 8.556 CGp after 12 months management 40.56± 5.580 EGp before management 81 51.91± 9.527 0.000 CGp before management 64 53.89± 8.720 0.000 EGp after 12 months management 36.14± 5.533 CGp after 12 months management 40.56± 5.580 EGp before management 83 51.98± 9.421 0.000 CGp before management 70 53.74± 8.731 0.000 EGp after 3 months management 49.10± 8.417 CGp after 3 months management 50.41± 7.662 EGp after 3 months management 81 49.07± 8.519 0.000 CGp after 3 months management 62 50.63± 7.629 0.000 EGp after 6 months management 44.73± 6.325 CGp after 6 months management 47.87± 6.674 EGp after 6 months management 85 44.60± 6.243 0.000 CGp after 6 months management 60 47.90± 6.516 0.000 EGp after 9 months management 40.31± 5.860 CGp after 9 months management 44.60± 6.040 EGp after 9 months management 81 40.49± 5.910 0.000 CGp after 9 months management 62 44.82± 6.208 0.000 EGp after 12 months management 36.14± 5.533 CGp after 12 months management 40.60± 5.609 Remarks: EGp: experimental group, CGp: Control group As shown in Table 4, the SAS score of experimental groups before management was 51.51± 8.898 points. After management, the scores of patients at each time node were significantly lower than those Frontiers in Medical Science Research ISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 Published by Francis Academic Press, UK -27- before management and the previous time node, and the difference was statistically significant, P<0.05. The SAS score of experimental groups before management was 53.49± 8.556 points. And the scores of patients at each time node after management were significantly lower than those before management and the previous time node, and the difference was statistically significant P0.05), while the scores of the two groups decreased after intervention, and the difference was statistically significant (P < 0.05). 4.5. Cyst diameter before and after treatment As shown in Table 5, the cyst diameter of experimental group before management was 44.09 ± 7.382 mm, and the value after management was significantly lower than that before management and the previous time point with statistical significance ( P ＜0.05 ). While the cyst diameter of control group was 42.81 ± 7.000 mm before management, and the cyst diameter after management was significantly lower than that before ma nagement and the previous time point, and the difference was statistically significant, P 0.05). Table 5: Comparison of cyst diameter Group Number x ±s P value Group Number  x ±s P value EGp 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 EGp before management 81 44.30± 7.286 0.000 CGp before management 64 43.16± 7.167 0.000 EGp after 12 months management 22.09± 12.175 CGp after 12 months management 26.56± 13.720 EGp before management 83 44.35± 7.208 0.000 CGp before management 70 43.11± 6.952 0.000 EGp after 3 months management 34.33± 17.314 CGp after 3 months management 34.06± 16.520 EGp after 3 months management 81 34.09± 17.460 0.000 CGp after 3 months management 61 33.74± 16.944 0.000 EGp after 6 months management 31.49± 16.233 CGp after 6 months management 32.38± 16.066 EGp after 6 months management 85 31.78± 15.928 0.000 CGp after 6 months management 59 32.29± 16.260 0.000 EGp after 9 months management 28.48± 14.392 CGp after 9 months management 29.25± 14.951 EGp after 9 months management 81 28.25± 14.646 0.001 CGp after 9 months management 62 29.19± 15.194 0.000 EGp after 12 months management 22.09± 12.175 CGp after 12 months management 26.44± 13.901 Remarks: EGp: experimental group, CGp: Control group 4.6. EMS disease cognition It can be seen from Table 6 that there was no significant difference in EMS disease cognition between the two groups before intervention (P > 0.05). After the intervention, the scores of the two groups were lower than those before intervention. There were significant differences in both groups before and after intervention and the two groups after intervention (P < 0.05). Table 6: Comparison of disease cognition Group Number  x ±s P value Group Number x ±s P value EGp before management 81 30.370± 13.556 0.000 CGp before management 66 33.379± 15.103 0.000 EGp after 12 months management 61.204± 25.078 CGp after 12 months management 56.212± 23.077 EGp before management 100 31.300± 13.681 0.761 EGp after 12 months management 66 66.174± 23.371 0.000 CGp before management 31.930± 15.294 CGp after 12 months management 56.212± 23.077 4.7. Overall management effect We can see from Table 7 that the follow-up rates of 100 patients in experimental group at 0, 3, 6, 9 and 12 months were 100 %, 83 %, 85 %, 87 % and 81 %, respectively. While the follow-up rates of 100 Frontiers in Medical Science Research ISSN 2618-1584 V ol. 4, Issue 10: 23-29, DOI: 10.25236/FMSR.2022.041005 Published by Francis Academic Press, UK -28- patients in the control group at 0, 3, 6, 9 and 12 months were 100 %, 70 %, 66 %, 66 % and 61%, respectively. Obviously, the follow-up rate between the two groups had significant difference, and there was statistical significance (P<0.05). Table 7: Comparison of follow-up rate Group Number Mean standard deviation P value Experiment group 5 87.20 7.497 0.020 Control group 5 72.60 15.646 5. Discussion Endometriosis has the following features: extensive lesion, diverse form, unknown etiology, and it is defined as a refractory disease for its high recurrence rate and difficult to cure, and with the characteristics similar to malignant tumors such as invasiveness, metastasis and recurrence [3 -6]. In recent years, with the in -depth understanding of endometriosis, it has risen from a common disease in women of childbearing age to a worldwide health problem. It not only increases the burden of health resources, but also seriously endangers the health life of patients. The daily work of obstetrics and gynecology doctors in China is relatively busy. How to effectively manage patients in working leisure is one of the urgent problems to be solved. Due to the wide application of smart phones, and related third-party platforms are more and more widely used [7]. Based on the third -party platform, this study expl ores a long -term management model for endometriosis patients, which is suitable for national situation. In this study, 200 patients with endometriosis diagnosed by clinic or surgery were taken as the research object, and the long-term management lasted for one year. Taking 3 months as a time node, the relevant data of patients were collected regularly, and the data of experimental group and control group were statistically analyzed. The results showed that the data (including NRS score, SDS score, SAS score, cyst diameter and EMS disease cognition) of the two groups after management were significantly decreased compared with those before management, the data of latter time node was also significantly decreased compared with the previous time node, and all th e difference were statistically significant (P < 0.05). Further, the subjective evaluation (such as SDS score, SAS score and EMS disease cognition) after one year intervention of the two groups were significantly different, and the difference showed statistical significance. For example, the scores of depressions and anxiety in experimental group were lower than those in control group, meanwhile, the scores of disease cognition questionnaire in the experimental group were higher. The objective evaluation data showed that (RS score and cyst diameter) in both groups decreased significantly, but there was no significant difference of the 12th month. It is thus clear that no matter what kind of management method is used, if patients can adhere to the treatment, the treatment effect is objectively equivalent. Moreover, from the overall management effect, the follow- up rate at each time point in experimental group was significantly higher than that in control group, and the difference between the two groups was statistically significant. It can be seen that the method used in experimental group can better realize the management of patients. In addition, the difference of management effect between the two groups was considered to be related to the fluctuation of new coronary pneumonia epidemic. Many patients who need offline treatment have delayed the treatment or referral due to the epidemic control and other reasons. Patients who use third - party platforms can freely communicate with doctors online during the epidemi c period, and learn the scientific knowledge released online, which helps improve the patient compliance. Moreover, patients learn more knowledge and benefit from the treatment (such as significant pain relief), which helps reduce depression and anxiety ps ychologically, forming a positive cycle and promoting each other, so that a virtuous cycle will be formed and promoted.

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