In recent years, medically unexplained physical symptoms (MUPS) are widely concerned by domestic and foreign scholars. However, China started late in this field with relatively backward development. It is of significant importance for the promotion of MUPS field development in China to learn the researches on MUPS by international scholars.
To discusses the current status, research hotspots and development trends of MUPS internationally by using bibliometrics method.
The papers related to MUPS from inception to 2022-08-15 were searched based on Web of Science core collection databases from July to August in 2022. The bibliometric analysis was performed on the included papers in terms of publication volume trends and the distributions of authors, institutions and research areas after screening and data processing. CiteSpace 6.1R3 software was used to conduct visualization analysis on collaboration between countries or regions, document co-citation, keywords co-occurrence, keywords clustering, and keywords with bursts.
A total of 1 615 papers were finally included, the number of annual publications in studies regarding MUPS showed an overall upward trend from 1985 to 2022, with the most rapid growth from 2014 to 2016. ROSMALEN J G M (43 papers), WITTHOFT M (41 papers) and RIEF W (31 papers) ranked the top three authors in terms of number of publications, and the total citations of the three scholars' papers also ranks in the top 10, with 954 times, 1 275 times and 1 339 times, respectively. The top three institutions in terms of number of publications were all from the UK, including University of London (143 papers), King's College London (95 papers) and University of Manchester (84 papers). The top three countries/regions in terms of number of publications were England (422 papers), the United States (341 papers), and Netherlands (268 papers), all of which cooperated closely with other countries. A total of 75 research areas were involved in all the literature, with most studies in psychiatry (605 papers). The literature co-citation network map includes 1 393 nodes and 6 108 connections, and the paper with the highest co-citation frequency was titled Somatoform Disorders and Medically Unexplained Symptoms in Primary Care. Except of "Medically unexplained symptoms", the top five keywords in terms of occurrence frequency were "primary care" (422 times), "somatoform disorder" (405 times), "somatization" (354 times), "prevalence" (217 times) and "depression" (211 times). A total of 12 clusters were obtained by keywords clustering analysis, reflecting in the subject category and epidemiological characteristics of MUPS, key subtypes of MUPS, main treatment methods and management of MUPS. Keyword with the highest intensity of burst was "somatic symptom disorder" "children" "bodily distress syndrome" "somatic symptom disorder" and "model" have burst in recent years and persisted till now.
At present, the publications of international studies regarding to MUPS show an upward stage, with research hotspots and trends mainly focus on the sutypes of MUPS with more researches, attention to juvenile groups and creation of effective communication models, correct evaluation and long-term management of MUPS, effectiveness of cognitive behavioral therapy for MUPS.
The diagnosis and treatment level of medically unexplained disease (MUD) in the community is closely related to the overall health service capacity of primary healthcare centers. However, general practitioners are not competent enough to diagnose and treat such diseases as shown in current studies. By combing the historical evolution of the introduction of the clinical pathway model into the field of general practice in China, this paper shows that the application of clinical pathway model in China is in a critical period of transition from simple diseases to complex diseases, and from general hospital specialties to general practice in primary care institutions, which confirms a broad application prospect in the diagnosis and treatment of MUD for clinical pathway model. This paper then summarizes the key bottleneck problems faced by the community general practice clinical pathway in China, which mainly include low recognition of clinical pathway by medical staff, difficulty in selecting types of MUD, and the inconsistency between paper form or simple electronic clinical pathway and the rapid development of medical informatization. It is further proposed on the basis that the construction of clinical pathways for diagnosis and treatment of MUD in the community should be based on general practice thinking as the core, and further exploration should be carried out and taking the clinical decision-making information platform of regional medical coordination as a new mode of clinical pathway by breaking through specialty thinking, focusing on dominant diseases, standardizing community diagnosis coding, etc. This paper provides a certain theoretical basis and strategic ideas for the future construction of clinical pathways for diagnosis and treatment of MUD in community general practice.
Medically unspecified disease (MUD) is characterized by complex and diverse symptoms that cannot be clearly diagnosed or rationally explained, which often leads to frequent hospital attendance, imposing a heavy economic burden on individuals, families and the healthcare system.
To understand the visits for MUD in general internal medicine clinics in county general hospitals by analyzing the results of a survey, providing a theoretical basis for standardized treatment of MUD by integrating evidence from this epidemiological survey and our ideas for general diagnosis and treatment of MUD in county general hospitals.
From January to March 2021, conditional sampling was used to select all patients (n=45 439) who attended the general internal medicine clinic (85 881 visits in total) in a grade B tertiary county general hospital in Taizhou, Zhejiang Province from January 1 to December 31, 2020 through the hospital information system. Among whom, adult patients with MUD were screened using the PRESUME screening method, and information involving the demographics, time of consultation and reasons for consultation was collected for analysis.
A total of 497 adult patients were identified with visits due to MUD, with a mean number of visits of 2.23 visits/person, and a mean age at visit of (51.6±15.9) years. There were sex-specific differences in age composition and attendances of MUD patients (P<0.01). As for the reasons for visits, men had more visits due to anxiety than women (P<0.05). The visits due to abdominal pain, anxiety and cough differed significantly by age (P<0.05). The visits in different seasons showed no significant differences by sex and age (P>0.05). The visits for cough differed significantly across the seasons (P<0.05) .
According to this survey, the visits due to MUD are influenced by various factors such as gender, age and season. Frequent visits for MUD due to various reasons cause difficulties in identifying and rationally treating the disease in the general internal medicine clinic as the first contact setting. To provide more accurate diagnosis and treatment for MUD patients, it is necessary to further develop the general medicine department, and make the general medicine department in county hospitals become the primary care center for MUD, and comprehensively enhance the effectiveness of county hospitals in serving the society.
