A 7.1-magnitude earthquake hit china again, 702 days after Wenchuan Earthquake at Yushu prefecture of Qinghai province, 4000 meters above sea level. Up to April 19th, the death toll climbed to 1706, with 256 missing and 12128 injured. West China Hospital, as a regional state-level hospital of Ministry of Health, organized the first batch of medical team with relief supplies at the first day after Yushu earthquake and rushed to Yushu taking part into the rescue effort in golden seventy-two hours. The second day after Yushu earthquake, medical apparatus and drugs valued 5,000,000 RMB were delivered to the rescue site and the second batch of medical team were positioned. Within thirty three hours after the earthquake, 102 people, including 93 earthquake related injuries and 9 armed police with severe altitude illness, were sent to our hospital by air in four batches successively. Based on the first-hand experience of medical rescue in Wenchuan Earthquake, a series of diagnosis and treatment criteria which were built and developed with evidence-based method, and “four concentration principles”, namely concentrating the wounded, concentrating the experts, concentrating resources, and concentrating treatments, our medical rescue in Yushu earthquake were carried out appropriately. Up to 12 am., April 19th, 93 cases from the disaster area have been treated, of whom 54 seriously wounded, 58 underwent operations and none death. The experience learnt from Wenchuan Earthquake have been used, improved and sublimated more rapidly, more appropriately, more effectively in the Yushu earthquake medical rescue.
Through reviewing the regulations on the right of emergency treatment of hospitals, we analyzed reasons of emergency treatment of hospitals, including uninformed patients and informed patients without consent in emergency situations, as well as the risk of emergency rescue of hospitals. We put forward how to consider the judgment of emergency situations, justification of emergency treatment of hospitals, and risk attribution. We suggested improving the related legislation and regulations, developing compulsory medical insurance and a medical rescue system on emergency treatment.
Objective To explore the current problems of training on ethics reviews in clinical trials in China. Methods We designed a quantitative survey to collect participants’ feedbacks on the training workshop on ethics reviews, which included contents, arrangement and structure, relevant to the workshop and their difficulties on ethics review work. Results A total of 60 questionnaires were sent and the response rate was 56.7% (34/60). A total of 120 participants from 18 provinces of China. Most of them were members of the virtual research center of evidence-base medicine of the Ministry of education. A total of 78.1% (25/32) participants thought they achieved their purpose after training, and 12.5% (4/32) did not meet their needs due to the poor language. The feedbacks of contents and quality of the workshop on ethics were shown in Table 1. The top useful contents (cents in 8-10) were: clinical trial registration, policies of WHO and China (93.8%, 30/32), data management and quality control in clinical trials, the roles of clinical trial registries and ethics committees (93.3%, 28/30), transparency in clinical trials (93.3%, 28/30), informed consent and beyond (91.8%, 31/34), and how to approach ethical review case studies (90.9%, 30/33), etc. Nobody considered workshop of less help.The majority (85.1%, 23/27) thought difficulties on ethic reviews existed and the main difficulties include: short of operational administrative rules (82.6%, 19/23), poor training opportunity (52.1%, 12/23), less supports from administrative (30.4%, 7/23) and financial (21.7%, 5/23), etc. The relevance (8-10 cents) to ethics workshop was: methods of teaching 75.9% (22/29), PPT 75% (21/28) and materials 42.9% (12/28). Conclusions There is some limitations in the first workshop on ethic reviews due to the lower response rate. However, it still shows the importance of training on ethics reviews. Training strategies should focus on different participants’ needs and the relevance to methods of teaching, and materials, etc. Workshopadopted lectures, cases studies analysis, more discussions and necessary translation will be welcome.
After Wenchuan earthquake on May 12, West China Medical School/ West China Hospital of Sichuan University organized a youth volunteer team for earthquake rescue and relief. A volunteer network was formed and relevant service regulations were formulated immediately. Volunteers have played an important role in post-earthquake evacuation of patients, emergency reception, ward care, on-call service, a service to help people find family members, telecommunications and some other major tasks.
As more and more issues have emerged in organ transplantion cases, there is an increasing dispute about the definition of death: whether the criteria of cardiopulmonary death or brain death should be applied. The conflict between rights and obligations in brain death and organ transplantion is becoming ever evident, and there is a need for clarity on the issue of death and organ transplantion. This needs to come through legislation, which would be the most economical and effective intervention to provide this clarity. The authors believe that the National People’s Congress of China (NPC), the Standing Committee of NPC, the State Council of China and the Supreme People’s Court of China may get involved in the legislation for issues related to brain death and organ transplantion. As for the selection of decrees related to brain death and organ transplantion, all provinces, autonomous regions and centrally-governed municipalities can not exercise corresponding local legislative power except for special economic zones. After brain death and organ transplant related laws, administrative regulations, local decrees, autonomous decrees and special decrees have been settled, relevant executive legislation may be enacted. During such a legislative procedure, pilot programs can be adopted so as to enhance the applicability and success rate of the legislation of brain death and organ transplant.
Objective We aimed to investigate the attitude and suggestion from doctors, pharmacists and civil servants concerning brain death and organ transplantation and the legislation. Methods A questionnaire with 10 sections and 44 questions was designed and distributed. The effective questionnaire data was then recorded and checked for descriptive analysis. Results In 1 400 questionnaires distributed, 1 063 were responded and 969 of them were valid and analyzed. The respondents showed an incomplete understanding of brain death and organ transplantation laws. Seventy-four percent of the respondents recognized and accepted the standard of brain death. They agreed that legislation should be involved in the removal of organs for transplantation, the future use of the organs, and insurance and compensation for the donor for possible health risks induced by organ removal. Of the 969 respondents, 92% considered it necessary to have legislation in brain death and organ transplantation, and 61% thought that it is time to legislate. Conclusion Legislation for brain death and organ transplantation is urgent and timely in China. The laws must include the respective rights and obligations of patients, close relatives, and medical institutions. Educating the public about brain death and organ transplantation should also be encouraged in a variety of ways.
Objective Based on the acquirable and optimized evidences at present, to explore the challenge and countermeasures for the development of nursing discipline in China, and to provide suggestions for promoting the construction of nursing discipline, platform, and talent team. Methods The study materials were searched in the following electronic databases including PubMed, EMbase, Web of Science, CNKI, VIP and CBM, as well as in the official websites of World Health Organization (WHO), International Council of Nurses (ICN), World Bank, the Ministry of Health (MOH) and the Ministry of Education (MOE) of China, and the domestic universities, colleges or technical secondary schools. Then the statistical analysis was conducted using SPSS 13.0 and Microsoft Excel software. Results a) By 2012, there were 855 nursing schools, 38 212 nursing undergraduates enrolled in universities, and 130 837 nursing students enrolled in junior colleges and senior vocational schools; b) The doctor-to-nurse ratio was 1 to 0.9 in 2010. The actual demand for doctors was 2.6 million, and there were still lack of 346 000 nurses; c) The age of nurses younger than 35 years old accounted for 50%. Those with primary professional title accounted for 64% to 69%, while less than 2.5% with advanced professional title; d) The training cost for a doctor and nurse/midwife in China only accounted for 2/5 of that in India and 1/5 to 1/4 in the sub-Sahara Africa; and e) To date, only 30.1% of disaster nursing studies in China provided research data, 30.6% were clinical experience and 38.3% were review. Conclusion Education and health systems need to be extensively reformed. It is necessary to train nursing students with core competencies using transformative learning. It is necessary to update textbooks and teaching methods, and funding should be appropriately increased. Nursing should cooperate with other disciplines, and apply evidence-based nursing methods to improve the quality of healthcare services and patient satisfaction.
Objective To evaluate the trends, dominant diseases and clinical outcomes of the global interventional therapy for tumors based on evidence, so as to provide references for standard access of interventional technology. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and VIP were electronically and comprehensively searched for relevant clinical or fundamental studies about interventional therapy for tumors from inception to September, 2012. Two reviewers independently screened literature according to the inclusion and exclusion criteria and extracted data. Then, descriptive analysis was performed using SPSS 13.0 and Microsoft Excel 2003 software. Results Totally, 4 544 studies were included, consisting of 4 136 (91.0%) clinical studies and 408 (9.0%) fundamental studies. These clinical studies including 155 systematic reviews (SRs), 338 randomized controlled trials (RCTs), 1 191 clinical controlled trials (CCTs), and 2 451 case series or case reports (CSs/CRs). Transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) were the most clinically frequenly-used interventional technologies for tumors, accounting for 32.6% and 17.1% of the total, respectively. Hepatocellular carcinoma (HCC) was the dominant tumor, which was mentioned in 99 SRs (57.6%), 198 RCTs (58.6%), 824 CCTs (69.1%) and 1 191 CSs/CRs (48.6%), following by colorectal liver metastases (CLM). Radiofrequency ablation (RFA) treating HCC resulted in a higher rate of 3-year survival (12 SRs/Meta-analyses) and lower recurrence (10 SRs/Meta-analyses) compared with percutaneous ethanol injection (PEI). Compared with hepatic resection (HR), RFA treating HCC resulted in lower rates of 3-year (11 SRs/Meta-analyses) and 5-year survival (9 SRs/Meta-analyses), and no significant difference was found in 1-year survival between the two groups (17 SRs/Meta-analyses). Preoperative TACE before HR or liver transplantation could not improve the survival for patients with advanced HCC (6 SRs/Meta-analyses), but postoperative TACE might prolong the 1-and 3-year survival (3 SRs/Meta-analyses). TACE combined with other interventional therapy (i.e., RFA, PEI) could also prolong the survival of HCC patients. For the treatment of uterine leiomyoma, uterine artery embolization (UAE) resulted in less hospital duration or operative time, and it caused a higher re-intervention rate, compared with surgery, but it lacked long-term outcomes. Conclusion Interventional therapy is an optional and promising technology for patients with tumors. We should well-consider currently available best clinical evidence as well as local medical facilities or skill level when applying them to clinical practice, so as to perform relevant interventional techniques with scientific, rational and standardized methods.
Objective To investigate the effectiveness of arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the posterior cruciate ligament (PCL) via posteromedial incision. Methods Between January 2010 and January 2012, 22 patients with acute tibial insertion avulsion of the PCL underwent arthroscopic reduction and fixation via posteromedial incision. There were 14 males and 8 females with an average age of 32 years (range, 18-48 years). The injury causes included traffic accident injury in 14 cases, sport injury in 4 cases, and falling injury in 4 cases. The disease duration ranged from 7 to 16 days (mean, 10 days). Of 22 patient, 14 had simple PCL injury, 6 had PCL injury with meniscus injury, and 2 with cartilage injury. The results of posterior drawer test were positive in all patients. The preoperative Lysholm score was 51.1 ± 3.4. Results All incisions healed by first intention without infection, deep venous thrombosis of lower limbs, or vessel and nerve injuries. All patients were followed up 12-24 months (mean, 18.4 months). X-ray films showed that all fractures healed with the healing time of 2-4 months (mean, 3 months). The Lysholm score was improved to 96.0 ± 2.2 at 6 months after operation, showing significant difference when compared with preoperative score (t=43.020, P=0.000). Conclusion Arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the PCL via posteromedial incision is a safe, easy, and effective method.
Objective To explore the surgical method and effectiveness of multi-spot suture fixation under arthroscope in treating tibial intercondylar anterior eminence fracture. Methods Between February 2006 and January 2010, 15 patients with tibial intercondylar anterior eminence fracture were treated with multi-spot suture fixation under arthroscope after fracture reduction. There were 14 males and 1 female with a median age of 33 years (range, 7-55 years). The injury causeswere traffic accident in 9 cases, sport in 2 cases, and fall ing in 4 cases. The anterior drawer test, Lachman test, and pivot shift test in all the cases turned out to be positive. The Lysholm score was 64.7 ± 1.3. According to Meyers-McKeever classification, 5 cases were classified as type II, 7 cases as type III, and 3 cases as type IV. Of them, 13 cases had fresh fracture and 2 cases had old fracture. Assisted with anterior cruciate l igament-aimer, bone tunnels (2 mm in diameter) were built through the fracture fragments after fracture reduction, through which Ethibond 2 polyester sutures were guided into the joint by No.18 spine needles; after knot of 2 sutures or knot of only 1 suture was made, the other ends of sutures were fastened together outside the joint. Results The incisions of all the cases healed by first intention with no compl ication of infection or deep venous thrombosis. Fifteen patients were followed up 14-48 months with an average of 24.2 months. The X-ray examination indicated fractures healed in all the cases at 2-4 months (mean, 3 months). At 6 months after operation, 14 cases showed negative results of Lachman test and anterior drawer test but 1 case positive, while all the cases showed negative results in pivot shift test. The extension and flexion spheres of knee activity were normal in 13 cases and were l imited in 2 cases. The Lysholm score was 95.1 ± 2.1, showing significant difference when compared with the preoperative score (t=43.020, P=0.000). Conclusion Multi-spot suture fixation under arthroscope is an effective method with small invasion, rel iable fixation, and simple operation for treating tibial intercondylar anterior eminence fracture.