Objective To be aware of the treatment status and economic burden of people with hemophilia (PWH) in mainland China, so as to seek the optimal therapy for them. Methods The relevant Chinese and English databases such as CBM, CNKI, VIP, WanFang Database, PubMed, EMbase and The Cochrane Library (Issue 6 of 12, June 2011) were searched in June, 2011. The economic analyses and studies on PWH treatment and economic burden published from 1980 to 2011 were collected. Results The diagnosis and treatment of PWH in mainland China lagged behind. More than 30% of PWH did not receive or occasionally received treatment, and less than 10% received prophylactic therapy. Lots of PWHs still used FFP or cryoglobulin which were easily to cause blood-borne viral diseases. More than half of PWH families could afford a little or completely could not afford the therapy. Low dose prophylactic therapy was cost-efficient than on-demand therapy. Based on the therapy status, it was estimated that approximately RMB 53 844 yuan per year per patient should be put into practice in order to have PWH received low-dose prophylactic therapy, and to prevent 80% of bleeding. Conclusion PWH in mainland China is poor in treatment status and heavy in economic burden, so it is an optimal way to adopt comprehensive care model and low-dose prophylactic therapy in mainland China.
Objective To investigate the injury types, dysfunction situation and rehabilitation deamnd of the Lushan earthquake victims. Methods The rehabilitation demand of 208 Lushan earthquake victims in the West China Hospital of Sichuan University were investigated using a questionnaire. Results Bone fractures accounted for the largest proportion of injury types, followed by combined injuries, soft tissue injuries, pulmonary contusion, and amputation. Most victims suffered from the motor dysfunction, balance disorder and restrictions in activities of daily living. More than 80% of victims had pain. A few victims had paresthesia and respiratory disorder. Most victims needed rehabilitation assistant devices and hospitalization treatment. Conclusion The injury types and dysfunction situation of Lushan earthquake victims are associated with the demand of rehabilitation assistant device. The tailored rehabilitation regimen can be made in combination with victim’s rehabilitation demand. The early intervention of rehabilitation medicine is extremely beneficial to the recovery of earthquake victims.
What drug dosage range is appropriate for treatment? What drug dosage range can maximally reduce the incidence of adverse drug reaction (ADR)? The gold zone method as a new method of evidence-based medical research was proposed to study those two blind areas of drug dosage in this article. Studying the dose-effect relationship, taking gold zone as the middle range and dividing empirical range into 3 sections were the key to study design. The evidence-based survey with extremely large sample showed a U-shaped rule existing between the antibiotics’ dosage and the incidence of ADR; and the dosage in gold zone appeared at the bottom of U-shaped curve. The gold zone method for determining dosage is a special breakthrough currently for solving those two blind areas of drug dosage
摘要:目的: 在风湿性心脏病患者瓣膜置换术中,评价罗库溴铵在麻醉诱导期间对患者心肌氧供和氧耗平衡的影响。 方法 :选择86例在中低温体循环下行瓣膜置换术的患者,采用随机双盲法分配成罗库溴铵组(n=42例)和维库溴铵组(n=41例)。给予咪唑安定(005～01 mg/kg)及芬太尼(10～15μg/kg)及等效剂量的罗库溴铵06 mg/kg或维库溴铵01 mg/kg(Org. Comp)进行麻醉诱导。监测麻醉诱导前至插管后10分钟(1次/1分)期间两组患者心肌氧供和氧耗的变化。 结果 :与基础值相比,罗库溴铵组患者在插管后5分钟期间心率增加了174%～135%,动脉收缩压增加了1694%～143%,平均动脉压增加了151%～132%。同期心率收缩压乘积增加了2267%～1396% (〖WTBX〗P lt;005)。心率和动脉血压在插管后1～7分钟期间明显高于同期的维库溴铵组患者(〖WTBX〗P lt;005)。 结论 :在ASA ⅢⅣ级、心功ⅡⅢ级风心病瓣膜病变患者进行瓣膜置换术中, 06 mg/kg罗库溴铵有潜在增加患者心肌耗氧量的作用。Abstract: Objective: To evaluate the effects of rocuronium on myocardial oxygen supplydemand in patients with rheumatic heart disease (RHD) during induction. Methods : 86 patients of either sex (ASA status ⅢⅣ; New York Heart Association classes ⅡⅢ) scheduled for valve replacement surgery were included in this randomized clinical trial (RCT). SwanGanz catheter was placed via right internal jugular vein before the induction of anaesthesia. Anaesthesia was induced with midazolam 00501mg.kg-1 and fentanyl 1015 μg·kg-1. The patients were randomized to receive either rocuronium 06 mg·kg-1 (group R, 〖WTBX〗n= 42) or vecuronium 01 mg·kg-1 (group V, 〖WTBX〗n= 41) to facilitate tracheal intubation when bispectral index (BIS) value dropped to 60 All data were recorded at the time before anaesthesia (Tb), loss of consciousness (Ts), administration of muscle relaxant (Tm), 1 min after administration of muscle relaxant (T1), when trainoffour stimulation (TOF) reached 0 (T2) and 1,2,3,4,5,7,10 min after tracheal intubation (T39).〖WTHZ〗Results : Heart rate (HR) increased by 174%135%, systemic arterial systolic pressure (SAP) increased by 1694%143%, mean arterial systolic pressure (MAP) increased by 151%132% and product of heart rate and arterial systolic pressure(RPP) increased 2267%1396% respectively during 5 minutes after intubation as compared with baseline in group R, which were significantly higher than those in group V during 5 minutes after intubation (〖WTBX〗P lt;005). Conclusion : An intubation dose of rocuronium should be used cautiously in patients with rheumatic heart disease (ASA status ⅢⅣ; NYHA classes IIⅢ).
ObjectiveTo analyze the effects of time-worn ritual endotracheal suction (TRES) and on-demand invasive airway suction (OIAS) for patients.MethodsPubMed, EMBASE, Cochrane Library, Web of Science, EBSCO, CBM, CNKI, WanFang and VIP databases were searched for all randomized controlled trials (RCTs) comparing TRES with OIAS for patients. The studies were selected according to inclusion and exclusion criteria. The articles were assessed and data were extracted from them. The RevMan 5.3 software was used to analyze the data.ResultsSeventeen randomized controlled trials were included finally, and 2 029 patients were included, involving 1 028 patients in the control group and 1 001 patients in the experimental group. The results of meta-analysis showed that compared with TRES, OIAS could reduce the damage to the airway mucosa injury (RR=0.18, 95%CI 0.13 - 0.26, P<0.000 01), reduce secondary respiratory infections (RR=0.44, 95%CI 0.30 - 0.65, P<0.000 1), decrease the occurrence of phlegm blockade (RR=0.20, 95%CI 0.13 - 0.33, P<0.000 01), shorten the hospital stay (MD=5.03, 5%CI 3.17 - 6.89, P<0.000 01), but not influence the drop in oxygen saturation and the drop in blood oxygen pressure (RR=0.50, 95%CI 0.21 - 1.17, P=0.11). However there was no significant difference in mortality between two groups (P=0.46).ConclusionOIAS is preferred for patients who need suction than TRES.
Objective To explore the matching relationship between the supply and demand of different types of integrated elderly care and medical service for the elderly population in the region, and achieve the simulation purpose of coordinated allocation and balanced development of supply and demand of integrated elderly care and medical service. Methods Combining literature, interviews, and expert consultation to sort out the main factors and system element relationships between the supply and demand of integrated elderly care and medical service in the region, the Vensim software was used to clarify the relationships and operation mechanisms between the subsystems of supply and demand of integrated elderly care and medical service. The data of the construction base for the integrated elderly care and medical service project in Suzhou city, Jiangsu province from January 1, 2010 to December 31, 2022 were selected. Results Combined with the accessibility and completeness of data, the main variables and indicators of the five subsystems were screened, and the causality diagram and flow diagram of the system dynamics were drawn to clarify the main variables and flow direction of the subsystems, and the constructed model was more stable in simulation operation. The simulation model results showed that the supply-demand ratio of home-based elderly care and community elderly care decreased relatively before 2012, and the institutional elderly care model gradually emerged and developed from 2013 to 2018. From 2019 to 2022, the supply-demand ratio of medical care with elderly care and elderly care with medical care decreased. Conclusions Based on the theoretical foundation of system dynamics, the supply and demand the integrated elderly care and medical service in the region are regarded as a complex system. Through the analysis of the system elements among the subsystems and the sorting out of the mechanisms, it can provide certain theoretical support for constructing and improving the system dynamics model for matching the supply and demand of integrated elderly care and medical service in the region.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.