After the Wenchuan Earthquake on May 12th, 2008, under the b leadership of the SichuanProvincial Party Committee, the People’s Government of Sichuan Province, and the Ministry of Health of the People’sRepublic of China, the Medical Security Team working at the Sichuan Provincial Headquarters for Wenchuan Earthquakeand Disaster Relief Work constructed a secure medical material distribution system through coordination and interactionamong and between regions, systems, and departments.
Objective We analyzed the emergency management of medical supplies of People’s Hospital of Deyang City in the first week after the Wenchuan earthquake o provide first-hand evidence concerning the management of medical supplies in a public emergency. Methods Retrospective statistical analysis was used to analyze the surgery related demand in the first week after earthquake, including the demand, the supply, donations and the inventory of the pre-3 demand. Results The demand during the first day after the earthquake was the largest, But some of the supplies were not enough because of the lack of supply in the first 1-2 days. During the first 3-4 days after the earthquake, emergency procurement and supplies donated just met the supply gap. One week after the earthquake because of a lag inthe supply chain and a reduction in surgeries, there was an excess of some supplies. Conclusions China should accelerate establish a medical consumables supply and demand instant information feedback system, as well as building a public emergency material platform and a guide for society to promply donate materials.
Objectives Through a systematic review, to summarize and describe various health security mechanisms of protecting financial risk from illness in low and middle income countries (LMICs), and to analyze causes that lead to different effects in financial risk protecting. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. Twenty-four electronic databases, websites of 11 health institutions, and the search engine Google were searched. Any original study to evaluate the role of financial protection of health security mechanism in LMICs was included. Pre-designed data extraction form was used for collecting strategies and study method of included studies, and extracted information was analyzed and described. Results Fifty-two studies were included, and 56 specific health security mechanisms were categorized into 6: community-based health insurance, social health insurance, health sector reform, subsidy, user fee, and new rural cooperative medical scheme (NRCMS) in China. Forty-two mechanisms had positive effect in financial protection, 6 were negative, 5 had no effect and the effect of the other 2 was unclear. Conclusion Mechanisms that produced positive effect can be summarized as: setting up of co-payment rate, design of benefit packages, providing free care for vulnerable population, delivering primary health care directly in remote area, and Chinese NRCMS. Mechanisms to protect the poor from financial risk of illness include: government provides health insurance, providing free care and setting up different co-payment rate according to income. The failure of health security mechanisms can be ascribed the deviation from its original goal of health security mechanism design, due to various inner or external causes.
During the medical rescue after the earthquake, the Security Department of West China Hospital understood those factors affecting the hospital safety in the earthquake disaster, established emergent communication platform and information release channel, and opened up special areas and passages for the wounded, so as to ensure smooth passages for the rescue work, security of disaster-relief materials as well as an orderly, safe and stable medical environment.
摘要:目的:探讨胺碘酮治疗充血性心力衰竭(CHF)心房颤动伴快速心室率的临床疗效。方法: 将106例各种原因所致的房颤伴快速心室率的CHF患者按入院顺序随机分为治疗组及对照组。两组抗CHF基础治疗相同,治疗组加用静脉负荷量胺碘酮150 mg后,再以1 000μg/min静脉点滴维持6小时,500 μg/min静滴18小时。同时口服胺碘酮0.2,3次/d,1周;再0.2,2次/d,1周以后以0.2,1次/d 至观察终点,随诊为12个月。 结果: 治疗组53例使用胺碘酮治疗可显著增加抗心律失常有效性,改善左室射血分数,减少心力衰竭再住院率,42例患者转复为室性心律。 结论: 静脉及口服胺碘酮同时应用治疗充血性心力衰竭房颤是有效和安全的。Abstract: Objective: To explore the effect and safety of amiodarone in the treatment of atrial fibrillation with congestive heart failure. Methods:One hundred and six patients of AF with CHF caused by a variety of reasons were randomly divided into treatment group and control group according to hospitalized order.The two groups were treated with the same antiCHF therapy,the treatment group was treated with loaded intravenous amiodarone 150 mg;and then dripped to 1 000 μg/min for 6 hours, dripped to 500 μg/min for 18 hours. United with oral amiodarone by amiodarone tablets with 0.2 g,3 time/day a week,further 0.2 g,2 times/day a week,later 0.2 g,1 times/day to the end.The end of followup time was 12 months. Results:In treatment group,53 cases with amiodarone therapy can significantly increase the effectives of antiarrhythmic, improve the rate and heart failure rehospitalization.42/53 patients reversed to sinus rhythm. Conclusion:The results showed it is effective and safe united with intravenous amiodarone and oral amiodarone in treatment of atrial fibrillation with organic heart disease.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.
ObjectiveTo construct a strategy for classification of clinical research data security for real-world research, based on the features of clinical research data.MethodsBased on the laws, regulations, and data security classification method in relevant fields, the clinical research data was classified into five security levels. Then, the method was gradually perfected through three times of revisions, which followed the advice from experts who were experienced in many relative areas, such as clinical medicine, clinical research methodology, clinical research management, ethics, genetics and public health data application and management.ResultsExperts’ opinions gradually converged through several times of consultation. The clinical research data was finally classified into five security levels with explicit definition and security policy for each security level. Thirty-three data categories, which covered demographic information, clinical examination, diagnosis, treatment information, genetic information, health economics information, medical data and information on research processes that have been published, were included in the five security levels.ConclusionsSince there is an increasing trend of data scale and the data security classification and management are necessary to ensure the data security and appropriately utilization of data. The method of clinical research data classification proposed in this paper can provide beneficial references for the further improvement of data security in the future.
Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (rs=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.
Objective To explore the safety and feasibility of day surgery program of surgical treatment of mild to moderate gluteal muscle contracture. Methods We retrospectively analyzed the clinical data of the patients who received invasive surgery to release gluteal muscle contracture in West China Hospital of Sichuan University between July 2021 and July 2022. Postoperative telephone follow-up was conducted on the 2nd, 3rd, and 30th day after surgery. The basic conditions, surgery duration, intraoperative blood loss, anesthesia duration, pain score 6 h after surgery, hospitalization expenses, postoperative complications and patient satisfaction were observed. Results A total of 44 patients, 17 males and 27 females, aged 18-51 years with a median age of 30.5 years, diagnosed as bilateral mild to moderate gluteal muscle contracture, were included in this study. All patients except one with unilateral surgery were successfully finished the bilateral surgeries and discharged as planned. The mean surgery duration was (71±13) min, intraoperative blood loss was (20±17) mL, anesthesia duration was (118±21) min. All patients complained mild pain or no pain (Numerical Rating Scale score≤3) except one patient received pain rescue (Numerical Rating Scale score=5) 6 h after surgery. The average hospitalization expenses was (10021.55±1142.10) yuan. Three patients complained the poor wound healing. All patients replied a normal life and work with a good satisfaction and without any severe complications by telephone follow up on the 30th day postoperatively. Conclusion Surgical treatment of mild to moderate gluteal muscle contracture is safe, effective and feasible in the day surgery mode.
Objective To compare the efficacy and safety of different cyclin-dependent kinase4/6 inhibitor (CDK4/6i) combined with endocrine therapy (ET) for HR+/HER2- advanced or metastatic breast cancer based on mesh meta-analysis. Methods Randomized controlled trials (RCTs) of CDK4/6i in the treatment of HR+/HER2- metastatic/advanced breast cancer were searched in PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, VIP, and SinoMed databases from inception to August 2023. Bayesian network meta-analysis was performed by R 4.2.0 software. Results Finally, 18 RCTs in 25 articles, covering 8 031 patients, involving 11 treatment regimens were included. There were no statistical differences in progression-free survival (PFS) or overall survival (OS) between CDK4/6i+ET combinations. DAL+FUL ranked first in PFS rate, and RIB+FUL ranked first in OS rate. In terms of effectiveness, ABE+AI and ABE+FUL ranked first in objective response rate (ORR) and clinical benefit rate (CBR), respectively. In terms of safety, there were significant differences in grade 3-4 AEs and SAE among some CDK4/6i types (P<0.05). Conclusion Current evidence shows that CDK4/6i+ET is superior to ET alone in the treatment of HR+/HER2- advanced/metastatic breast cancer, and different combinations of CDK4/6i+ET have the same or similar effects, but the combination has a higher incidence of adverse reactions, and a reasonable treatment plan should be selected according to the individual situation of patients.