The number of clinical guidelines developed and published in different countries is increasing worldwide. Too many guidelines do not remain in regular use, even though the aim is to implement them in clinical practice. The scientific validity and reliability of the guidelines need to be reviewed. Here is a case presented to show how to optimally use the evidence-based guideline to improve clinical decision making.
Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.
ObjectiveTo analyze the state of rehabilitation after Lushan earthquake for improving the rehabilitation and personnel training system. MethodsFrom April 21st to May 5th, 2013, we collected data related to earthquake victims and the staff structure from West China Hospital, Leshan Downtown Hospital, Emeishan Hospital of Traditional Chinese Medicine (TCM), and Ya'an People's Hospital through interview and field investigation. ResultsTwo weeks after the earthquake, 25 220 victims received treatments in Sichuan Province, 6 545 surgeries were conducted, and 947 victims received postoperative early rehabilitation. A total of 392 victims received treatments in West China Hospital, Sichuan University, including 321 in-patients. In Leshan Downtown Hospital, Emeishan Hospital of TCM and Ya'an People's Hospital, the proportion of rehabilitation doctors reached 11.5% among all the doctors, the rehabilitation nurses reached to 8.6% among all nurses, and the rehabilitation therapists with certification reached to 4/5. ConclusionThe construction of the rehabilitation system and discipline, the cultivation of professional personnel, and popularization of rehabilitation concept are essential for development of rehabilitation in Sichuan province.
Nausea and vomiting are common side effects of anti cancer drug therapy, and significantly impact patient quality of life and treatment efficacy. Timely and effective prevention and management of these symptoms are crucial. In consideration of the healthcare situation in Sichuan province and relevant research findings, we have updated the "Expert consensus on the prevention and treatment of anti cancer drug induced nausea and vomiting of Sichuan province (2024)". This consensus aims to provide clinicians with professional advice and guidance tailored to the conditions in Sichuan province.
Objective To collect and analyze the data of emergency medicine supply for both Wenchuan and Lushan earthquakes victims in the West China Hospital, so as to provide evidence for scientifically and efficiently carrying out the logistical support for emergency rescue medicines supply, and improving the coping capacity for those similar public health emergencies. Methods Both medicine constituent ratios and DDDs were taken as evaluation indexes, and the data were input by Excel software. Then the following items were analyzed: the use and cost of emergency medicine for victims admitted in the hospital from one day to one month after earthquake, as well as, the acceptance, allocation and use of the donation medicines for both Wenchuan and Lusan earthquakes. Results During the first month after Lushan earthquake, the victims used 26 categories of medicines involving 455 drug specifications in the West China Hospital. The dosage and DDDs of therapeutic medicines were higher than those of ancillary medicines. The donation medicines for Lushan earthquake accepted by the hospital were in 8 categories involving 16 drug specifications, and they were all used to rescue the victims in the hospital. Based on the hospital emergency medicine supply system oriented by the information of victim’s medicine use, the drug specification and total drug cost of the donation medicines for Lushan earthquake decreased by 90.91% and 89.73%, respectively, indicating a more accurate and efficient system compared with those for Wenchuan earthquake. Conclusion The implementation of the hospital emergency medicine supply system oriented by the information of victim’s medicine use is helpful to improve the time efficiency and pertinence of earthquake medical rescue.
目的:了解地震住院伤员的身心状态,进行针对性心理干预。方法:采用方便抽样,应用作者根据应激理论设计的应激身心反应调查表［1］,通过对地震伤员的观察和访谈,对在2008年5月12日至5月30日在四川大学华西医院住院的371名地震伤员进行身心状态的评估,并进行有针对性的心理干预。结果:①地震伤员灾后急性期心身应激反应较严重,其中出现频率最多的症状是睡眠困难,对突然的噪音或声音感到紧张害怕,心情沮丧,感到身体紧张,心情难以平静;②不同性别地震伤员身心反应存在一定差异,女性反应症状重于男性;③年龄在小于12岁、12～18岁和41～50岁年龄段地震伤员的身心反应与其他年龄段地震伤员的身心反应存在差异;④地震伤员的身心反应与其性别、年龄、文化、个人受伤情况有关。结论:地震伤员灾后身心反应严重,急性期给予针对性心理干预十分重要。
Objective To survey the current status of residents’ health examination in township medical units in Shuangliu county, so as to provide references for exploring the residents’ health examination mode suitable for the well-off rural hospitals, and for improving the effects of physical examination. Methods The self-designed questionnaires were made to survey the current situation of health examination for the residents in 24 township medical units in Shuangliu County, including 3 central township hospitals, 3 community health centers and 18 general township hospitals; and the outline was designed to interview the people responsible for managing and implementing the resident’s examination work. The Epidate 3.1 was used for data input, the SPSS 17.0 was used for descriptive statistics and stratified analysis, and the classification method was adopted for qualitative research of personal interview data. Results The number of primary health care units for carrying out residents’ health examination got gradually increased year by year from 2008 to 2010; and all 24 township-level medical units had already carried out that examination by 2010. But some issues still existed such as lower participation rate and ineffective utilization of the archives. Conclusion a) It is necessary to prepare well, enhance organizing, expand publicity, and increase participation rate when primary health care units carry out the health examination for residents; b) It is necessary requires to fasten the informatization construction of health archives, and to quicken the process and analysis of examination information; and c) It is advisable to constantly optimize the examination items according to exam information, to improve the qualification of medical staffs, and to fasten the construction of exam team.
通过与首都医科大学、南京医科大学、中山医科大学、四川大学的康复医学研究人员2000年1月至2008年3月止发表在康复医学主要五种杂志上的期刊论文,从论文年代分布、领域论文分布、核心期刊发文率、基金资助研究情况、主题分布情况等方面进行了全面的统计分析,比较客观地揭示和描述了新世纪初四川大学华西医院康复医学中心康复医学研究与发展的基本状况,并提出发展的可能策略。
Objective To analyze the rationality of emergency medication in the West China Hospital after Lushan earthquake based on the actual drug use of earthquake victims. Methods We applied DDDs and DUI as evaluation index, input data using Excel software, and analyzed if the emergency medication was required for the injury/illness and the rationality of emergency medication. Results Earthquake victims mainly had trauma and wound infection and they were given antibiotics as main treatment one week after the earthquake. Drugs for the respiratory system and digestive system were mainly used in patients who mainly manifested as non-traumatic diseases and internal diseases four weeks after the earthquake. Among 49 kinds of drugs which could be calculated for the value of DUI, injection accounted for a larger proportion than non-injection (59.18% vs. 40.82%). The results showed that, the medication (DUI=1) only accounted for 12.24%; the medication (DUIlt;1, Mean=0.65) accounted for 38.78%, which implied insufficient drug use; the medication (DUIgt;1, Mean=1.77) accounted for 46.94%, which implied drug overuse. Conclusion Medication for every system is basically timely and rational when treating symptoms and causes in the West China Hospital within one month after Lushan earthquake. However, the rationality of emergency medications using DUI=1 under normal conditions still needs to be further verified.
Objective To study and analyze the related data to emergent public health events in 2008 Wenchuan Earthquake and two years before and after the earthquake, to examine the emergent health control system of Sichuan in terms of organization, implement, current status and problems, so as to offer first-hand data and decision-making references to the perfection of the monitoring system and raising the effect of control and prevention of the emergent public health envents effect. Methods The report data were statistically analyzed by Excel, EpiInfo software. Results Between 2006 and 2010, the emergent public health events in Sichuan had reduced gradually year by year, and a wave trough was formed in 2008 when Wenchuan Earthquake attacked; the emergent public health events in each year mainly took place in two peaks, one was from April to June and the other was from September to November. Compared with the period between 2006 and 2010, five among six heavily afflicted cities and prefectures with 18 heavily damaged counties in 2008 had dropped in the listing of emergent public health events. Between 2006 and 2010, the emergent public health events happening in schools of Sichuan accounted for 75.00%, especially the township primary schools were on the top of each index as place, cause, morbidity and mortality, but there were no serious emergent public health events. Among nine types of emergent public health events, the contagious disease events accounted for 79.30% while the food poisoning events accounted for 14.33%; and the contagious disease events mainly were respiratory tract infection diseases such as chicken pox, mumps and measles, and hepatitis A which were all preventable with vaccine, and accounted for 82.93%. Conclusion The construction of Sichuan’s health emergency system is a good foundation for the handling of emergent public health events. The emergent public health events in the whole province get gradually reduced year by year between 2006 and 2010, and all kinds of emergent public health events have been handled properly. With the national support for the disaster relief of Wenchuan Earthquake, the provincial emergent public health events after the quake in 2008 have scored the lowest level in the history without severe epidemics after the earthquake; and the plan of no severe epidemics within three years after the earthquake has come true with partner assistance in health system. By improving the control of contagious disease, food poison and preventable diseases, the incidence of emergent public health events can be dramatically reduced with lower morbidity and mortality. Only by means of multi-departmental cooperation and social participation for jointly preventing and controlling school emergent public health events, especially for preventing and controlling the contagious diseases in countryside and township primary schools, can all kinds of emergent public health events be timely prevented and controlled with decreased hazard.