ObjectiveTo systematically review the prognosis of fetal isolated hyper echogenic kidneys (IHEK) on prenatal ultrasound examination. MethodsPubMed, EMbase, Web of Science, WanFang Data, and CNKI databases were electronically searched to collect cross-sectional studies on the prognosis of fetal IHEK on prenatal ultrasound examination from January 1990 to January 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies; then, meta-analysis was performed by using R 3.5.2 software. ResultsA total of 9 cross-sectional studies involving 348 fetuses were included. The results of meta-analysis showed that the incidence rate of live births was 79% (95%CI 69% to 88%), termination of pregnancy/neonatal mortality (TOP/NND) was 30% (95%CI 15% to 45%), normal kidneys was 34% (95%CI 15% to 53%), autosomal recessive polycystic kidney disease (ARPKD) was 21% (95%CI 12% to 30%), autosomal dominant polycystic kidney disease (ADPKD) was 13% (95%CI 5% to 21%), and multicystic dysplastic kidney (MCDK) was 4% (95%CI 2% to 7%). Subgroup analysis showed that the prognosis of normal amniotic fluid subgroup was significantly superior to that of reduced amniotic fluid subgroup. ConclusionCurrent evidence shows that the incidence of adverse pregnancy outcomes in patients with IHEK on prenatal ultrasound examination is high, the prognosis is superior when IHEK with normal amniotic fluid volume, and is worse when with small amniotic fluid volume. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
ObjectiveTo explore the quality of life (QOL) of rural cognitive function impaired elderly in Guangyuan city and analysis the influencing factors, in order to provide evidence for improving the QOL of rural cognitive function impaired elderly. MethodsBy stratified cluster sampling method, Mini-Mental State Examination (MMSE) was adopted in the cognitive function impaired screening in Guangyuan rural area of Sichuan province in 2012, then we used SF-12 questionnaire to evaluate the QOL of those rural elderly (more than 60 years old) whose cognitive function was impaired. ResultsA total of 270 rural cognitive function impaired elderly were selected from 735 old people. The results of QOL assessment showed that:the mean of physical component summary (PCS) was 37.93±11.55, and the mean of mental component summary (MCS) was 44.07±13.14. Gender, age, education levels, economic situation of the selfassessment, chronic disease, being engaging in physical labour and daily life care were correlated with the score of QOL. ConclusionIn order to improve their QOL, we should help the elderly with cognitive function impaired and focus on prevention and individual treatment; their special difficulties should be fully considered when making the policy of health care and social security.
Objective To investigate critical thinking disposition inventory on medical students to offer evidence for building a medical education model with core competency as guide, evidence-based medicine as carrier and lifelong learning as purpose. Methods Chinese Version of Critical Thinking Disposition Inventory was used to investigate the current status of critical thinking of 617 medical undergraduates and graduates of Sichuan University. Results The average total score was more than 280 points. Average total scores of medical students in different educational systems from high to low were 309 points (eight-year-program), 298 points (postgraduates), 287 points (seven-year-program) and 286 points (five-year-program), respectively. The scores of three items including “seek truth”, “systematicity” and “confidence” were lower than 40 points in students both of five-year-program and seven-year program. There was no significant difference in total scores and each item between genders and varied ages. Conclusion The main factors which influence critical thinking in medical students of China include education idea, teaching atmosphere, teaching methods and teaching evaluation system.
Objectives To evaluate pulmonary physicians’knowledge level about prevention and treatment of chronic obstructive pulmonary disease( COPD) in some urban areas in China. Methods A total of 258 pulmonary physicians were interviewed face-to-face in 24 hospitals from July to October in 2006. The questionnaire included the knowledge of COPD, prescriptions at initial visit and follow-up, pulmonary function test monitoring, assessment and intervention in stable COPD, knowledge and evaluation of the commonly used medicines, the effects of smoking cessation and adopted measures, as well as the knowledge of treatment prospects and patients’ education. Results Eighty-eight percent of pulmonary physicians considered themselves knowledgeable on COPD, and 95% were familiar with the severity classification. Most of them knew about GOLD and Chinese Guideline of Prevention and Treatment to COPD, and paid attention to chest X-ray and pulmonary function test during diagnosis. The standards in evaluation of stable COPD patients were not well understood, and 92% of physicians claimed for pulmonary function test in stable stage. Seventy-nine percent of physicians actively suggested the patients quit smoking. The prescription for COPD patients at iniative and maintenance therapy met the guideline on the whole, but the mucolytic agents were appreciated too much and used too frequently. Thirty-three percent of physicians took it necessary to treat stable COPD,and 69% believed that pharmacotherapy for stable COPD could rersult in satisfactory quality of life.Conclusions In some big cities in China, the pulmonary physicians have good knowledge about COPD. But long-term prevention and intervention, especially in pharmacotherapy, are still unsatisfactory.
ObjectiveBased on the off-label drug use (OLDU) record application of alprostadil injection (Lipo-PGE1) which was the only one rejected in the Guangdong General Hospital in 2013, we retrospectively investigated all the background information of inpatients' OLDU of Lipo-PGE1 in 2012, so as to provide references for intervention of OLDU and effect evaluation. MethodsAccording to OLDU in dose record application of clinical departments, we summarized medical orders about inpatients' use of Lipo-PGE1 during hospitalization in 2012 and analyzed OLDU situation according to drug labels. Then, we summarized situation of drug use in all departments, analyzed OLDU incidence in dose, calculated prescribed daily dose (PDD) and drug use density (DUD) in each department to evaluate the degree of OLDU in dose. Resultsa) A total of 106 576 medical orders involving 8 620 case-times were analyzed. According to the data of cases, medical orders and drug use amount, the OLDU incidences were 34.43%, 25.16% and 41.37%, respectively. Lipo-PGE1 was used in every clinical department in this hospital and OLDU occurred in 69.44% departments (25/36). b) According to the number of medical orders, there were 6 departments with the OLDU incidence in dose > 50% and 5 departments with the OLDU incidence in dose during 50% to 20%. c) The average of PDD of the whole hospital was 12.77 μg. A total of 25 departments' PDDs were off-label, and 10 departments' PDDs were above the average level of the whole hospital. The ICU's PDD was the highest, with 2.35 times more than label dose. d) The PDD in each department was not directly proportional to DUD, which indicated the degree of OLDU in dose was not directly proportional to use intensity. This may be caused by different disease burdens in departments. ConclusionLipo-PGE1 is widely used in the Guangdong General Hospital where OLDU in dose occurs commonly. Since PDD and DUD reflect different contents, the two indicators should be combined to monitor OLDU.
ObjectiveTo investigate the burden of disease in Xinjin county of Chengdu city from 2009 to 2010. so as to provide baseline data for the study on the healthcare service system. MethodsThe prevalence of diseases among outpatients and inpatients in Xinjin county was collected and then analyzed using Microsoft Excel 2003 and SPSS 13.0 software. Resultsa) The numbers of out-patient and in-patients with the top 20 diseases had been increased by 106.8% and 43.2%, respectively in 2010 than those in 2009. According to International Statistical Classification of Diseases (ICD)-10, the diagnosis of the diseases involved in 11 types of diseases among outpatients. For out-patients, the top 3 categories were diseases of respiratory, digestive systems and injury, poisoning and certain other consequences of external causes, accounting for 85.06% and 82.69% of total diseases in 2009 and 2010, respectively. Among them, upper respiratory infections, acute bronchitis and superficial injury cumulatively accounted for 61.61% in 2009 and 59.53% in 2010. b) The diagnosis of the diseases involved in 12 types of diseases among in-patients. For in-patients, the top 4 categories were diseases of the respiratory system, pregnancy, disease during childbirth and puerperium, digestive and the circulatory systems. Among them, the diseases of the respiratory system accounted for 53.55% and 50.82% in 2009 and 2010, respectively. The top 4 diseases among in-patients were acute bronchitis, chronic bronchitis, COPD, and acute gastritis, accounting for 48.12% and 49.54% cumulatively in 2009 and 2010. Meanwhile, the prevalence of hypertension and diabetes increased dramatically into the top 10 diseases. c) The acute diseases were mainly distributed in township hospitals, while the chronic diseases were mainly distributed in county-level hospitals. ConclusionThe major burden of diseases is the diseases of the respiratory, digestive and circulatory diseases in Xinjin county of Chengdu city from 2009 to 2010. The chronic diseases are mainly distributed in county-level hospitals, while the acute diseases are mainly distributed in township hospitals or community healthcare centres. The common diseases are relatively stable which provide better conditions for the selection and use of the essential medical services and essential medicine list.
ObjectiveTo investigate the use of anti-hypertensive drugs among hypertension patients in examination medical center. MethodThis was a cross-sectional survey. Data of 3 000 cases of medical examination center health records from December 2012 to December 2013 were sampled, and 1 310 patients with hypertension were screened for analysis of medication. ResultsIn the 1 310 hypertension patients, 959 used antihypertensive drugs before, among whom 423 (44.11%) accepted only one anti-hypertensive drug and 536 (55.89%) accepted compound anti-hypertensive drugs or combined medicine. In patients of the previous kind, calcium channel blocker classes of antihypertensive drugs were used the most (n=244, 25.44%). Among the second kind of patients, 359 (37.43%) were treated with a two-compound drug or a combination of two drugs, and most of them used the combination of calcium channel blocker with angiotensin receptor blocker or calcium channel blocker with angiotensin converting enzyme inhibitor. ConclusionsThe current using of anti-hypertensive drug is in accordance with the recommendation of anti-hypertensive treatment guidelines in some way, but there are still some gaps between real clinical practice and guidelines.
ObjectivesTo establish statistical analysis and result reporting model for evaluation of the applicability of the clinical guidelines. We conducted an empirical study for clinical guidelines for the prevention and treatment of type 2 diabetes in China.MethodsA cross-sectional survey was conducted to select 6 to 8 doctors in geriatric, endocrinology, nephrology or related departments from medical institutions. The questionnaire was filled by doctors at a conference and electronic questionnaires were sent to those who did not attend the conference. Descriptive analysis was carried out for characteristics of evaluators, scores of each dimension, access to guidelines and factors affecting implementation. The Kruskal-Wallis rank-sum test and Nemenyi test were used for multi-group comparison and pairwise comparison. Multiple linear regressions with the stepwise strategy were used to screen out the association factors.ResultsA total of 725 questionnaires were collected in this survey. There were 722 valid questionnaires with an active recovery rate of 99.6%. The results showed the accessibility score was lowest and the acceptability score was highest. The results of multi-group comparison and multiple linear regression analysis showed that familiarity with the guidelines was the influencing factor of each score (P<0.05). The guidelines were primarily obtained from academic conferences (52.1%), WeChat (45.4%), and biomedical literature databases (43.5%). Among the evaluators, 44 (41.9%) believed that there were implementation obstacles in the guidelines, among which 136 (18.8%), 134 (18.5%) and 133 (18.4%) believed that implementation obstacles were medical personnel factor, patient factor and environmental factor.ConclusionsIn this study, a data analysis and result report model for the assessment of the applicability of the guidelines is established to provide evidence for the development/revision of the guidelines.
ObjectiveTo investigate the prevalence of chronic obstructive pulmonary disease (COPD) and related risk factors in two districts and five counties in Jiaxing city of Zhejiang province. MethodsWe randomly selected people over the age of 40 in 10 communities of two districts and five counties in Jiaxing city by cluster sampling and random sampling to investigate the prevalence of COPD from January 2013 to December 2013. All included patients received pulmonary function test at the same time. ResultsA total of 1 256 cases of adults over the age of 40 were included, among which, 1 056 cases with complete data and qualified for pulmonary function test. There were 410 males with mean age of 58.74±11.62, and 646 females with mean age of 59.45±11.72. The overall prevalence of COPD was 13.60%. Male and female prevalence rates were 13.90% and 13.41%, respectively. Divided by age, the prevalence of the age of 40 to 50 was 3.38%, the age of 51 to 60 was 9.57%, the age of 61 to 70 was 19.15%, and the age of above 70 was 29.35%. The results of multivariate logistic regression analysis showed that the main risk factors of COPD were smoking, passive smoking, history of dust exposure, chronic respiratory disease history and age. ConclusionThe total prevalence of COPD in Jiaxing area is high, and the female prevalence rate is especially higher than the national average level, which is the epidemiological characteristic of this area. Because the risk factors of COPD are complex, an integrated control strategy should be adopted.
ObjectiveTo investigate the prevalence of subclinical hypothyroidism (SCH) in health check-up population of West China Hospital of Sichuan University from 2011 to 2012 and to discuss the relationship between SCH and metabolic syndrome (MS). MethodsThose who received thyroid function tests and health examination in the West China Hospital of Sichuan University from 2011 to 2012 were enrolled in the study. The data of medical history, blood pressure, height, weight, thyroid function, TG, HDL-C, FPG were collected. All data were analyzed by SPSS 18.0 software. ResultsA total of 11 976 persons (7 488 male and 4 488 female) received thyroid function tests. There were 1 820 persons (884 males and 936 females, 15.20%) who suffered from SCH. The SCH prevalence was significantly higher in females (20.86%) than that in males (11.81%) (P < 0.01). The people over 60 years old had the highest SCH prevalence. There were 1 145 persons (1 005 males and 140 females) suffered from MS among all 11 976 persons. The MS prevalence was significantly higher in males (13.42%) than that in females (3.12%) (P < 0.01). The SCH prevalence of the MS group was higher, which in the health group was lower (P < 0.01). The TSH level in the MS group was higher, while it was lower in the health group. ConclusionThe prevalence of SCH is higher in health check-up population; and SCH apparently increases the risk of morbidity of MS.