ObjectiveTo explore the application effect of standardized management on video-electroencephalogram (VEEG) monitoring.MethodsIn January 2018, a multidisciplinary standardized management team composed with doctors, technicians, and nurses was established. The standardized management plan for VEEG monitoring from outpatient, pre-hospital appointment, hospitalization and post-discharge follow-up was developed; the special quilt for epilepsy patients was designed and customized, braided for the patient instead of shaving head, standardized the work flow of the staff, standardized the health education of the patients and their families, and standardized the quality control of the implementation process. The standardized managemen effect carried out from January to December 2018 (after standardized managemen) was compared with the management effect from January to December 2017 (before standardized managemen).ResultsAfter standardized management, the average waiting time of patients decreased from (2.08±1.13) hours to (0.53±0.21) hours, and the average hospitalization days decreased from (6.63±2.54) days to (6.14±2.17) days. The pass rate of patient preparation increased from 63.14% to 90.09%. The capture rate of seizure onset increased from 73.37% to 97.08%. The accuracy of the record increased from 33.12% to 94.10%, the doctor’s satisfaction increased from 76.34±29.53 to 97.99±9.27, and the patient’s satisfaction increased from 90.04±18.97 to 99.03±6.51. The difference was statistically significant (P<0.05).ConclusionStandardization management is conducive to ensuring the homogeneity of clinical medical care, reducing the average waiting time and the average hospitalization days, improving the capture rate and accuracy of seizures, ensuring the quality of medical care and improving patient’s satisfaction.
ObjectiveTo summary the standard treatment for early gastric cancer. MethodsThe current early gastric cancer treatment guidelines around the world were analyzed and the standardized treatment patterns for early gastric cancer were concluded. ResultsThe accurate preoperative evaluation for early gastric cancer is the basis of standardized treatment which can be divided into staging evaluation and histological evaluation.The staging evaluation is focused on the gastric wall invasion and lymph node involvement of the tumor while the histologic evaluation emphasize the histological type and grading of the tumor.According to the precise evaluation for early gastric cancer, endoscopic surgery, laparoscopic surgery, open surgery, and multimodal therapy can be applied individually to the patients.Different treatment methods have their indications, but the indications of the therapies in different guidelines are suggested with slight differences. ConclusionIn clinical practice, the choice of treatment should be made with comprehensive consideration of diagnosis and individual characteristics of patients to achieve the most benefit on prognosis.
As the intensity of clinical and research work is high, teaching is gradually paid less attention to and the quality of education cannot be ensured. In this context, a full-time teaching position is set up in West China Hospital which is taken responsibility by qualified clinicians, to improve the teaching quality by strict management and omni-directional teaching. We introduce the setting and running of the full-time teaching position in West China Hospital in this paper.
Emergency treatment of ocular trauma is a systematic and complicated work. Rapid and correct diagnosis and treatment are needed to maximize the recovery of ocular structure and function. In recent years, China has made remarkable progress in the emergency treatment of ocular trauma, including the development of Expert consensus on the norms of emergency treatment of ocular trauma in China (2019), the establishment of a national ocular trauma database, and the development of VisionGo Artificial Intelligence prediction system for ocular trauma. These measures improve the treatment level of ocular trauma and provide support for the prediction of postoperative visual acuity in severe traumatic eyes. However, with the development of economy and society, the characteristics of ocular trauma in our country have changed. For example, the majority of hospitalized patients were open ocular injuries, farmers and workers were the main occupational groups, and the proportion of eye injuries caused by traffic injuries increased year by year, and the proportion of women and minors increased. Although the annual loss of life of ocular trauma disability in China has decreased faster than the world average, the emergency treatment of ocular trauma still faces many challenges, such as regional differences, insufficient primary medical resources, lack of standardized training, and insufficient promotion of emergency treatment standards. In order to cope with these challenges, it is necessary to further strengthen the popularization of science and technology for the prevention and treatment of ocular trauma, standardize the emergency treatment process, strengthen the training of grass-roots medical personnel, strengthen the safety of emergency surgery, and pay special attention to the particularity of children's ocular trauma. In addition, relevant research has been actively carried out to establish a complete database of emergency patients with ocular trauma to promote the accurate prevention and treatment of ocular trauma.
Objective To explore the application value of standardized patient (SP)-based teaching method in the teaching of medical history taking for international students. Methods During the autumn semester of 2017, 96 international medical students were randomly divided into two groups, with 48 students in the SP-based teaching group and 48 students in the conventional teaching group. The test scores of medical history taking in English in internal medical practice of the two groups were compared. The teaching feedback from the international students was collected and evaluated by online questionnaire survey. Results The scores of medical history taking examination in internal medical practice of the students using SP-based teaching method were higher than those of the students using conventional teaching method (86.5±9.7 vs.78.2±10.6), and the difference was statistically significant (t=3.983, P<0.001). According to the questionnaire analysis, in terms of whether the current teaching method could enhance learning interest, improve communication ability, promote clinical skills, train clinical thinking, and highlight humanistic care, students with positive views in the SP-based teaching group accounted for 92.86%, 97.62%, 85.71%, 90.48%, and 95.24%, respectively, while students with positive views in the conventional teaching group accounted for 90.00%, 87.50%, 82.50%, 77.50%, and 97.50%, respectively, and the differences were not statistically significant (P>0.05). Conclusions Well-trained SP has a good application value in clinical practice of internal medicine and diagnostics teaching for international students. SP-based teaching method has been accepted and supported by the majority of international medical students who have experienced it.
Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.
Sample size, mean and standard deviation are necessary when conducting meta-analysis for continuous outcomes. Advanced methods of data extraction were needed if the mean and the standard deviation couldn’t be obtained from a literature directly. Eight methods were introduced and two examples were given to illustrate how to apply the methods.
ObjectiveTo investigate the effect of surgery and influence of posttreatment with non-standardized and standardized operation by reviewing and analyzing the sporadic medullary thyroid carcinoma operation cases. MethodsThe clinical data of 26 patients with sporadic medullary thyroid carcinoma treated by surgery from January 2000 to March 2013 in this hospital were analyzed retrospectively.These patients were divided into non-standardized operation group and standardized operation group (total thyroidectomy with lymph node dissection) according to the operation models.The biochemical cure rate, the complication rates of recurrent laryngeal nerve injury and hypopara-thyroidism of these two groups were investigated and compared. ResultsThe 1-year biochemical cure rate had no statistical difference between the non-standardized operation group and standardized operation group (84.21% versus 100%, χ2=1.249 4, P > 0.05), the 1-year recurrence rate was 15.79% and 0, respectively.The 5-year biochemical cure rate of the standardized operation group was significantly higher than that of the non-standardized operation group (100% versus 16.67%, χ2=4.444 4, P < 0.05).The 5-year recurrence rate was 0 and 83.33%, respectively.However, there was no obvious difference between the two groups on the injury rate of recurrent laryngeal nerve (χ2=0.070 8, P > 0.05), as well as the rate of hypoparathyroidism (χ2=2.722 7, P > 0.05). ConclusionsCompared with the non-standardized model, the standardized operation model (total thyroidectomy with lymph node dissection) shows a higher cure rate and a lower recurrent rate, and it does not increase the complication rates of hypoparathyroidism and recurrent laryngeal nerve injury
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.
Data management system is a major factor affecting the quality of clinical trial. Development of data management system include a steering group and data safety and monitoring board, data collection, database, performance of the data safety and monitoring, as well as locking of database. This article provides key issues of the five parts so as to help researchers understand the clinical trial data management system.