ObjectiveTo explore the application of PDCA cycle in the examination of medical quality of Tibetan area hospitals. MethodsIn the October 2014, PDCA cycle theory was introduced into the examination of Tibetan hospital medical quality. We collected quality problems existing in the medical activities actively, analyzed the reason and influencing factors and made corresponding plans. Then we implemented the plans and measures strictly, surveyed the results, found out and analyzed the problems, summarized the results of the examination, and turned the unsolved problems to the next PDCA circulation. Continuous follow-up was performed until the results were satisfactory. Based on Sichuan Province Secondary Comprehensive Hospital Evaluation Standard, we analyzed the medical quality of the hospital before PDCA application (July to September 2014) and after PDCA application (October to December 2014). ResultsThe incidence of medical nursing documents writing defects decreased from 12.4% to 5.9%. Hospital infection management defect rate declined from 13.5% to 5.3% and drug safety management defect rate declined from 11.8% to 2.5%, and all the differences were statistically significant (P<0.05). ConclusionPDCA cycle in the Tibetan hospital for medical quality examination has greatly improved the medical quality of Tibetan hospitals.
Objective To primarily test the reliability and validity of the Kashin-Beck Disease (KBD) affected big joints function assessing system for adult Tibetans in Rangtang County. Method From June to July 2009, 142 KBD patients were investigated with the function assessing system in Rangtang County of Ngawa. Cronbach’s α coefficient was calculated to estimate internal consistency reliability. Pearson’s r for the correlation of the items with the total score of the scale was computed to test the internal validity. Principal component factor analysis with varimax rotation analysis was conducted to explore construct validity. Result Both the response and complete rates of the scale were 100%. The time for completing the scale was 7.8±3.4 minutes. Cronbach’s α was 0.857, which revealed satisfactory internal consistency reliability. Pearson correlation analysis revealed significant correlation between the scores of each item and the total score of the scale (Plt;0.05). Pearson’s r value of each item was more than 0.4, only except the items of “sitting with legs crossed” and “standing at attention”. The principal factor analysis extracted three latent factors explaining 68.1% of the variation together. The latent factors weights of the items were over 0.4 except the items of “standing at attention”, "taking food” and “wiping after defecation”. Conclusion The reliability and validity of KBD affected big joints function assessing system for adult Tibetans in Rangtang County was good in this primary test, the function assessing system has to be widely applied and further assessed among Tibetans suffered with KBD, in order to provide a standard evaluation criterion in KBD integrate control.
ObjectiveTo evaluate the diagnostic value of interferon-gamma release assay (TB-IGRA) for tuberculosis in the Tibetan. MethodsFrom January 2014 to December 2014, suspected Tibetan tuberculosis patients were enrolled from AVIC 363 Hospital and underwent TB-IGRA test. All patients were also underwent smear test for Mycobacteria. The diagnostic value of TB-IGRA test for Tibetan TB patients was analyzed. ResultsA total of 77 suspected Tibetan tuberculosis patients were included. According to the diagnostic criteria, of the 77 suspected patients, 50 were diagnosed as TB patients, and 27 were diagnosed as not-TB patients. The sensitivity and specificity of TB-IGRA test was 86% and 81.5%. While the sensitivity and specificity of smear test were 22% and 100%, respectively. ConclusionThe TB-IGRA test is superior to smear test, and is the fast and sensitivity test for diagnosing Tibetan TB patients.
ObjectiveTo compare the outcomes of kidney transplantation (KT) between Tibetan and Han recipients.MethodsPatients greater than 18 years old, who had received the first ABO-compatible KT between April 2006 and March 2017, were retrospectively included. A propensity score matching (PSM) of Tibetans to Hans was performed by 1∶3 ratio. Survival, renal function and adverse events of the two groups were compared.ResultsOf the 1 820 patients who fit the screening criteria, 123 Tibetans and 357 Hans were included after PSM. The median follow-up time was 48 months. There was no statistically significant difference in death-censored grafts survival (P=0.061) or patients survival (P=0.440) between the two groups. The serum creatinine was higher in Tibetans than that in Hans within one year after KT (P<0.05), and the estimated glomerular filtration rate was lower in Tibetans than that in Hans within 5 years after KT (P<0.05), but no difference thereafter (P>0.05). The incidence of delayed graft function in Tibetan patients after operation was higher than that in Han patients (4.9% vs. 1.4%, P=0.037), but there was no significant difference in the incidence of acute rejection, infection, reoperation, or cancer between the two groups (P>0.05).ConclusionTibetans receiving KT achieve excellent and comparable long-term graft and patient survival to Hans, with similar long-term graft function.
Objective To explore the relationship between obesity and the three targets including blood pressure, glucose, and lipid. Methods A total of 181 adult Tibetans who underwent physical examination between March and September 2015 at Xigaze People's Hospital were enrolled in this study. Their obesity degrees were assessed with body mass index (BMI) and waist circumference (WC) respectively. The levels of blood pressure, glucose, and lipid were compared at the different levels of BMI or WC. Results The incidence of systematic obesity and central obesity in these adults were 57.5% and 79.0%, respectively. Compared the overweight group with the normal BMI group, the systolic pressure and diastolic pressure of the former were 9.26 mm Hg (1 mm Hg=0.133 kPa) [95% confidence interval (CI) (3.46, 15.07) mm Hg, P=0.002] and 7.76 mm Hg [95%CI (3.96, 11.57) mm Hg, P<0.001] higher, respectively. Similarly, the systolic pressure and diastolic pressure of the central obesity group were 8.24 mm Hg [95%CI (1.03, 15.46) mm Hg,P=0.026] and 6.79 mm Hg [95%CI (2.03, 11.55) mm Hg, P=0.006] higher than those in the normal WC group, respectively. For the normal WC or normal BMI subjects, the detection rate of dyslipidemia reached up to 50.0% and 52.6%. Conclusions With the increase of BMI/WC values, the level of blood pressure rises. Even though WC or BMI is normal, the detection rate of dyslipidemia is high.
Objective This study aimed to provide data about the clinical features of first seizure in the Ganzi Tibetan Autonomous Prefecture to improve the strategies for epilepsy prevention and control in this region. Methods We reviewed the clinical record of patients with first seizure in Neurology Department, Ganzi Tibetan Autonomous Prefecture People’s Hospital between January 2015 and October 2017 and summarised their clinical features. Results One hundred and one patients were included in this study with the average age of (43.0±18.4) years. Twenty-nine cases were diagnosed as statusepilepticus, 5 (17.2%) of whom died in 30 days. Among the 45 patients diagnosed with acute symptomatic seizure, 22 cases (48.9%) were caused by cerebral infection, including neurocysticercosis (n=4, 8.9%), tuberculous infection (n=8, 17.7%) and viral infection (n=7, 15.6%). Other causes of acute symptomatic seizure included cerebrovascular diseases (n=13, 28.8%), high altitude (n=3, 6.7%) and alcohol related or alcohol withdrawl (n=3, 6.7%). Conclutions These data suggest that the control of cerebral infections is essential for the prevention and treatment of seizures in the Ganzi Tibetan Autonomous Prefecture. Education of local primary doctors about status epilepticus will enable better management of seizures in this population.
Tibetan population has been living in Tibet plateau for more than thousands of years ago. Although, the environment is unlikely to be an ideal place for residence. They have evolved genetical and physiological adaptions living in Tibetan highlands. In recent several years, foreign scientists have noticed that lung cancer mortality is reduced at high altitude. Many in vitro and in vivo experiments explored the mechanism of this phenomenon. In this review we discuss the lung cancer incidence and mortally of Tibetan population, as well as the possible underlying mechanism including oxygen level, radiation, inhalable particulate matter, metabolism, hypoxic induced factor pathway and immune system. But, the clinical data as well as basic researches of Tibetan population remain insufficient, which required further investigation.
ObjectiveTo explore and discuss the risk factors of early onset coronary heart disease in Tibetan residents. MethodsWe selected Tibetan residents with coronary heart disease who were hospitalized in the Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region between January 2011 and May 2013, and then divided them into two groups by age (early onset and late onset coronary heart disease groups). Univariate analysis was performed between two groups by gender, family history, smoking, drinking, hypertension, diabetes, levels of blood lipid, respectively. The factors with significant differences were extracted for logistic regression. Data analysis was performed using SPSS 16.0 software. ResultsA total of 64 Tibetan residents with coronary heart disease were included, of which, 22 cases were in the early onset groups and 42 cases the late onset group. The results of univariate analysis showed that, significant differences were found in gender, family history, and levels of HDL-C and LDL-C (all P < 0.05). Besides, the results of logistic regression showed that, family history (OR=3.374, P < 0.05), high triglycerides level (OR=2.369, P < 0.05), low HDL-C level (OR=0.014, P < 0.05) and high level of LDL-C (OR=3.008, P < 0.05) were independent risk factors of early onset coronary heart disease in Tibetan residents. ConclusionPositive family history, high triglycerides level, low HDL-C level and high level of LDL-C are independent risk factors of early onset coronary heart disease in Tibetan residents.
Objective To analyze clinical characteristics and treatment experience of 143 tibetan victims of China Yushu earthquake, so as to provide reference for emergency preparation for earthquake disasters. Methods A retrospective study from April 16th to April 22th, 2010 was designed. A total of 143 injured Tibetans (74 men, 69 women) of the magnitude 7.1 Yushu earthquake were included in this study. Data from victims was collected retrospectively as follows: age, gender, cause of injury, place and time of rescue, chief complaint, primary diagnosis, onsite treatment, transfer, psychological crisis intervention and so on. Results The 143 tibetan victims contained 67 fracture cases (4 open fracture, 63 closed fracture), 5 joint dislocation cases and 3 neural injury cases. 62 victims with fracture were treated by Tibetan-Chinese therapy combined with external fixation, 5 victims were operated with emergency surgery, 6 victims refused to the surgical debridement and suture, and no dead case reported. All patients were given 3 to 11 psychological intervention treatments. As to the aspect of the wounded transferring, 48 cases among 54 supposed evacuating victims were transferred to Xinin hospitals, and the other six refused to be transferred and kept staying in the original place for treatment. Conclusion The clinical characteristics of the tibetan victims are outstanding. The medical rescue for disaster in ethnic region should be appropriate for features of disaster areas.Both the individualized remedy and early psychological intervention are regarded as the important measures for improving the general level of earthquake medical rescue in ethnic regions.
ObjectiveTo investigate the association between local population's lifestyle and the morbidity of cerebral stroke in Ganzi Tibetan state, so as to provided references for preventing stroke in the local region. MethodsA representative population sample (including residents, farmers and herdsmen) of Kangding, Dege, Ganzi, Litang and Batang county was selected through randomized cluster sampling from September 2010 to June 2012. Data including lifestyle, housing conditions and stroke status were collected using a questionnaire. Then statistic analysis was performed using SPSS 19.0 software. ResultsA total of 7 038 cases were investigated, of which 125 cases with cerebral stroke were found. The morbidity of stroke was 1 923/100 000. Smoking, alcohol drinking, excessive intake of salt and overweight were positively associated with the risk of cerebral stroke, while appropriate physical exercise was negatively associated with cerebral stroke. Housing conditions and height above sea level were not obviously associated with cerebral stroke. ConclusionThe prevalence of cerebral stroke is high in Ganzi Tibetan state, which is related to special local population's lifestyle. It is very important to reinforce the work for the prevention and control of stroke.