Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.
Health poverty alleviation is an important practice in implementing the basic strategy of precision poverty alleviation. It is also an important measure to win the battle against poverty in rural areas. Through the investigation of local medical and health conditions, West China Hospital of Sichuan University built a demand-oriented framework for medical poverty alleviation in Ganzi Prefecture, and gradually carried out precision top-level design, discipline construction, technical training, talent training, endemic disease prevention and control; through establishinga regional medical cooperation network, built featured specialies, built the backbone of medical and health forces, achieved the prevention of endemic diseases throughout life cycle, and improved the overall medical and health service capacity of Ganzi Prefecture. This article introduces the exploration and practice of the demand-oriented model in Ganzi Prefecture by West China Hospital of Sichuan University, aiming at providing a guide for the precision health poverty alleviation in China.
Objective To identify and analyze all medical injury liability disputes lawsuits pertaining to inferior vena cava filters (IVCF) in “Lexis?China” database, the causes and outcomes of litigation of the cases were clarified with a view, and to provide suggestions for preventing potential medical patient dispute lawsuits and improving the clinical diagnosis and treatment level of doctors. Method The term “inferior vena cava filter” was searched in Lexis?China, and spanning from 2011-01-01 to 2022-12-31. Results A total of 221 cases of medical injury liability disputes were found, after screening and exclusion, a total of 179 relevant cases were included in this study for analysis. All first instance lawsuits were brought by patients against hospitals and had a high rate of compensation awarded (91.6%). Forty four cases were entered second instance litigation, and the proportion of maintaining the original judgment was high (68.2%). The main content involving the modification of the judgment was to increase the compensation amount (85.7%). In the 14 lawsuits related to the failure to place IVCF by the medical authority, the litigation points were all disputes arising from the hospital’s improper diagnosis and treatment of VTE patients, which led to the failure to place IVCF, with the highest proportion (92.3%) of improper diagnosis and treatment of pulmonary embolism (PE). For PE and deep vein thrombosis patients with clear indications for IVCF implantation but not placed, leading to litigation, the hospital bore different liability for compensation (18%–100%) depending on the fault factors of the hospital’s negligence in diagnosis and treatment. The hospital could also be held responsible for inadequate informed disclosure to affect patient judgment (23.1%). In 165 lawsuits related to the placement of IVCF, the vast majority of IVCF implants were for the diagnosis and treatment of VTE in patients (73.9%). However, such unplanned operations caused additional injuries and expenses to patients, and VTE occurred most frequently during hospitalization (76.2%). This type of embolism was most commonly secondary to fracture incision and fixation surgery (31.2%), and the average liability of hospitals for compensation varied due to different secondary factors. The occurrence of intraoperative and postoperative complications related to IVCF implantation could also lead to litigation (18.8%), and the proportion of dead patients in litigation was relatively high (32.3%). The most common complication leading to litigation was PE recurrence or exacerbation (22.5%), while intraoperative complications were vascular injury during interventional procedures (2/3). The overall trend of IVCF-related lawsuits reserves between 2011 and 2020 showed an overall upward trend, reaching a peak of 37 cases in 2020; the average amount of damages exceeded 100 000 yuan per case in 10 of the 12 years included in the statistics. Conclusions In China’s IVCF-related medical liability lawsuits, patients most often sue their doctors, who are often sued for failure to insert a filter due to untimely diagnosis and treatment of VTE, inadequate notification of informed consent for IVCF insertion, unplanned IVCF insertion due to the presence of VTE and IVCF-related complications, and the outcome is often unfavourable to the doctors. In addition, the number of IVCF related lawsuits and hospital compensation amounts have remained high in recent years.
ObjectivesTo evaluate the methodological quality of clinical practice guidelines (CPGs) of Chinese rehabilitation medicine.MethodsCBM, VIP, CNKI, WanFang Data and Medlive databases were electronically searched to collect CPGs of Chinese rehabilitation medicine from January 1979 to May 2018. Four reviewers evaluated the methodological quality of the CPGs by AGREE Ⅱ.ResultsA total of 11 CPGs were included, which involved 5 CPGs on nervous system rehabilitation, 1 CPG on bone and joint system rehabilitation, 1 CPG each on pediatric rehabilitation, internal medicine system rehabilitation, burn rehabilitation, earthquake rehabilitation and rehabilitation diagnosis and treatment criteria respectively. The results of AGREE Ⅱ score showed that the average scores on six domains were 65.3%, 28.0%, 9.3%, 42.1%, 6.3% and 4.0%. There were not any level A (recommended) guidelines. Two guidelines were level B (recommended after being revised). The other nine guidelines were level C (not recommended).ConclusionsThere are a few rehabilitation CPGs in China and the quality of methodology is low. AGREE's methods and concepts have not been fully used for formulation. The rigor of development, clarity of presentation, applicability and editorial independence of guidelines should be emphasized, so as to produce high level CPGs and improve clinical practice quality in rehabilitation medicine.
Mitral regurgitation (MR) is the most common heart valve disease. In recent years, the rise of interventional therapy has expanded the indications of interventional treatment for patients with MR, but the epidemiological characteristics of MR (especially the number of patients with MR requiring treatment) in China are still unclear. In this paper, we analyzed and estimated the number of MR patients in China based on three epidemiological studies in Europe and America, and referring to the patients population surveys from Zhongshan Hospital Affiliated to Fudan University, the Second Affiliated Hospital Zhejiang University School of Medicine and Beijing Fuwai Hospital. Our analysis estimated that about 7.5 million patients with MR need intervention in China, including about 5.5 million patients with severe MR.
OBJECTIVE: To investigate the effect of local application of basic fibroblast growth factor (bFGF) and sucralfate on the skin tissue structure after expansion. METHODS: Continuous tissue expansion (CTE) experimental animal model was made with constant pressure pump in nine white pigs. The bFGF and sucralfate were perfused between tissue and tissue expander. Both bFGF and sucralfate were injected in group I, both bFGF and normal saline in group II, only sucralfate in group III, and normal saline in group IV as control group. The samples were took from each pig for histomorphological assessment on the 3rd day and 6th week after expansion. RESULTS: Compared with control group, epidermal, granular spinous and basal cell thickness increased significantly (P lt; 0.05) in group I; in dermal layer, dermal thickened slightly and the collagen fibers became thicker and orderly; the elastic fiber regenerated significantly; the density of fibroblasts and capillaries significantly increased (P lt; 0.05) in group I. The collagen fibers were broken on the 3rd day and 6th week after expansion in control group. However, the thickness of the fibrous capsule layer was similar in each group. CONCLUSION: Local application of exogenous bFGF and sucralfate combined with CTE can greatly promote the skin growth. It can accelerate the tissue expansion.
ObjectiveTo systematically review the prevalence of low back pain in adult population in China, so as to provide a reliable scientific basis for further scientific research and social decision-making of low back pain.MethodsPubMed, EMbase, VIP, WanFang Data and CNKI databases were electronically searched to collect the studies on prevalence of low back pain in adult population in China from inception to October 28, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, systematic review was performed.ResultsA total of 16 studies were included. The results showed that: significant heterogeneity had been observed among the different studies. The previous affected prevalence was 7.21% to 39.0%, annual prevalence was 20.88% to 29.88%, and time period prevalence was 6.11% to 28.5%. Six studies reported the different prevalence between genders, in which only one study found a little higher prevalence in male, and the other five found higher prevalence in females than males.ConclusionsCurrent evidence shows that there is significant heterogeneity in studies on prevalence of low back pain among adults in China, and all of them are data from a single province or region. It is suggested that a national prospective survey should be conducted to provide more accurate epidemiological data.
ObjectivesTo systematically review the direct medical cost and burden of lung cancer in Chinese population.MethodsDatabases such as PubMed, Scopus, CNKI, VIP and WanFang Data were searched for studies investigating cost or burden of lung cancer in Chinese population from inception to September, 2017. Based on inclusion and exclusion criteria, two researchers screened literature, extracted data, and assessed methodological quality of included studies according to methods from Molinier, LA. Descriptive analysis was used to analyze the direct medical cost in conjunction with its composition and other aspects including various costs of different therapeutic regimens and temporal trends.ResultsA total of 42 studies were included. The direct medical cost per person per year varied from 55 295 yuan to 77 431 yuan. In addition, the direct medical cost for hospitalization ranged from 8 582 yuan to 65 562 yuan. The cost of drug accounted for the largest part. Costs showed differences in diverse treatment regimens and time periods.ConclusionsHigh quality studies on direct medical cost of lung cancer in China are rare. The direct medical burden of lung cancer in China is seriously high. As a consequence, control work is urgently required. Numerous factors including sample size, region, methods for dealing with data and value sets could influence the measurement results of cost. Future research could set focus on analysis based on time dimension, cost of target drug as well as the adverse effects caused by medication.
Based on the scientific research management experience for many years and the characteristics and advantages of the hospital, West China Hospital of Sichuan University develops an innovative scientific research management model relying on deepening the top-level design of scientific research management, strengthening the information management means, establishing the assessment and evaluation system of full-time scientific research personnel, and creating the benchmark of scientific research technician training industry. The “West China Model” of innovative scientific research management has achieved remarkable results. The comprehensive strength of scientific research has been strong, the management strength of scientific research has been greatly improved, and the scientific and technological research on the epidemic situation has been accurately deployed. The “West China Model” of innovative scientific research management not only provides a working path for research hospitals, but also lays a theoretical foundation for the exploration and establishment of the “scientific research management-scientific research team-scientific research project” trinity innovative hospital scientific research management system, which plays a positive role in effectively stimulating the vitality of scientific research and improving the core medical technology.
Cancer prevention and control is an important healthcare task towards major diseases of the Chinese people and an important part of the “Healthy China 2030” plan outline. This article summarizes and introduces the current status and practical experience of subnational cancer prevention and treatment status in Yibin City and Ya’an City of Sichuan Province. Lung cancer, digestive system cancers, and cervical and breast cancers compose of the majority of cancers with high incidence. In the aspect of cancer epidemiology, there are certain disparities among cities and between urban and rural areas, among which the mortality risk of cancer in rural areas is higher. In Yibin and Ya’an cities, the specialized agencies and governance system for subnational cancer prevention and control are still in the early stage of development, and the background data such as cancer-specific survival rate, public awareness of core knowledge on cancer prevention and control, quality control of key techniques, and healthcare resources in subnational areas are still unclear. Therefore, all levels of cancer prevention and control need further strengthening the organizational leadership and system construction, and promoting the hierarchic healthcare and balanced development.
