Objective To improve the satisfaction of standardized remote consultation of epilepsy center in patients with refractory epilepsy, and initially establish a standardized remote consultation model of three-level comprehensive epilepsy center. Methods Based on the characteristics of our epilepsy center, we designed a set of standardized remote consultation process of epilepsy center in tertiary hospitals, including sorting out patient data before consultation, improving examination, application of multi-modal technology during consultation, notification of results after consultation, and decision of operation time and method. A total of 209 patients who received remote consultation in our epilepsy center from January 2022 to June 2023 were selected as the observation group, and 150 patients who received offline consultation in our epilepsy center during the same period were randomly selected as the control group. The satisfaction of patients in the two groups on the service of doctors and nurses in consultation and the consultation results were compared. Results Through the application of the new multi-modal remote consultation mode, the number of consultations gradually increased, Compared with the offline consultation mode, there was no significant difference in patients' satisfaction with the service of doctors and nurses in remote consultation mode (P<0.05). Conclusion The establishment of standardized remote consultation mode in epilepsy center has effectively reduced the economic burden of patients, simplified the medical treatment process and improved the service quality, but the consultation quality has not been affected.
Objective Tissue engineering advance in supplying the reparative and reconstructive medicine with promising tissue engineered medical products(TEMPs) and the new therapy alternative. The related supervision and administration of TEMPs is being developed and the standard research of TEMPs is also in progress. The Food and Drug Administration(FDA) of the United States has treated TEMPs as combined products and supervised them according to the level of risk to patients. Lately, FDA has determined that the Center for Devices and Radiological Health (CDRH) should take charge of examination and approval of TEMPs, with the cooperation of the Center for Biological Evaluations and Research(CBER). The regulatory controls have been established respectively in European Union and Japan. In China, TEMPs are identified as medical devices combined with cells. The Department of Medical Device of the State Food and Drug Administration (SFDA) is responsible for the examination and approval of TEMPs, and National Institute for the Control of Pharmaceutical amp; Biological Products(NICPBP) is responsible for evaluation tests. The standards of TEMPs are formulated mainly by the American Society of Testing Materials(ASTM) and International Standardization Organization(ISO).
Objective To evaluate the long-term efficacy of extended and standard surgery for carcinoma of head of pancreas by using meta-analysis. Methods Related articls （1990-2012） were searched in Pubmed， WOS， Embase， WanFang， SinoMed， and CNKI. Study on quality of these literatures were evaluated by using the Jadad score. The patients with pancreatic head carcinoma underwent extended radical resection and standard radical resection were classified to treatment group and control group， respectively. The mortality， morbidity， and survival rates of 1-， 3-， and 5-year after operation in the two groups were evaluated by using meta-analysis. Results A total of 11 studies fitted the selection crit-eria， including 744 patients. Among them 357 cases were in standard radical resection group and 387 cases in the extended radical resection group. The results of meta-analysis showed that： ①The morbidity after operation did not significantly differed between the extended radical resection group and standard radical resection group （OR=1.360， 95% CI=0.990-1.870， P=0.050）. ②The mortality of the two groups did not significantly differed （OR=0.870， 95% CI=0.430-1.760，P=0.700）. ③There were no significant differences in survival rates of 1-， 3-， and 5-year between the two groups （OR=0.880， 95% CI=0.450-1.720， P=0.710；OR=0.940， 95% CI=0.590-1.480，P=0.710；OR=1.000， 95% CI=0.600-1.67， P=1.000）. Conclusion Compared with standard radical resection， extended radical resection can not improve the survival rates of 1-， 3-， and 5-year after operation， and can’t reduce the mortality and morbidity after operation
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.
Laparoscopy has become a commonly used approach to diagnosis and treatment of acute abdomen, and it has good diagnostic value and therapeutic effect in selective cases. It should be practiced by experienced surgeons in laparoscopic surgery and emergency abdominal surgery. Hemodynamic instability, severe abdominal distension, fecal peritonitis, and tumor perforation are contraindications to laparoscopy. In recent years, more and more acute abdominal diseases can be successfully treated by laparoscopy. Randomized controlled trials have proved the laparoscopic treatment in acute appendicitis, acute cholecystitis, peptic ulcer perforation, acute gynecological diseases was comparable to open surgery, and had advantages of fewer complications and faster postoperative recovery. The utilization of laparoscopy in other diseases such as blunt and penetrating abdominal trauma, small intestinal obstruction, and diverticulitis with perforation remains controversial, and needs more randomized controlled trials to investigate the feasibility of laparoscopic surgery.
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.
ObjectiveTo analyze the relationship between maximum standardized uptake value (SUVmax) of primary tumor detected by 18F-FDG positron emission tomography/computed tomography (PET/CT) and clinicopathologic factors in stageⅠnon-small cell lung cancer (NSCLC), and investigate the prognostic value of PET/CT on pathological feature.
MethodsWe retrospectively analyzed clinical data of 182 patients with stageⅠNSCLC who underwent 18F-FDG PET/CT scan before lobectomy or segmentectomy in China-Japan Friendship Hospital from April 2013 to June 2014. There were 121 male and 61 female patients with their ages of 34-85 (68.1±9.8) years. Clinicopathologic factors including sex, age, smoking history, histology, TNM stage, T stage, tumor size, lymphatic vessel invasion, blood vessel invasion (BVI) and visceral pleural invasion were evaluated to identify the independent factors affecting SUVmax by univariate and multivariate regression analysis. The diagnostic efficiency and best cut-off point of SUVmax were calculated by the receiver operating characteristic curve.
ResultsThe univariate analysis identified that sex (P=0.015), smoking history (P=0.001), histology (P < 0.001), TNM stage (P=0.004), T stage (P=0.001), tumor size (P < 0.001), BVI (P=0.001) were factors affecting SUVmax. Only histology (P=0.001), tumor size (P=0.006), BVI (P=0.009) were found to be significant independent factors according to multivariate regression analysis. The SUVmax of primary tumor was a predictor for BVI with the highest diagnostic accuracy at a cut-off value of 4.85, the sensitivity and specificity were 65.5% and 71.7%.
ConclusionThe SUVmax is correlated with histology, tumor size and BVI in stageⅠNSCLC, higher in patients with non-adenocarcinoma, lager tumor and positive BVI. Furthermore, the probability of BVI could be predicted by SUVmax of the primary tumor.
ObjectiveTo understand the progress and problems of liver transplantation standard for hepatocellular carcinoma.
MethodsThe related articles regarding transplant criteria of hepatocellular carcinoma were reviewed and analyzed.
ResultsSince Milan criteria were proposed by Mazzaferro in 1996, a number of criteria were porposed by many transplant centers. These criteria expanded Milan criteria. Compared with Milan criteria, these criteria expanded tumor size and (or) tumor number, or combined with some biological variables, or combined with some immunological variables. However, there are still some issues should be clarified.
ConclusionDespite there are many transplant criteria of hepatocellular carcinoma, but a number of issues should be further investigated.
In order to promote the implementation of the three standards of central sterile supply department (CSSD), new standards for cleaning and disinfection/sterilization of flexible endoscope, dental instruments, and environmental surface in healthcare, this article elaborates about central management of CSSD; management of loaners and implants; technique of autoclave sterilization, ethylene oxide sterilization, and hydrogen peroxide sterilization; high level disinfection or sterilization of flexible endoscope; disinfection and sterilization of dental instruments; daily and enhanced cleaning and disinfection of environmental surface in healthcare facilities. This could help clinical healthcare workers to implement these new standards, effectively prevent nosocomical infection, and guarantee the personal safety of patients.
Standardized residents training is a necessary way to cultivate qualified clinical physicians, and the teaching ability of their mentors will be a key factor affecting the quality of standardized residents training. In view of the problems existing in the current teachers training of standardized residents training, West China Hospital of Sichuan University has innovatively built a “coordination of six priorities” teachers training system to conduct hierarchical training for different types of mentors, in order to improve the quality and achieve homogenization of training. This article mainly elaborates on the problems in the current residents teachers training, the “coordination of six priorities” teachers training system of West China Hospital of Sichuan University, and the effect of the teachers training.
