The number of clinical guidelines developed and published in different countries is increasing worldwide. Too many guidelines do not remain in regular use, even though the aim is to implement them in clinical practice. The scientific validity and reliability of the guidelines need to be reviewed. Here is a case presented to show how to optimally use the evidence-based guideline to improve clinical decision making.
Objective To provide baseline date for further research by retrospectively investigating the disease constitution of over-60-year old patients in the West China Hospital of Sichuan University in 2011. Methods The information of over-60-year old outpatients was extracted from HIS and their diagnoses were classified by ICD-10. The data of single disease among top 3 categories of diseases were rearranged and analyzed by Excel software. Results The total of over-60-year old outpatients was 895 123 person-time in 2011, accounting for 19.65%, including 716 826 person-time in specialist outpatient clinics. The specialist diagnoses of 683 491 person-time could be classified by ICD-10, accounting for 95.35% of specialist outpatients. The top 12 diseases were neoplasm, circulatory, digestive, factors influencing health status and contacting with health services, respiratory, musculoskeletal system and connective tissues, nervous, eyes, symptoms/signs and abnormal clinical and laboratory findings, non-classified, mental and behavioral disorders, endocrine, and genitourinary system diseases, and the cumulative constituent ratio was 92.96%. The main pathogenic sites of neoplasm were bronchus and lung (21.98%), esophagus (8.66%), stomach (8.10%), rectum (7.37%), prostate (5.86%), and liver and intrahepatic bile ducts (5.55%), with a cumulative constituent ratio of 57.72%. The main disease burden in circulatory system was hypertension (39.50%), chronic ischaemic heart disease (11.17%), and cerebral infarction (9.70%), and the cumulative constituent ratio was 60.38%. While the main disease burden in digestive system was gastritis and duodenitis (24.98%), other diseases of digestive system (9.26%), and other diseases of liver (8.90%), and the cumulative constituent ratio was 43.13%. There were more female than male among the over-60-year old outpatients (50.67% vs. 49.33%), and male was higher than female only in the incidence of neoplasm, respiratory, factors influencing health status and contacting with health services, and genitourinary system diseases. The disease constitution ratio of 60-69 years old patients was 58.21%. The top 3 neoplasm were the malignant tumors in digestive (38.20%), respiratory and intrathoracic organs (24.70%), and lymphoid, haematopoietic and related tissue (11.97%), with a cumulative constituent ratio of 74.87%. Conclusion The top 3 disease burden of over-60-year old outpatients in West China Hospital were neoplasm, circulatory and digestive diseases, which reflects the trend and law of treatment demands of old patients. It needs to deeply analyze the frequency and flow pattern of patients, and to provide evidence for preventing and treating geriatric diseases.
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.
Cadre education and training is the elementary step in building a high quality, basic, and strategic cadre ranks project. The summer training of cadres in West China Hospital of Sichuan University is one aspect of the training system of cadres in our hospital. This paper introduces the current situation of summer cadre training, the training needs of cadres and the changes of internal and external environment in our hospital from 2009 to 2012, so as to continue constructing our summer cadres training product brand.
Objective To comparatively analyze the rationality of emergency medication after Wenchuan earthquake with that after Lushan earthquake in West China Hospital of Sichuan University, based on the use of medicine of the victim’s disease spectrum. Method By using Excel, defined daily dose system (DDDs) and drug utilization index (DUI) were used as the evaluation indexes to analyze the rationality of emergency medication in West China Hospital of Sichuan University within one month after Wenchuan earthquake and Lushan earthquake. Results Within one month after Wenchuan and Lushan earthquake, there were 1 839 and 488 victims treated in the hospital, respectively. Within one month after the two earthquakes, the variation tendency of DDDs of drugs and number of victims was consistent, and the consistency was better in Lushan earthquake than that in Wenchuan earthquake. Among the 60 drugs which DDDs were ranked top five in their pharmacological class (top ten for antimicrobials) in Wenchuan earthquake, the majority of them were injections (injections vs. non-injections: 70.0% vs. 30.0%); the results showed that the medication (DUI=1) only accounted for 10.0%, the medication (DUI<1) accounted for 28.3%, which implied that the use of drugs was insufficient, the medication (DUI>1) accounted for 61.7%, which implied that drugs were overused; the average of DUI was 1.61. And in Lushan earthquake, injections also accounted for a larger proportion than non-injections (63.3%vs. 36.7%); the results showed that the medication (DUI=1) accounted for 15.0%, the medication (DUI<1) accounted for 38.3%, the medication (DUI>1) accounted for 46.7%; the average of DUI was 1.30. Conclusions Base on the DUI, we draw the conclusion that the rationality of emergency drug use and the timeliness of emergency drug supply were better in Lushan earthquake than those in Wenchuan earthquake. But the rationality of using the DUI, which is an evaluation index for normal conditions, to evaluate the emergency conditions still needs to be further verified.
通过与首都医科大学、南京医科大学、中山医科大学、四川大学的康复医学研究人员2000年1月至2008年3月止发表在康复医学主要五种杂志上的期刊论文,从论文年代分布、领域论文分布、核心期刊发文率、基金资助研究情况、主题分布情况等方面进行了全面的统计分析,比较客观地揭示和描述了新世纪初四川大学华西医院康复医学中心康复医学研究与发展的基本状况,并提出发展的可能策略。
Objective To analyze the costs of emergency medication in the West China Hospital within one month after Lushan earthquake based on actual medication of the victims’ disease spectrum. Methods We collected emergency medication data as evaluation index in the West China Hospital within one month after Lushan earthquake, including daily cost, cumulative percentage of pharmacology category, average cost per day/person, average cost per day/person when DUI=1, difference between average cost per day /person, and average cost per day/person when DUI=1, etc. Then, we input data using Excel software for statistically analyzing the costs of emergency medication within one month after the earthquake. Results During one month after the earthquake, the costs changed consistently with the number of victims, which implied the change of costs was rational. Injuries were classified into 6 categories and 12 kinds according to ICD-10. The costs of medication accounted for 71% of the total costs. Six kinds of illness accounted for 21%. Medication for injuries was classified into 3 categories and 18 kinds; average cost per day was 186.87 yuan and average cost per person was 1 702.70 yuan. Medication for illness was classified into 5 categories and 28 kinds; average cost per day was 38.96 yuan and average cost per person was 185.13 yuan. The mean value of average cost per day/person of injection was 14.52/5.08 times more than that of non-injection. Meanwhile, the mean value of average cost per day/person of imported medication was 7.10/5.28 times more than that of domestic medication. Conclusion The factors that impact the medication costs include: a) disease burden and traumatic conditions of the sick and wound; b) administration pathway (injection vs. non-injection); c) imported or domestic medication; and d) the rationality of taking DUI as evaluation index. When DUIgt;1, injection through the vein and imported medication take a larger share which increase the costs of medication. Emergency rescue package should mainly prepare for the injury. In order to ensure the timely, safe and effective medication, injection should be given priority to. We also should take into consideration crash-resistance/anti-quake package, reasonable dosage, convenience-to-use of drugs as well as the needs of the illness.
By analyzing the current situation and problems of China’s precision healthy poverty alleviation, combining the current situation of poverty alleviation areas and its own clinical and regional advantages, West China Hospital of Sichuan University explores a practical “West China Way” to solve the healthy poverty problem. We insist on demand orientation, build the top-level design, and implement precise policies. Starting with the promotion of health screening, we actualizes hospital management, multi-disciplinary collaboration, integrated medical care construction according to regional needs, “double-group” style assistance, stratified and graded training, and telemedicine education. As the combination of “transfusion” and “hematopoiesis”, we help the local areas to build modern systems of hospital management, technology, and human resource.
The construction of high-level talent teams is the core of building up high-level universities and hospitals, and it is an important reference index for the ranking of universities and academic disciplines. The first-class medical talent teams is an essential requirement for comprehensive hospitals to be ranked as "Double First-Class". Based on the practice of construction of high-level medical talents in West China Hospital of Sichuan University, this paper introduces the optimal appoaches in this regard.
Shortly after Wenchuan earthquake, the department of nosocomial infection control initiated the emergency response plan immediately. Based on the conditions of the wounded delivered to the hospital, especial infection control plans were designed to prevent hospital acquired infections of multi-drug resistant bacteria and infectious disease spread in hospital. The infection control persons inspected the health care workers carried out the plans every day. Through enforced the rules of standard precautions, contact precautions and disinfection methods thoroughly, an effective and efficient medical rescue service has been offered to the wounded.