ObjectiveTo discuss the influence of tutorial system in standardized emergency residency training. MethodWe reviewed the settings and management of tutorial system in the Emergency Department of West China Hospital since 2009, and summarized the achievements. ResultsThrough practice in these years, the clinical skills, teaching abilities and scientific research capability of standardized-training emergency residents were enhanced greatly. ConclusionsTutorial system facilitates standardized emergency residency training.
ObjectiveTo investigate the efficacy and safety of intravenous diltiazem in controlling ventricular rate in elderly patients with atrial fibrillation. MethodWe retrospectively analyzed the clinical data of patients suffering from atrial fibrillation with rapid ventricular rate presented to the Emergency Department between January 2014 and January 2015, and found that 57 elderly patients aged over 70 were treated with intravenous diltiazem for ventricular rate controlling. We analyzed the general situation of this group of patients, the changes of heart rate and mean arterial pressure before and after the treatment, and the adverse reactions to the treatment. ResultsThe total effective rate was 92.9%, and the mean onset time was (13.3±7.3) minutes. The mean arterial pressure showed no significant difference after treatment, and the heart function showed no significant deterioration. Only 4 patients (7.0%) had symptoms of transient hypotension. ConclusionsFor elderly patients with atrial fibrillation with rapid ventricular rate, intravenous diltiazem can control the ventricular rate rapidly, efficiently, safely, and sustainably.
ObjectiveTo explore the effect of continuous improvement of quality control system on the emergency treatment efficiency for patients with acute ST segment elevation myocardial infarction (STEMI) after the establishment of Chest Pain Center. MethodsWe retrospectively analyzed the differences of theory examination scores acquired by the Chest Pain Center staff one month before and after they got the system training. Moreover, we designated the STEMI patients treated between May and August 2015 after the establishment of Chest Pain Center but before optimization of process to group A (n=70), and patients treated from September to December 2015 after optimization of process to group B (n=55). Then we analyzed the differences between these two groups in terms of the time from patients' arriving to registration, the time from arriving to first order, the length of stay in Emergency Department, and even the time from door to balloon (D2B). ResultsThe scores acquired by Chest Pain Center staff before and after system training were 69.89±6.34 and 87.09±4.39 respectively, with a significant difference (P＜0.05). All the time indicators of both group A and group B were shown as median and quartile. The time from patients' arriving to registration of group A and group B was 6.0 (0.0, 11.0) minutes and 1.0 (0.0, 3.0) minutes (P＜0.05); the time from arriving to first order was 12.8 (9.0, 18.0) minutes and 5.0 (3.0, 9.0) minutes (P＜0.05); the length of stay in Emergency Department was 54.0 (44.0,77.0) minutes and 33.0 (20.0, 61.0) minutes (P＜0.05); and the time of D2B was 107.5 (89.0, 130.0) minutes and 79.0 (63.0, 108.0) minutes (P＜0.05). ConclusionAfter taking measures such as drawing lessons from the past, training staff and optimizing process continuously, we have significantly shortened the acute STEMI patients' length of stay in the Emergency Department, which has saved more time for the following rescue of STEMI patients.
Objective To investigate the correlation between plasma aminoterminal pro-B-type natriuretic peptide (NT-proBNP) level and severity of coronary artery lesions in patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods NSTEMI patients presenting to the Emergency Department and Department of Cardiology from January 2013 to March 2017 were divided into four groups: thrombosis without stenosis, single vessel disease, double vessel diseases, and three vessel diseases. The general situation of the patients, the plasma NT-proBNP, troponin T, echocardiogram and coronary angiography results were analyzed. Results A total of 88 patients were included including 6 in thrombosis without stenosis group, 20 in single vessel disease group, 31 in double vessel diseases group, and 31 in three vessel diseases group. The NT-proBNP level, left ventricular ejection fraction, left ventricular end diastolic diameter, and coronary Gensini score in three vessel diseases group differed much from those in the other groups (P<0.05). The correlation of NT-proBNP with coronary Gensini score in all the patients was positve (t=0.663, P<0.05). Conclusion The level of plasma NT-proBNP in patients with NSTEMI is related to the severity of coronary artery disease.
The Medical Administration and Hospital Administration of the National Health Commission released the "2021 China Chest Pain Center Quality Control Report" in January 2022. This report analyzes the construction ratio of chest pain centers in the second-level and above medical institutions nationwide in 2021 and the construction of standard and basic chest pain centers, mainly from the way of coming to the hospital, symptom onset to first medical contact time, door to wire time, reperfusion therapy ratio, in-hospital mortality, proportion of discharges with medication recommended by the guidelines and average length and cost of hospital stay of ST-segment elevation myocardial infarction patients to comprehensively describe the current status of the construction of the national chest pain centers. This article interprets the report in detail by reviewing relevant literature.
The national policy on high-quality development of hospitals proposes to strengthen information technology support and actively promote the multi-disciplinary team (MDT) model. How to use the “Internet Plus” technology and operation mode to promote MDT communication and improve the efficiency of diagnosis and treatment in the digital and intelligent information age is a direction worthy of attention and research. This paper systematically reviews the current development status of MDT informatization construction at home and abroad. Based on the current challenges and opportunities, it makes prospects for the future development of MDT informatization construction from the aspects of strengthening the digital and intelligent support of MDT operation, connecting MDT “information silos”, and deepening the construction of MDT supervision and effect evaluation system, etc.
Rare diseases are mostly genetic disorders that often manifest in childhood, characterized by severe conditions, difficulties in diagnosis and treatment, and poor homogeneity in clinical management. Clinical research on rare diseases contributes to enhancing the diagnosis and treatment capabilities for rare diseases in China and promotes the development of rare disease medicine. Clinical research on rare diseases in China started relatively late, and there is currently no mature and comprehensive system for clinical research on rare diseases. This article analyzes the current state of clinical research on rare diseases in China, identifies existing problems and research difficulties, and proposes ideas and key measures for the construction of China’s clinical research system on rare diseases, aiming to provide opinions and suggestions for the construction of China’s clinical research system on rare diseases.
Complement 1 esterase inhibitor (C1-INH) is a serine protease inhibitor, which is an important regulatory substance in the plasma cascade reaction and can regulate the complement system and bradykinin-forming system. hereditary angioedema (HAE) is a rare autosomal dominant inherited disease, mainly caused by a mutation of the gene controlling the synthesis of C1-INH resulting in reduced or dysfunctional levels of C1-INH in patients. C1-INH substitution therapy is one of the main therapeutic strategies for controlling HAE attacks. This article mainly collates and analyzes related research literature, summarizes the progress of C1-INH treatment of HAE, and provides some references for clinicians to treat HAE.