Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

AIM： To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma. METHODS： From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging. RESULTS： The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage （P 〈 0.05）. The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%, 50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0% respectively; the survival of different stage patients differed markedly （P 〈 0.001）. Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection （28 mo vs 18 mo; P 〈 0.05）. The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy （91.4% vs 68%; P 〈 0.05 ）. And it was also higher in detecting port vein involvement （90% vs 54.5%; P 〈 0.05）.CONCLUSION： The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability, the likelihood of metastatic disease, and survival. A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler UItrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.（OR = 2.46, 95% CI = 0.98-6.14）, and a significantly elevated risk of developing esophageal cancer among alcohol drinkers among alcohol drinkers （OR = 9.86, 95% CI = 3.10-31.38）. CONCLUSION： ADH2 and ALDH2 genotypes areassociated with esophageal cancer risk. ADH2＊1 allele and ALDH2＊2 allele carriers have a much higher risk of developing esophageal cancer, especially among alcohol drinkers.

Under the narrative medicine theory to establish the evidence-based medical record written by doctors and patients through integrated therapy of traditional Chinese and western on digestive system diseases

Objective:The aim of this article was to discuss the theory of doctor-patient co-operated evidence-based medical record and set up the preliminary frame of the doctor-patient co-operated evidence-based medical record following the concept of narrative evidence-based medicine.Methods:The information was searched from Pubmed,Embase,CBMdisc,CNKI.A preliminary agreement was reached by referring to the principles of narrative medicine and advises given by experts of digestive system and evidence-based medicine in both Traditional Chinese Medicine and Western Medicine.Result:This research is a useful attempt to discuss the establishment of doctor-patient co-operated evidence-based medical record guided by the direction of narrative evidence-based medicine.Reflection and outlook:Doctor-patient co-operated medical record can be a key factor of the curative effect evaluation methodology system of integrated therapy of Tradition Chinese Medicine and Western Medicine on spleen and stomach diseases.

The effect of digital health technologies on managing symptoms across pediatric cancer continuum:A systematic review

Objective:Pediatric cancer patients endure multiple symptoms during treatment and also in survivorship.Digital health technologies provide an innovative way to support their symptom management.This review aimed to examine the effect of digital health technologies on managing symptoms among across pediatric cancer continuum.Methods:A systematic literature search of six English and three Chinese electronic databases was combined with hand searching,to identify eligible research studies from database establishment to November 30,2019.Two reviewers carried out data selection,data extraction,and quality appraisal independently.A narrative approach was taken to summarize data.Results:Four randomized control trials,two quasi-experiments,and five one group pre-posttest designed studies,were included in the review with a total of 425 participants.The methodological quality of the studies was generally fair.Seven symptoms(anxiety,depression,pain,anger,fatigue,fear,distress)and seven digital health technologies(visual reality,website,humanoid robot,app,wearable devices,short messages and videoconference)were reported in the included studies.Conclusions:Current evidence supports the effect of digital health technologies is generally mixed and inconclusive.There is a trend of positive effects found in the interventions that feature digital health technologies’interactive function.This review highlights the need for further investigation with rigorous research designs and the consideration of influencing factors from the symptoms,participants,and context levels to inform a better digital health implementation.

Data Envelopment Analysis on Evaluating the Efficiency of Public Hospitals in Tianjin,China

Public hospitals are the most important components of health systems and account for a large proportion of health resources in China. However, few researches on the efficiency assessment of public hospitals have been conducted in Tianjin, China. On the basis of the data of annual health service report in 2013 from the Ministry of Health, we measured the relative efficiency of the tertiary general public hospitals in Tianjin and estimated the magnitudes of output increase and/or input reduction by using data envelopment analysis to improve hospital efficiency. The main findings of this study indicate that more than half of the sample hospitals operate at a technical and scale efficiency, and the prevalent scale inefficiency is increasing returns to scale. Moreover, it is a prominent issue that health resource constraint and resource waste coexist. Health policy-makers and hospital administrators would need to address these problems by taking comprehensive measures such as optimizing the allocation of health resources, implementing hierarchical diagnosis and treatment, as well as innovating medical-service operating mechanism of public hospital to improve the people's wellbeing.

Adapting the Servqual Scale to a Private Hospital Emergency Services： An Empirical Investigation

Most of the time, clients only have one opportunity to evaluate a service received in terms of quality and satisfaction; under this premise organizations have been concerned with developing, in a permanent manner, a quality evaluation culture in the services offered to their clients. To do this, procedures and methods that let them achieve it, have been implemented. That is the case of the model that concedes to measure and evaluate service quality, which is redefined and named Servqual, considering a multidimensional theoretical construct that explains the client＇s perception of quality service considering the differences between what is expected and what is received. Therefore, the goal of this study is to identify the factors that define the quality of emergency services provided by a private hospital in Hermosillo, Sonora, Mtxico, a sample of 384 patients, with a confidence level of 95% and a margin of permissible error of 5%. A questionnaire with 22 items was applied to measure the perceptions and expectations of users in terms of the quality of the service, which was subjected to an extensive evaluation of reliability and construct validity, with an estimate Cronbach＇s alpha of 95.6% and 97.9% respectively. The results showed that Servqual is a valid, reliable, and dependable instrument to monitor and measure the quality of the services offered in private hospitals in Hermosillo, and permit hospital administrators to identify opportunities or improvement areas, from the patients＇ perspective.

Accounting Harmonization for the Assessment of the Public Expenditure in Healthcare Service： Evidence From the Italian Experience

The introduction of the New Public Management （NPM） has not bridged the differences among the various European accounting traditions. In Italy, in particular, there are still different accounting methods in all public sectors. In the healthcare system, these differences have emerged more strongly. The recent Italian reform on accounting harmonization seems to be the answer to this accounting disharmony and represents a means of controlling public expenditure. This study aims to analyze the consolidated financial statement and the consolidated cash flow statement of the regional healthcare system as a new tool for the accounting harmonization. This paper is divided into two logical parts： In the first part, the authors analyze how the new accounting model is evolving under the current reform; in the second part, the authors analyze the consolidated financial statement and the consolidated cash flow statement that has been applied experimentally over the last two years in the Umbria Region.

Correlation Between Helicobacter pylori Infection and Tongue Manifestations:A Meta-analysis

Objective To analyze the relationship between Helicobacter pylori(H.pylori)infection and the manifestations of the tongue.Methods Without language restrictions,we searched databases including CAJD,CBMdisc,CDFD,CMFD,PubMed,Cochrane,and EMBASE and made meta-analysis for all literature we have collected.Results Six studies with 975 patients and 50 healthy people in total were included in the analytic pool.There were significant differences in the numbers of H.pylori infections between patients with thin and thick tongue coatings(OR=2.02,95%CI 1.32–3.07,P=0.001).In yellow tongue subgroup,there was a significant difference between patients with thick and thin coatings(OR=2.09,95%CI 1.16–3.77,P=0.01).There was a significant difference in the prevalence of H.pylori infection between patients with yellow and white coatings(OR=2.86,95%CI 2.10–3.90,P<0.001).The frequency of H.pylori infection was significantly increased in patients with red and purple tongues compared with those with pale red tongues(OR=3.42,95%CI 2.40–4.88,P<0.001;OR=7.51,95%CI 3.57–15.79,P<0.001).Conclusion Red or purple tongues and yellow tongues with thick coatings are indicators of a risk of H.pylori infection in patients with GI symptoms.Our study shows that tongue manifestations could serve as a feasible predictor of H.pylori infection in patients with GI symptoms,and determination of the exact association between tongue manifestations and H.pylori infection could enable an understanding of the objectivity of TCM.Long-term and rigorous controlled trials are needed in the future to evaluate the correlating factors.

How to select elderly colorectal cancer patients for surgery: a pilot study in an Italian academic medical center

Objective: Cancer is one of the most common diagnoses in elderly patients. Of all types of abdominal cancer, colorectal cancer(CRC) is undoubtedly the most frequent. Median age at diagnosis is approximately 70 years old worldwide. Due to the multiple comorbidities affecting elderly people, frailty evaluation is very important in order to avoid over- or undertreatment. This pilot study was designed to investigate the variables capable of predicting the long-term risk of mortality and living situation after surgery for CRC.Methods: Patients with 70 years old and older undergoing elective surgery for CRC were prospectively enrolled in the study. The patients were preoperatively screened using 11 internationally-validated-frailty-assessment tests. The endpoints of the study were long-term mortality and living situation. The data were analyzed using univariate Cox proportional-hazard regression analysis to verify the predictive value of score indices in order to identify possible risk factors.Results: Forty-six patients were studied. The median follow-up time after surgery was 4.6 years(range, 2.9-5.7 years) and no patients were lost to follow-up. The overall mortality rate was 39%. Four of the patients who survived(4/28, 14%) lost their functional autonomy. The preoperative impaired Timed Up and Go(TUG), Eastern Cooperative Group Performance Status(ECOG PS), Instrumental Activities of Daily Living(IADLs), Vulnerable Elders Survey(VES-13) scoring systems were significantly associated with increased long term mortality risk.Conclusion: Simplified frailty-assessing tools should be routinely used in elderly cancer patients before treatment in order to stratify patient risk. The TUG, ECOG-PS, IADLs and VES-13 scoring systems are potentially able to predict long-term mortality and disability. Additional studies will be needed to confirm the preliminary data in order to improve management strategies for oncogeriatric surgical patients.

Patient safety culture and handoff evaluation of nurses in small and medium-sized hospitals

Objectives:This study was conducted to investigate the current status of handoffs,perception of patient safety culture,and degrees of handoff evaluation in small and medium-sized hospitals and identified factors that make a difference in handoff evaluation.Methods:This is a descriptive study.425 nurses who work at small and medium-sized hospitals in South Korea were included in our study.They completed a set of self-reporting questionnaires that evaluated demographic data,handoff-related characteristics,perception of patient safety culture,and handoff evaluation.Results:Results showed that the overall score of awareness of a patient safety culture was 3.65±0.45,the level was moderate.The score of handoff evaluation was 5.24±0.85.Most nurses experienced errors in handoff and most nurses had no guidelines and checklist in the ward.Handoff evaluation differed significantly according to the level of education,work patterns,duration of hospital employment,handoff method,degree of satisfaction with the current handoff method,errors occurring at the time of handoff,handoff guidelines,and appropriateness of handoff education time(P<0.05).Conclusion:For handoff improvement,guidelines and standards should be established.It is necessary to develop a structured handoff education system.And formal handoff education should be implemented to spread knowledge uniformly.

Assessment of community health needs of Chongqing residents: a qualitative study

Objective: The aim of this preliminary qualitative study was to gain insight into community health needs in order to develop health program for community in Chongqing. Methods: Totally 40 participants were assigned into 6 focus group discussions. All groups were led by local language speakers, and their talking was recorded after gaining informed consent. Transcribed data were coded and subjected to thematic analysis. Results: The main obtained themes were that community health problems were chronic noncommunicable disease, main health service needs included regularly free check-up and health education, and perceived health risk factors were unhealthy lifestyle and behavior as well as environment problems. Conclusion: Our community health needs assessment (CHNA) with FGDs indicate that residents realize the importance of prevention of disease. Our study identifies that primarily community health promotion is one of the priorities of community health service needs, including reorienting health service, health education, guiding behavior or lifestyle, and creating healthy environments. The findings of this study can provide guidance to the development of more effective and pertinent health program in this community.

Assessment and impact of diastolic function by echocardiography in elderly patients

Doppler echocardiography is the gold standard for assessment of diastolic dysfunction, which is increasingly recognised as a cause of heart failure, especially in the elderly. Using a combination of Doppler echocardiography techniques, it is possible to identify grades of dia- stolic dysftmction, estimate left ventricular filling pressures and establish the chronicity of diastolic dysfunction. These physiologi- cally-derived measures have been widely validated against invasive measurements of left heart pressures and have been shown to be prog- nostically valuable in a wide range of clinical settings. This review explores the mechanisms, and approaches to the assessment of diastolic dysfunction in the elderly. The challenge for clinicians is to identify pathophysiological changes from those associated with normal ageing. When used in combination, and taking age into account, Doppler echocardiographic parameters are helpful in the assessment of dyspnoea in older patients and provide prognostic insights.

Geriatric assessment for oncologists

The world is experiencing aging of its population. Age-specific incidence rates of cancer are higher and cancer is now recognized as a part of aging. Treating older patients can be challenging. The clinical behavior of some tumors changes with age and the aging process itself brings physiological changes leading to decline in the function of organs. It is essential to identify those patients with longer life expectancy, potentially more likely to benefit from aggressive treatment vs. those that are more vulnerable to adverse outcomes. A primary determination when considering therapy for an older cancer patient is a patient's physiologic, rather than chronologic age. In order to differentiate amongst patients of the same age, it is useful to determine if a patient is fit or frail. Frail older adults have multiple chronic conditions and difficulties maintaining independence. They may be more vulnerable to therapy toxicities, and may not have substantial lasting benefits from therapy. Geriatric assessment(GA) may be used as a tool to determine reversible deficits and devise treatment strategies to mitigate such deficits. GA is also used in treatment decision making by clinicians, helping to risk stratify patients prior to potentially high-risk therapy. An important practical aspect of GA is the feasibility of incorporating it into a busy oncology practice. Key considerations in performing the GA include: available resources, patient population, GA tools to use, and who will be responsible for using the GA results and develop care plans. Challenges in implementing GA in clinical practice will be discussed.

Evaluation of the Nutritional Supplement VIUSID Vet Powder on the Productive Behaviour of Sows and Boars

The objective of this research was to evaluate the effect of administering VIUSID vet powder on the productive behaviour of sows and the quality of semen of boars. Two experiments were conducted on farms in the province of Sancti Spiritus, in the central region of Cuba. One was with sows, starting 21 days before parturition until weaning, and another was with boars in directed mounting. Each sow received 10 grams of VIUSID vet powder everyday, mixed with food, from 21 days before the probable date of farrowing and until weaning （33-day lactation period）. In the boars, the treatment consisted of administering 10 grams of VIUSID vet powder with feed, once a day for 6 weeks （week 1 to 6）; from week 7 onwards, the supplement was suspended. Results showed that, supplying VIUSID vet powder significantly improved the principal post-partum productivity indicators and significantly reduced diarrhoea and administration to boars in production for 6 weeks, which has improved spermatic motility and does not affect the other variables representative of the quality of the semen.

Systematic evaluation and Meta-analysis of acupuncture and collaterals cupping therapy for Knee Osteoarthritis

Objective:In order to obtain the best treatment program for Knee Osteoarthritis(KOA),to alleviate the pain of patients with KOA,and to systematically evaluate the efficacy of acupuncture cupping therapy for KOA.Methods:we used computer to search the databases of CNKI(1989-2018.10),Wanfang(1989-2018.10),VIP(1989-2018.10),PubMed(1966-2018.10),EMbase(1986-2018.10)and Cochrane Library(the 3rd issue of 2018).And the literature quality was evaluated by Jadad scale.Results:A total of 19 eligible RCT studies were included,and a total of 2,088 patients participated in the eligible clinical study.Meta-analysis results showed that the total effective rate OR combination=2.85[OR=3.98,95%CI(2.98,5.32),P<0.00001].The results showed that the curative effect of acupuncture and collaterals cupping in the treatment of KOA was superior to other therapies.Conclusion:Acupuncture and cupping therapy of traditional Chinese medicine is effective and safe in treating KOA.Due to the impact of the original study on Meta-analysis results,more large samples and high-quality clinical trials are still needed to verify.

An epidemic of violence on medical personnel:are we prepared

The incidence of violence against doctors has been increasing, both in China and worldwide. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial medical malpractice or even no fault of theirs. The once glittering halo of medical workers is being shredded thanks to the stressed health system and a lack of evaluation for risk of violence of the patients. Modem China sees a wide disparity between industry standards in rural and urban areas. People seeking health care service are often scared, can＇t get timely service and turn their anger towards those around them. To change a whole system in this giant nation is too hard a rock. Therefore, our focus is on the prompt awareness and preparation of a possible patient violence. The simplest approaches seem to be the most effective. Medical staffs should re-leam empathy on patients and be better trained on recognizing and reducing conflicts

Evaluation of the Regulation of Antibiotics Consumption in Bujumbura, Burundi

Abstract： Background： Antibiotic self-medication is highly prevalent in the developing countries. The objective of the study was to evaluate self-medication with antibiotics and the regulation of antibiotics consumption in the private and public pharmacies of the urban area of Bujumbura. Methods： A cross sectional study using self-administered questionnaire was conducted in private and public pharmacies of Bujumbura. 460 clients were randomly chosen and 32 sellers randomly selected from January to September 2015 and interviewed. Results： Of the 460 participants, 186 （40.43%） practiced self-medication to antibiotics. The average age was 34.89 years. Abdominal pain was the first motivation to practice self-medication （20.8%）. Amoxicillin was the antibiotic most commonly used （47.3%）. Inaccessibility to health care facilities due to the lack of financial resources was cited to be the root of this phenomenon （62%） and these antibiotics were mostly acquired from community pharmacies without prescriptions （84.4%）. Conclusions： The high cost of care and the low level ofstudy of the patients are factors favoring this phenomenon. A national policy for regulation use of antibiotics without a medical prescription and an educational program to general population on the effective use of antibiotics are therefore needed.

Requirements for Evaluation on Drug-medical Device

The administration of combination products in U.S.Food and Drug Administration(FDA)are analyzed and summarized in this paper.Furthermore,the technical evaluation on drug-medical device in the State Food and Drug Administration of China(SFDA)is also illustrated.Meanwhile,this paper discusses how to promote the development of drug-medical device in the administration and technical evaluation.

Merit and Evaluation Models for Managers in the National Health System： An Empirical Study

The national health system （NHS） complexity increase requires a review of the managerial human resources evaluation and recruiting methods, considering that nowadays doctors need to improve not just their clinical capabilities, but also managerial competences. At this end it is important to develop performances control models and to identify appropriate results indicators, with the aim of introducing an effective doctors selection system for managerial roles. The paper considers the Italian situation and tests the current evaluation and selection methods, by analysing the literature and the existing legislation and by interviewing experts. Moreover, in order to reach an innovative model, complex organizations have been taken into account as benchmarks. Three different categories of experts have been interviewed and texted： national health care organizations managers, companies managers, and business consultants. The 137 interviewed experts have been asked about four main questions concerning the evaluation for hiring managers as chief medical director, department director, and head of complex units. The conducted research suggests four different options in order to evaluate and to select heads of complex unit for the most strategic roles. By consequence, the analysis shows that required characteristics must be managerial attitudes as well as clinical capabilities.