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Objective To systematically review the efficacy and safety of drug-eluting stent(DES) versus coronary artery bypass grafting(CABG) in the treatment of left anterior descending coronary artery(CAD) stenosis.Methods Literature about the efficacy and safety of DES versus CABG for LAD stenosis was retrieved from digital databases of MEDLINE, EMbase, PubMed, and the Cochrane Library by November 2016.Data extraction and quality assessment of included studies were conducted by two independent reviewers.RevMan 5.3 software was used to perform meta-analysis.Results Ten studies involving 9771 patients were finally included.The results of meta-analysis showed that there was no significant difference in mortality [RR=0.88,95%CI(0.70,1.11),P=0.28],major adverse cardiovascular events[MACE,RR=1.04,95%CI(0.88,1.24),P=0.63] or myocardial infarction [MI,RR=0.92,95%CI(0.56,1.53),P=0.75], but PCI-DES significantly increased the risk of TVR [OR=2.43,95%CI(1.61,3.69),P<0.0001].Conclusion For LAD stenosis, PCI-DES strategy causes as high a rate of mortality, MACE and MI as CABG or DES, but PCI-DES can significantly increase the risk of TVR, so we should be cautious clinically.
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Objective To analyze the perioperative conditions and long-term survival of patients with non-small cell lung cancer (NSCLC) after thoracoscopic lobectomy. Methods 119 patients with NSCLC underwent thoracoscopic lobectomy from January 2006 to December 2012 were enrolled in the study, then collecting and analyzing their perioperative indicators, pathological results and follow-up data. Results 9 patients converted to thoracotomy with a conversion rate of 7.0 %. The median operation time, the median intraoperative blood loss and off-bed activity time were 170 min (65~440 min), 90 ml (15~3 000 ml) and (32.9 ± 16.3) h after operation respectively. The time and amount of postoperative drainage, the length of hospital stay were (6.7 ± 3.2) d, (1 690.0 ± 410.5) ml, (9.2 ± 4.0) d respectively. The incidence of perioperative mortality and postoperative complications were 0.8 %, 13.4 % respectively. For postoperative pathological type, 96 cases of adenocarcinoma, 19 cases of squamous carcinoma, 2 cases of adenosquamous carcinoma and 2 cases of large cell carcinoma. For discharge patients, the median follow-up time was 34.5 months (0 ~ 102 months). The incidence of local recurrence and distant metastasis in observation group were 5.0 % and 17.6 % respectively. 1-year overall survival (OS) and disease free survival (DFS) were 85.3 % and 79.5 %, 3-year OS and DFS were 69.8 % and 64.8 %, 5-year OS and DFS were 60.8 %and 58.6 % respectively. There was no significant difference in 1-year, 3-year and 5-year OS and DFS between adenocarcinoma and squamous carcinoma (P > 0.05) while there were significant difference in local recurrence and distant metastasis among different stages (P < 0.05). In addition to slightly low OS, DFS of Ⅲ a , Ⅲ b and Ⅳ DFS and OS, the overall living conditions among all stage were similar. Conclusions The long-term survival condition of thoracoscopic lobectomy for NSCLC is ideal, and it’s a safe and effective operation, worthy of clinical promoting.
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Hospital entrustment will incur cultural conflicts,which calls for cultural integration as the best means to ease such frictions and conflicts between two hospitals of cultural difference.Renmin Hospital of Wuhan University (Hubei general hospital)directly hosted Hanchuan people's hospital,and implemented the president responsibility system under the leadership of the management committee.By means of cultural integration to reshape Hanchuan hospital culture,Hubei general hospital has rebuilt the latter's culture.Such reshaping features the following:development as the core,scientific management as the breakthrough,employees as the center,technology upgrade as the basis,and patients service as the direction.Cultural integration has furthered development of the hospital entrusted,and turned frictions and conflicts into infiltration and integration.As a result,Hanchuan hospital is upgraded in general in terms of management and service quality.
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The ongoing health reform features direct hosting of county-level hospitals by provincial level hospitals as an important means and effective attempt to improve comprehensive service capacity of the former.This paper introduces the“Hanchuan Model”,in which Hubei People’s Hospital has hosted Hanchuan city People’s Hospital,and analyzed the operation performance and hurdles found.Based on such studies,the authors recommend on the vertical integration of medical resources by means of hosting, and comprehensive reforms of county public hospitals.
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Centering on hospital crisis communication management,the paper analyzed the relationship between hospital crises and new media environment.The new media form is studied as the basic dimension,to explore the new media′s timeliness,openness,interactivity and uncontrollability,as well as their impact on the hospital crisis management.It discussed the lack of hospital crisis communication management under the context of new media environment,and proposed how the hospitals make use of the new media,and adjust their strategies to respond to the crisis.These points prove both academic and practical for the construction of the new mechanism of China ’s hospital crisis communication management,and encourage the new media to play their social public functions.