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According to the Ethical Review Measures for Life Sciences and Medical Research Involving Humans jointly issued by the National Health Commission, the Ministry of Education, the Ministry of Science and Technology and the State Administration of Traditional Chinese Medicine in 2023, to optimize the ethical review process and reduce the burden on clinical researchers, it is proposed that some eligible situations can be "exempted from ethical review". This is a breakthrough progress in China’s ethical review management measures that firstly aimed at "exemption from ethical review". This paper reviewed and sorted out the relevant situations about exemption from review at home and abroad, focused on analyzing and exploring the four situations of exemption from review, especially discussed and analyzed the understanding of anonymization and personal sensitive information in exemption from review, and proposed practical suggestions for the four situations. Based on the actual situation of ethical review work, this paper also explored the establishment of practical standards and processes for exemption from review, providing reference for other medical institutions to implement the exemption from ethical review process.
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Objective:To evaluate direct bilirubin /total bilirubin(D/T), B-mode ultrasound(BUS), multislice spiral computed tomography (MSCT), magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) in the diagnosis of choledocholithiasis abdominal pain (CAP).Methods:We retrospectively analyzed the materials of patients who were diagnosed with choledocholithiasis abdominal pain by above imagines in the emergency department of Beijing Friendship Hospital during March 2016 to December 2018. The stones were taken out by endoscopic retrograde cholangiopancreatography or surgical operation as the golden standard.Results:Among 256 patients, 195 cases, 138 cases, 107 cases and 26 cases were diagnosed by EUS, MRCP, CT and BUS, respectively. The sensitivity were 0.86, 0.62, 0.45, 0.13, respectively. The specificity were 0.86, 0.81, 0.75, 0.87. The positive predictive value were 0.97, 0.96, 0.91, 0.83.The negative predictive value were 0.55, 0.19, 0.21, 0.16. The accuracy rate were 0.88, 0.64, 0.48, 0.30, respectively. The sensitivity of D/T and D/T combined with EUS in the diagnosis of CAP were 0.57 and 0.67, and the accuracy were 0.16 and 0.56, respectively.Conclusions:EUS has a high diagnostic value for CAP. MRCP is superior to CT in the value of diagnosis of CAP. BUS in imaging diagnosis of CAP value is relatively low, but D/T combined with BUS can improve the sensitivity and accuracy of diagnosis for CAP.
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The emergency department is not only the place of treating emergency and critically ill patients, but also the frontline of identification and treatment of infectious disease. To ensure the treatment of the acute and critical diseases and the safety of the hospital, the emergency department should be included in the prevention and control system of infectious diseases. Therefore, we should attach great importance to the role of emergency department in the prevention and control system of infectious diseases, by establishing standardized protocols of ward layout, treatment procedure, management and training. We suggest that it is essential to strengthen the integrated management with the infectious diseases department, and jointly build a new emergency medical service system to deal with infectious diseases.
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Objective:To explore the achievements of clinical teaching and scientific research acquired by visiting scholars funded by medical foundation, which will be benefit for the improvement for cultivation of innovative talents in general hospitals.Methods:Questionnaire data of 132 visiting scholars supported by Beijing Li Huanying Medical Foundation from 2010 to 2016 were analyzed and applied by descriptive statistics.Results:Study abroad has played a positive role in promoting clinical skills, teaching level, and scientific research capacity building. Visitors have significantly improved their teaching titles, mentor positions, paper publishing and approved funding projects, in which there was a year-on-year growth trend high level projects funded.Conclusions:Study abroad is conducive to stimulating the enthusiasm and creativity of medical talents, and also an effective way to enhance the overall strength of the hospital. The foundation exerts the overall planning and leadership role of talent construction, and provides full-chain service and management for overseas study personnel, which is the key to maximize the teaching and research output of medical personnel.
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Objective To explore the relationship between those myocardial markers serum cardiac troponin T (cTNT),serum cardiac troponin I (cTNI),N-terminal pro-brain natriuretic peptide (NT-proBNP),echocardiography and myocardial injury in the oldest-old septic patients,as well as to evaluate prognosis in the oldest-old septic patients.Methods 140 oldest-old septic patients hospitalized in Beijing Friendship Hospital from January 1 st,2015 to Jun 31st,2017 were collected and analyzed retrospectively.They were divided into survival group (90 cases) death group (50 cases)according to their survival time.Serum cTNT,cTNI and NT-proBNP level at 1,3 and 7d post-diagnosis were collected and echocardiography left ventricular diastolic diameter (EDD),left ventricular systolic diameter (ESD),right ventricular diameter (RV),left ventricular ejection fraction (EF) was performed.Results 140 oldest-old septic patients were enrolled in the analysis.There were 90 cases in survival group and 50 cases in death group.Mean values of cTNT,cTNI,NT-proBNP,EDD,ESD in survival group were obviously higher than those in death group (P ＜ 0.05),left ventricular ejection fraction (LVEF) in survival group was lower than that in death group (P ＜ 0.01).But there were no difference in E/A and RV between survival group and death group (P ＞ 0.05).There were positive correlation between cTNT,cTNI,NT-proBNP and EDD,ESD (P ＜ 0.05),negative correlation between cTNT,cTNI,NT-proBNP and LVEF (P ＜ 0.05),and no correlation between cTNT,cTNI,NT-proBNP and E/A,RV (P ＞0.05).There were obviously correlation between cTNT,cTNI,NT-proBNP,EDD,ESD and mortality rate (OR ＞ 1,P ＜ 0.05).It was shown the prognosis value of cTNT,cTNI,NT-proBNP,EDD,ESD to mortality rate in oldest-old septic patient.The prognosis value was cTNT ＞ NT-proBNP ＞ cTNI ＞ EDD ＞ ESD.Conclusions There were obviously correlation between cT NT,cTNI,NT-proBNP,EDD,ESD and myocardium restrain,heart dysfunction as well as mortality rate.cTNT was the best prognosis indicator in sensitivity,and NT-proBNP was the best prognosis indicator in specificity.The combination of cTNT and NT-proBNP can better forecast the prognosis of the oldest-old septic patient.
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Objective To observe the occurrence of myocardial apoptosis and discussing the mechanism of the effects of glucocorticoid on myocardial apoptosis in septic rats in order to provide the rationale for clinical strategy.Methods A total of 60 Wistar rats weighing 230-280 g were randomly (random number) divided into control group and experimental group (n =30 in each group).Cecal ligation and puncture (CLP) was performed in rats to induce sepsis,and Cefoperazone Sodium/Sulbactam Sodium (200 mg/kg) was injected into caudal vein 4 hours after CLP,twice a day.In addition,glucocorticoid was given to rats of experimental group.After rats sacrificed,their left ventricular myocardia were rapidly taken out and myocardial apoptosis rate was measured and the level of Bcl-2 was assayed at 6 h,24 h,and 72 h after CLP.Measured data were analyzed with independent-samples t-test and One-Way ANOVA.Results The rates of myocardial apoptosis in experimental group were obviously lower than those in control groups respectively (F=9.11,t=5.681,P＜0.01) (6ht=11.416,P＜0.01; 24ht=6.217,P＜0.01; 72 h t =3.76,P ＜0.01).The rates of myocardial apoptosis in 24 h in control and 72 h control groups were distinctively higher than those in 6 h control group,respectively (F =13.254,sig =0.000,P ＜0.01 ; sig =0.004,P ＜ 0.01).The rates ofmyocardial apoptosis in group 24 h control were higher than those in 72 h control group (sig =0.039,P ＜ 0.05).The rates of myocardial apoptosis make no difference among experimental group (F =2.488,6/24 h sig =0.132,P ＞ 0.05 ; 24/72 h sig =0.549,P ＞ 0.05 ; 6/72 h sig =0.053,P ＞ 0.05).Conclusions The rate of myocardial apoptosis is peaked at 24 h in sepsis rat,and the rate of myocardial apoptosis can be obviously decreased by administration of glucocorticoid.
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Objective To explore the role of BNP (B-type natriuretic peptide) in the early assessment of patients with acute pulmonary embolism (PE).MethodsEighty-six patients hospitalized in Beijing Friendship Hospital from November 2005 to June 2010 diagnosed as acute PE were studied retrospectively.The differences of BNP and other indicators and the relationship of BNP and right ventricular and right atrial pressure gradient value ( RV-RA PG) were compared between two groups divided by whether right ventricular dysfunction exists or not.imilarly,the differences of BNP and other indictors were compared between the two groups divided by complications exists or not.ResultsIn the right ventricular dysfunction group and control group,BNP was ( 1356.8 ±675.4) pg/ml and ( 103.8 ±51.4) pg/ml,respectively,and the differences are significant.BNP and RV-RA PG had a significant correlation (γ =0.824,P ＜0.01 ) by Linear correlation analysis.BNP had a reliable diagnostic power for right ventricular dysfunction ( AUC 0.907).In the group with complications and none -complication group,BNP value was ( 1356.8 ±675.4)pg/mlvs.(103.8 ±51.4) pg/ml,and pH value was (7.372 ±3.7) vs.(7.446 ±3.5),and the differences were all significant ( P ＜ 0.05 ). Conclusions BNP has important significance in early predicting the occurring,severity and prognosis of congestive heart failure caused by acute pulmonary embolism; pH of the early arterial blood gas has positive significance for early diagnose and treatment and predicting the severity and prognosis of patients suffering acute pulmonary embolism.
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Objective To investigate the degree of cardiac function impairment, and clinical implications of BNP,TnT and TnI in patients with severe sepsis and septic shock retrospectively by comparing the differences in levels of BNP,TnT and TnI among those patients.Methods From December 2005 through December 2010,98 patients admitted with severe sepsis ( n =57 ) or septic shock ( n =41 )were enrolled to be studied.The inclusion criteria were ( 1 ) echocardiography was performed; (2) levels of serum BNP,TnT and TnI were determined on the 1st day,3rd day and 7th days after admission.These 98 patients were divided into 2 major groups:severe sepsis group (S) and septic shock group (SS) ; and each major group was further divided into 4 subgroups,including severe sepsis normal cardiac function (Sn) ;severe sepsis abnormal cardiac function (Sa); severe sepsis death (Sd),severe sepsis survival (Ss);septic shock normal cardiac function ( SSn ),septic shock abnormal cardiac function ( Ssa ),septic shock death (SSd) and septic shock survival (SSs).Then comparisonsof the plasma levels of BNP,TnT and TnI were carried out among groups respectively.The morality difference between groups S vs SS,and Savs Sn,and Ssa vs SSn were compared by using the Chi-square Test.The differences in BNP,TnT and Tnl between groups were compared by SNK-q test.Correlation between ejection fraction (EF) value and those biomarkers was calculated by Pearson correlation coefficient.The relationship between those biomarkers and outcomes was determined by using receiver operating characteristic curve (ROC). Results ( 1 ) There were no significant differences in levels of BNP and TnI between group S and SS,but TnT level in patients of SS group was significantly higher than that in S group ( P =0.001 ).( 2 ) TnT,BNP,Tnl levels in Sa group were significantly higher than those in group Sn; and BNP level in group SSd was significantly higher than that in SSs group (P =0.001 ).(3) BNP,TnT and TnI levels in group Ssa were significantly higher than those in group SSn,and BNP level in SSd group was significantly higher than that in SSs ( Pday 1 =0.001,Pday3 =0.001,Pday7 =0.016). (4) TnT and TnI levels in group SSn were significantly higher than those in group Sn,and BNP levels in SSn group on the 1st day,3rd day and 7th days were significantly higher than those in Sn group (Pday1 =0.006,Pday3 =0.006,Pday7 =0.001).(5) Higher mortality rates in group S and group SS were associated with higher BNP level.(6) Group Sa and Ssa had higher mortality rate than group Sn and SSn ( Sa vs.Sn,P ＜ 0.05,Ssa vs.SSn,P ＜ 0.05).(7) EF and serum BNP level in group Sd and group SSd at admission had negative correlation ( r =- 0.603,P ＜ 0.01 ),and BNP level higher than 0.39 ng/ml within the first 72 hours after admission may be an independent prognostic factor of mortality ( sensitivity 92.9％,specificity 80.8％ ).Conclusions Plasma BNP,TnT,TnI levels have a positive correlation with cardiac function impairment. Significant elevation in BNP,TnT,and TnI levels indicates sever cardiac dysfunction and thus a worsening prognosis is expected.Serum BNP could be a useful diagnostic indicator for the septic patients with cardiac dysfunction.
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Objective To identify shortcomings in the current evaluation index system of medical quality. Methods The documentary analysis focused on the existing index system comprises the Hospital Management and Quality Evaluation Standards (2007) by China Hospital Association, Hospital Management Evaluation Guidelines (2005) by the Ministry of Health, and Implementation Rules of Hospital Management Evaluation Standards for Beijing (2007). JCI Accreditation Standards for Hospitals (edition 2) (2003), and New Hospital Accreditation Standards for Taiwan (2005, 2006) were referred to in the study. Results The shortcomings found include the weak operability of indexes, and the deficiency of evaluation indexes from the point of hospital visiting process by patients. Conclusion In view of the hospital visiting process of patients, add more indexes for patients' hospital visiting process,and quantize and highlight the operability of indexes, with summary and optimization of experiences in time by steps.
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To explore how to create and optimize a promotion index system of medical quality evaluation, this article focuses on the hospital visiting process from patients, using analyzing collected those index system from couples of Grade Ⅲ hospitals in Beijing, and combining the results of literal study, field study and specialist consult, according to the different situation of general hospitals and specially hospitals, with the spirit of "maintaining the patients benefits, safeguarding the patients safety,and enhancing the medical quality", introduces the framework of the promotion index system, the rules to select the indicator, and so on, and discusses several problerns related to creating the index system.
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The paper described the framework for the hospital to compile its "12th Five-year Plan", including the introduction, status quo analysis, planned objectives, and implementation strategy.The introduction in which needs to pinpoint the strategic objectives of the hospital in five years; the status quo analysis to cover the strengths, weakness, and threats and opportunities faced by the hospital in terms of both internal and external conditions; the planned objectives need to clarify the vision,mission, general goals and targets; and the specific strategies in the end. A scientific and feasible development plan can only be compiled based on conditions of the hospital, scientific rules and framework.
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Based on an analysis of the current condition of emergency department facilities in domestic urban hospitals and lessons drawn during the SARS outbreak,the paper argues that due attention ought to be paid to the spread of infectious diseases resulting from the inherent drawbacks in the construction of emergency departments.It presents constructive suggestions on ways in which construction of and medical procedures in emergency departments could meet the requirements for infectious disease prevention and treatment.
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In the past 20 years, emergency medicine in China has witnessed rapid development and emergency care has contributed considerably to safeguarding people's life and health. The emergency departments in most hospitals have completed the transition from being dependent to being supportive and some hospitals have set up autonomous emergency departments. The functions and business scope of emergency care have gradually been clarified. However, some problems remain to be solved in such aspects of emergency care as training, management, scientific research, and professional promotion.
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A disastrous tsunami hit the littoral countries of the Indian Ocean towards the end of 2004. Upon instructions from higher authorities, our hospital dispatched an able and efficient relief team to Sri Lanka. During the 17 days of relief efforts, the team treated and cured close to 3 000 victims, winning high praise from the government of the disaster-hit country, We have learned from organizing the relief work that effective organization and coordination is the key to smooth preparation, powerful ideological work is the guarantee of fulfilling the task, careful training and technical support is the basis of ensuring the success of the task, sufficient material preparation is the essential condition for completing the task, and unimpeded communication is beneficial to understanding the situation and seeking countermeasures in a limely manner.