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Objective:To evaluate the association between the use of emergency medical services (EMS) and the severity of disease among patients admitted to the emergency room, to analyze the characteristics of the patients, and to build prediction model providing evidence-based use of EMS resources.Methods:The data of patients admitted to the Emergency Room of the First Affiliated Hospital of University of Science and Technology of China from January 2020 to July 2021 were extracted from the Chinese Emergency Triage Assessment and Treatment (CETAT) database. Patients were divided into the EMS use group (AB+ group) and self-seeing group (AB-group) according to whether they used EMS. The patients’ general condition, vital signs and laboratory tests results were recorded. The severity of patients’ condition was judged based on whether the patient was admitted to the department of critical medicine, specialized care unit, emergency operation and/or emergency percutaneous intervention. A 9-variable model that did not require laboratory inspection and 22-variable model that required laboratory inspection were established to correct the propensity score to analyze the correlation between the severity of disease and the EMS use. In the subgroup analysis, the correlation between the EMS use and severity of the patients was analyzed according to the reason of the patient’s visit.Results:During the study period, 16 489 patients were admitted to the emergency room, and 6975 patients were finally enrolled in this study. There were 2768 patients (39.7%) in the AB+ group and 4207 patients (60.3%) in the AB-group. In the AB+ group 522 patients (18.9%) were in high risk, and in the AB-group 563 patients (13.4%) were in high risk. Compared with the AB-group, patients in the AB+ group were older and had a higher proportion of coma, a faster autonomic heart rate, and a lower diastolic blood pressure and peripheral oxygen saturation (SpO 2). In the 9-variable model, sex, consciousness, temperature, heart rate and diastolic blood pressure were associated with the EMS use. In the 22-variable model, consciousness, SpO 2, neutrophils, and albumin were the relevant factors for patients using EMS. Before the correction of propensity score, the EMS use was an independent risk factor for critically ill patients ( OR=1.5, 95% CI 1.32-1.72, P<0.001). After adjusted using 9-variable propensity score, the EMS use ratio decreased significantly compared with that without correction ( OR=1.24,95% CI 1.08-1.42, P<0.001). Interestingly, after adjusted with propensity score match with 22-variable model, there was no association between the severity of disease and t the EMS use ( OR=1.10,95% CI 0.95-1.28, P=0.195). In subgroup analysis, patients’ chief complaint of central nervous system, cardiovascular system, and trauma were the top three reasons at admission. Before the propensity score correction, the EMS calling patients with chief complaint of central nervous system, digestive system, and trauma were related to the severity of the patients. After adjusted with 9-variable model the EMS use was associated with the severity of the disease only in trauma patients, and after adjusted with 22-variable model there was no statistical difference considering the severity of the disease in all subgroups. Conclusions:The EMS use is common. However, the association of the EMS use with the severity of disease is decreased with variable models using propensity score. These findings indicate that the EMS use should be based on multivariable models, which may be important in detecting critically ill patients, optimizing the EMS use, and avoiding unnecessary call in the future.
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Objective] To sum up professor He Ruoping’s clinical experience and academic views in the treatment of bone marrow suppression after chemotherapy in patients with malignant tumor. [Method] Through the way of clinical practice with teacher, arranging medical records and clinical observation, systematically arranging He Ruoping’s clinical experience and academic perspective in the aspects of etiology and pathogenesis, treatment ideas and drug characteristics. And further explain the characteristics of the treatment of He through case analysis.[Result] He Ruoping believes that the treatment of bone marrow suppression after chemotherapy related closely with spleen and kidney, and is also related with interweaving of toxicity, deficiency and blood stasis. The treatment should be based on kidney, spleen, centralizer, make Qi and blood sufficient. Besides, supplemented by the Quxie treatment, make Qi and blood flow.[Conclusion] Using Yishen Jianpi Fuzheng, supplemented by eliminating method in treating post chemotherapy bone marrow suppression, has significant clinical effect, has the value of popularization and application.
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Objective To analyze the spectrum of anus disease during the medical selection of flying cadets and com-pare the medical standard between US Air Force and Chinese Air Force in order to improve the system of medical selection. Methods The data on flying cadets of Chinese Air Force medical selection from 2012 to 2015 were retrospectively analyzed and these data were re-analyzed by medical standards for US Air Force flying cadets.Results Ninety students were elimi-nated because of anal disease,including 65 hemorrhoids,14 fistula and 11 fissure.The rate of disqualification from 2012 to 2015 was 48.28%, 33.33%, 31.37%, 39.69%and there was no significant statistical difference between each two years (x2 =2.6154,P=0.4548).There was statistically significant difference(P=0<0.05)in hemorrhoids standards between CAF and USAF,and significant difference in fistula and fissure standards.Conclusion Compared with Chinese medical se-lection standards,the US Air Force standards focus on whether the symptoms of disease have effect on air safety and effi-ciency.To improve our medical selection standards,we need to learn from foreign air forces and take our own conditions into account.
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Objective To compare the standards for recruitment of cadet pilots between PLA Air Force and the US Air Force,so as to offer reference for revising PLAAF medical standards for recruiting cadet pilots.Methods Literature from medical bibliographic databases and foreign military official websites was retrieved, four published reports and network information were cited and PLAAF medical standards were compared with those in China.Results The American medical standards include Department of Defense Instruction, Air Force Medical Examination and Standards, Air Force Medical Standards Directory, and Air Force Waiver Guide,which are independent and aimed directly at different examinations so that medical requirements have been gradually broadened.Compared to our standards, the American medical selection is more dependent on clinic consultations, and more detailed in specifications of diseases, more focused on body functions than on body shape, and the psychological screening is more subtle.Conclusion The standards adopted by US Air Force are more evidence-based.We are to rectify our medical standards accordingly, which should be efficacious, safe and effective for improving the overall quality of our military pilots.
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Objective To analyze the change in qualification rate of comprehensive assessment , and to provide an effective theoretical basis for future selection and recruitment of military flying cadets .Methods Group A consisted of 400 cadets who were randomly chosen from the final selection with the physical examination conclusions of disqualifiedandqualified by comprehensive assessmentin a certain year via the cross-sectional investigation method , and group B was composed of 400 cadets who were chosen from the following year with the same method as group A .A questionnaire con-cerning demographic features was conducted among all cadets .A database was established with Epidata 3.02 software, and SPSS 16.0 software was used to analyze diseases which were qualified by comprehensive assessment.Results The qualification rate of comprehensive assessment in group A was higher than group B (45.00%vs 34.75%, P<0.01),there were differences between the two groups in overweight ( underweight ) ,deflection of nasal septum , gallbladder polyp , spinal malformation and undertall(P<0.05 or P<0.01).Conclusion The expert consensus which is made by the air force ex-perts through their work experience and the foreign air force standards has a positive application effect in the practical work . It is an efficient supplement to the physical examination standards and has an important effect on military aviator selection .
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Objective To evaluate the medical indexes for student pilots from different areas , to discover the major different indexes between different areas ,and to establish the space distribution model of military pilots .Methods A cross-section survey was conducted among student pilots , and 290 student pilots sampled as respondents were interviewed with questionnaires and subjected to a physical examination , involving distant vision , heart function , and pulmonary function , before a database was established , cleaned and analyzed by EpiData 3.02, SAS 9.13 with double checking .Results There was no difference between the medical indexes of student pilots from 7 areas, but the psychological selection performance record and the entrance examination record were different .Student pilots from area E had the highest psychological selection performance record while those from area D had the highest entrance examination record .Conclusion Student pilots have area difference ,so we should pay close attention to their birth place during recruitment of student pilots .
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The fact that incision inflammation ratio is related to the time of preoperative skin preparation was explored.227 cases made skin preparation a day or two hours before surgical operation were analysed prospectively in this study.There is statistical significant difference between the two periods of preoperative skin preparation:the second (two hours before surgical operation) can greatly lower the ratio of incision inflammation.