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@#In patients with a functionally univentricular heart, the Fontan strategy achieves separation of the systemic and pulmonary circulation and reduction of ventricular volume overload. Contemporary modifications of surgical techniques have significantly improved survival rate. However, the resulting Fontan physiology is associated with high morbidity. Despite large improvements in outcomes of contemporary Fontan patients, a large burden of disease exists in this patient population. In face of the imbalance of medical resources in China and different understanding of Fontan treatment in various regions, there is no consensus on the current status of Fontan strategy, surgical technique and perioperative treatment. By reviewing large amounts of literature, assessing survival rate and risk factors for mortality and complications of the Fontan circulation, knowledge sharing from tens of experts, we achieved a consensus on many aspects of palliation of Fontan. We hope this consensus will help Chinese colleagues further continue their efforts to improve surgical outcomes of the univentricular heart patients.
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Background: Antimicrobials form the cornerstone of prescriptions for treating infection. Surgical management cannot be possible without the use of antibiotics. Severity of infection, suspected spectrum of organisms and their sensitivity, co-morbidities of the patient, route of antibiotic administration are the important parameter to consider before selecting antibiotic.Methods: Cross-sectional, hospital based, descriptive study was conducted in the ward of Surgery Department of IQ City Medical college, Durgapur over a period of 1 year. The relevant information was entered into the pretested preformats (containing name, age, sex, diagnosis, ongoing treatment as recorded from patients’ prescription slips or CRFs) and analyzed. Necessary permission was granted by the Institutional Ethical Committee and written informed consent was obtained from the patients prior to collecting their prescription slips/CRF.Results: Commonest cause of hospitalization was cholelithiasis (318 (32.7%)). Antimicrobials were the most commonly prescribed drugs (1626 (31.6%)). Single antibiotic prescribing frequency are similar to two antibiotic prescribing (both 44%). Piperacillin+Tazobactum combination most commonly prescribe antibiotic.Conclusions: Beta lactam antibiotic specifically Piperacillin (ATC class: J01D) were the most commonly prescribed antibiotic agents both before and after surgical procedures.
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Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.
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Background: Rural Bengal has one of the highest snakebite prevalence in India. This prospective observational study was initiated with the motive to analyse the effects and adherence to implementation of the new national snakebite protocol 2016.Methods: Data were collected from the patients admitted with snake bite on a pre-designed and pre tested case study form and analysed with the help of descriptive statistics.Results: A total of 75 patients arrived in the hospital during the study period out which 53 were male (most in the age group of 31-40 years) and majority of them were farmers (26.6%) or housewives (25%). Maximum of them were bitten in the lower limbs (54.6%) and peak time of bite was between 6 am-12 pm (40%). Most of them reached the hospital late, i.e., beyond 2 hours (70.6%). It was found that there were 26 neurotoxic, 16 hemotoxic and 1 neuro-hemotoxic cases and the rest were non-venomous cases. Fifty-one of them received ASV and 4 died. There was 80% adherence in the indication of ASV administration, 73.3% in the ASV dose, 32% in the monitoring after ASV administration, 94.66% in the monitoring 20 WBCT, 100% in adherence to haemodialysis as indicated.Conclusions: The results showed good adherence in all the parameters. Protocol guided treatment has also resulted in rational use of ASV. So, from this study, it was concluded that protocol guided treatment is effective in snakebite management, but its continuous revision and amendments should be considered in future.
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@#The study was conducted to evaluate compliance of antibiotics prescribing in three selected outpatients healthcare facilities in Papua New Guinea(PNG), to the country specific Standard Treatment Guidelines(STG)and to identify factors influencing prescribing pattern. The study was carried out in the Losuia Health Centre (LHC), Alotau Provincial Hospital and Port Moresby General Hospital (PMGH) outpatient departments. The study sample involved300participants at each setting. Oral amoxicillin products, chloramphenicol and co-trimoxazole made up approximately 70% of the antibiotics prescribed to 637/1090 of patients. Almost one-quarter (24.4%) of prescriptions for antibiotics were non-compliant selections. At the LHC approximately 20% of both dosage and duration errors occurred. Overall non-compliant prescribing for children was approximately 50% but significantly more compliant at PMGH (P= 0.0058) contrasting with the other settings. At the LHC only 30.6% of antibiotic prescriptions for children were compliant with STG requirements and fulfilled PNG regulatory requirements. With respect to the STGs, Community Health Workers (68.0%) and Nurse Officers made more non-compliant antibiotic selections. High levels of antibiotic prescribing combined with high levels of non-compliant antibiotic prescribing as compared to PNG-STGs, were identified in this study. This is a disturbing finding as it raises many questions related to quality assurance of health care interventions in PNG. The data also raises a clinical concern for the high level of oral chloramphenicol prescribed in out-patient settings.
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Dental caries is a major disease that threaten human's oral healthy severely with the characteristics of high incidence, low rate of treatment and high rate of retreatment. At present, restorative treatment remains the main method for caries treatment. With the development of the Minimally Invasive Cosmetic Dentistry (MICD), reasonable application of various treatment technologies, maximum preservation of tooth tissues and realizing the maximization of treatment effects become problems that call for immediate solution in dental clinics. In addition, there still exist a large number of old restorations that need standard retreatments. Here, some difficulty influence factors of dental caries clinical treatment such as systemic and oral factors, individual caries susceptibility, treatment technologies and materials, retreatment methods of old restorations and technique sensitivity are analyzed, and corresponding processing strategies are also put forward.
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Humans , Dental Caries , Dental Caries Susceptibility , RetreatmentABSTRACT
INTRODUCTION: There is limited data from India regarding elderly non‑Hodgkin’s lymphomas (NHL) patients. Hence, this audit was planned to study the clinic‑pathological features and treatment outcomes in elderly NHL patients. METHODS: Retrospective analysis of all NHL patients above age of 59 years treated at the author’s institute, between December 2010 and December 2013 was done. Case records were reviewed for baseline details, staging details, prognostic factors, treatment delivered, response, toxicity and efficacy. SPSS version 16 (IBM, Newyork) was used for analysis. Descriptive statistics was performed. Kaplan–Meir survival analysis was done for estimation of progression‑free survival (PFS) and overall survival (OS). Univariate analysis was done for identifying factors affecting PFS and OS. RESULTS: Out of 141 NHL patients, 67 patients were identified subjected to the inclusion criteria. The median age was 68 years (60–92). Majority were B‑cell NHL (86.6%). The commonest subtype in B‑cell was diffuse large B‑cell lymphoma (55.2%). Fifty‑four patients took treatment. The treatment intent was curative in 41 patients (61.2%). Among the patients receiving curative treatment, 16 patients couldn’t receive treatment in accordance with NCCN guidelines due to financial issues. Two years PFS was 55%. Two years PFS for B‑cell NHL and T‑cell NHL were 55% and 50% respectively (P = 0.982). Two years PFS for standard Rx and nonstandard Rx were 62% and 50% respectively, but it didn’t reach statistical significance (P = 0.537). Two years OS for the entire cohort was 84%. CONCLUSION: Standard treatment in accordance with guidelines can be delivered in elderly patients irrespective of age. There is a need for creating financial assistance for patients, so that potentially curative treatments are not denied.
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This paper describes 15 years’ experience of the development process of the first set of comprehensive standard treatment guidelines (STGs) for India and their adoption or adaptation by various state governments. The aim is to shorten the learning curve for those embarking on a similar exercise, given the key role of high-quality STGs that are accepted by the clinical community in furthering universal health coverage. The main overall obstacles to STG development are: (i) weak understanding of the concept; (ii) lack of time, enthusiasm and availability of local expertise; and (iii) managing consensus between specialists and generalists. Major concerns to prescribers are: encroachment on professional autonomy, loss of treating the patient as an individual and applying the same standards at all levels of health care. Processes to address these challenges are described. At the policy level, major threats to successful completion and focused implementation are: frequent changes in governance, shifts in priorities and discontinuity. In the authors’ experience, compared with each state developing their own STGs afresh, adaptation of pre-existing valid guidelines after an active adaptation process involving local clinical leaders is not only simpler and quicker but also establishes local ownership and facilitates acceptance of a quality document. Executive orders and in-service sensitization programmes to introduce STGs further enhance their adoption in clinical practice.
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Background: Assessment of antimicrobial use can be performed by evaluating their use. Drug use evaluation is a performance improvement method that focuses on evaluation and improvement of drug use processes to achieve optimal patient outcomes. The objective of this study was to evaluate the rational use of ceftriaxone in Medical ward of Dessie referral Hospital, Dessie-Ethiopia. Methods: Retrospective systematic study was used to assess rational use of ceftriaxone. The study was conducted by reviewing medication records of 316 patients, who received ceftriaxone during hospitalization at Medical ward of Dessie referral Hospital from December 30, 2011 to January, 2013. A systematic sampling method was used to select inpatient prescriptions in this ward with ceftriaxone and patient cards were located based on the medical record number on the prescription papers. Data was collected by using structured format and evaluated against WHO criteria for drug use evaluation as per standard treatment guideline of Ethiopia. Results: Most patients were dosed as 2 g/day (79.4%). The duration of therapy was found to be high in the range 2-7 days (51.69%). Ceftriaxone was mainly used as pneumonia treatment (38.8%). Maintenance fluids were the most commonly co-administered medications with a frequency of 62.16%. The use of ceftriaxone was appropriate only in 170 cases (55.8%) for the justification of use. Most of inappropriate uses were seen in terms of duration during treatment of pneumonia followed by frequency for the treatment of meningitis. Consistency of prescriber to the national standard treatment guideline was found to be low. Conclusions: To improve rational use and prevent the development of resistance; prescribers should adhere to the national standard treatment guideline. Intensification of short term trainings and antibiotic control systems are some of the possible solutions the hospital has to do.ceftriaxone therapy does not meet the current STG of Ethiopia.
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Objective To analyze the clinical value of chemotherapy combined with endocine therapy after standard treatment failure for advanced metastatic breast cancer.Methods 30 metastatic breast cancer patients after standard treatment failure were analyzed.Etoposide (75-100 mg/d) wasused on days 1-10,followed by 11 days of rest combined with medroxyprogesterone 0.5 g,twice per day,or megestrol 160 mg/d for 21 days.Clinical effects and life quility were analysed.Results The median treatment line of this therapy was 6 (range 3-9).The clinical benefit rate is 16.7 ％ (5/30),and the median progression free survival (PFS) was 4.0 months (range 1.0-13.0 months).Conclusion The combination of chemotherapy (etoposide) and endocrine therapy (progesterone) is a choice of treatment after standard drug failure for advanced mastatic breast cancer patients.
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Objective To assess the effect of the Asthma Healthy Breathing Center on healthy behaviour of asthma patients . Methods Asthma Healthy Breathing Center management mode including asthma specialist out-patient ,asthma health mission cen-ter and asthma patients club .Doctors ,nurses and patients participated jointly in standard treatment ,systematic education manage-ment on asthma patients .the change of treating patients and self management present situation ,the symptoms and lung ventilation function of 144 asthma patients from January 2010 to January 2011 before and after the management were studied .Results After standardization management treatment ,accept and use of inhaled steroid ,correct use of inhaled drugs method ,insisting on drug treatment ,abuse of antibiotics and composition of unknown traditional Chinese medicine(TCM)of 144 patients have been improved significantly from 41 .67% ,20 .14% ,26 .39% ,68 .75% to 93 .06% ,95 .14% ,94 .44% ,6 .25 respectively (P<0 .05) .Knowledge of asthma self-management ,adhere to the peak current meter monitoring used ,records of asthma diary ,health education activities have been improved significantly from 12 .50% ,5 .56% ,5 .56% ,13 .89% to 75 .00% ,88 .89% ,88 .89% ,95 .83% (P<0 .05) .ACT as-sessment ,FEV1 predicated value ,PEF predicated value have been improved from 15 .00 ± 3 .34 ,60 .2 ± 13 .50 ,63 .65 ± 11 .23 to 23 . 00 ± 2 .23 ,77 .6 ± 8 .30 ,80 .00 ± 6 .50(P<0 .05) .Conclusion Establishing Asthma Healthy Breathing Center can significantly im-prove the patient′s health behavior ,and it indicated that establish Prompt construction area slow disease control and prevention cen-ter is effective and necessary for the treatment of patients with asthma .
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Traditional Chinese medicine plays more and more important roles in treating malignant tumor.Great amount of clinical and basic researches manifested that Chinese medicine can stable tumor Jesion,prolong survival time,improve life quality and so on.As TCM entering an era from sporadic treatments to systemic and standard treatments for malignant tumor,evidence-based medicine leads the basis for it.
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OBJECTIVE:To provide reference for promoting the development of medical and health care in China.METHO-DS:The development process of national essential drug system was reviewed and analyzed and the experience of WHO was drawn on to design the future of national essential drug system in China.RESULTS & CONCLUSION:WHO proposed the concept of national essential drugs and recommended medical institutions to establish drug and therapeutics committee and to prepare "Standard Treatment Guidelines" and "National Formulary" for management of rational use of national essential drug.While essential drug system and basic medical security system have been worked out in China,their impacts of them are not satisfactory because of weak enforcement. "National Essential Drugs List ? The Part for Primary Health Care and Health Institutions" (2009 version) and National Formulary Indicate.The Part of Chemicals and Bidogical Products were published,and they are symbols of the re-beginning of national essential drug system.