Assessment of demand for rehabilitation services and analysis of causes of the gap between supply and demand in China / 中国康复理论与实践

ObjectiveTo evaluate the overall demand for rehabilitation services from the perspective of the groups with disabilities, diseases, injuries and older adults, and explore the causes of the supply and demand gap of rehabilitation services. MethodsThe literatures in the field of rehabilitation were collected, summarized and analyzed, including policy documents issued by World Health Organization and relevant departments in China, surveys, and researches. ResultsThe demand for rehabilitation services caused by disabilities, chronic diseases, injuries and population ageing were vast in China, but many were still unmet. The main reasons leading to the gap included those population trend and health situation, the insufficient reserve of rehabilitation resources coming from incomplete development of rehabilitation service system early, and inadequate construction of disability reporting system, which could not efficiently meet rehabilitation demand with supply. ConclusionThe strategies to optimize the rehabilitation services system and promote the quality of the services based on the disability reporting system are warranted.

Study on the application of oral magnesium sulfate solution in split doses as bowel preparation for colonoscopy in elderly patients / 中华内科杂志

Objective To evaluate the efficacy and safety of oral magnesium sulfate solution in split doses as bowel preparation in elderly patients undergoing colonoscopy.Methods A total of 368 elderly patients undergoing colonoscopy were enrolled at PLA General Hospital.The patients were randomly divided into magnesium sulfate solution orally in split doses group (group A,n=178) and single dose group (group B,n=190).Parameters including general information,defecation frequency,Boston bowel preparation score (BBPS),detection rate of lesions and adverse reactions.Results The frequency of defecations in group A was (7.6± 1.4),more than that in group B (6.6± 1.5) with statistical significance (P＜0.05).The duration of bowel preparation in group A was (128.6±25.3) min,shorter than that of group B (165.4±29.7) min (P＜0.05).The BBPS in group A was (8.09±0.67),better than that of group B (7.34±0.58) (P＜0.05).The detection rates of intestinal polyps and micropolyps (diameter＜0.5 cm) in group A were 73/178 (41.0％) and 51/178 (28.7％) respectively,compared with 58/190 (30.5％) and 37/190 (19.5％) in group B (both P＜0.05).In group A,8 patients reported adverse reactions as abdominal distension and discomfort.One patient had ST-T abnormality of electrocardiogram (ECG).No nausea or vomiting occurred,yet 2 cases needed enema for inadequate bowel preparation.Twenty-one cases in group B reported adverse events including 7 with nausea and vomiting.There were 13 patients treated with enema.Abnormal ECG was found in 4 patients in group B.The satisfaction rate of group A was 97.8％,higher than that of group B (91.6％) (P＜0.05).Conclusions The effect of bowel preparation of elderly patients with magnesium sulfate solution in split dose has a better tolerance,good cleaning effect and low incidence of adverse reactions.It is an ideal choice for the elderly to prepare colonoscopy.

Effect of the public hospital trusteeship based on the employee satisfaction / 中国卫生政策研究

Objective: To investigate the hospital employee satisfaction and trustworthiness in the background of the trusteeship mode and to find out the problems after trusteeship.Methods: Minnesota satisfaction questionnaire (MSQ) and the self-made questionnaire were used to conduct the survey.Results: The overall employee satisfaction (3.80±0.86) and trustworthiness (3.95±0.77)were higher.The highest level of trustworthiness concerned the cultural connotation (84.8%) followed by the management concept (82.8%) for overall satisfaction.The lowest level of employee satisfaction concerned income and workload (53.7%), followed by the working conditions and environment (55.3%).The administrative staff satisfaction was higher compared to that of medical staff (p=0.001), which showed significant statistical differences.Conclusions: The hospital has made some achievements after the trusteeship system reform, however, it still needs improvement and further strengthening in many aspects.The hospital must always keep abreast of the demands of workforce and improve the staff satisfaction so as to promote its continuous and sustainable development.

An analysis for the clinical difference between post infectious irritable bowel syndrome and non post infectious irritable bowel syndrome / 中华内科杂志

Objective To study the clinical discrepancy between patients with post infectious irritable bowel syndrome(PI-IBS) and non post infectious irritable bowel syndrome(NPI-IBS),and assess the value of serum intestinal fatty acid binding protein (I-FABP) for differential diagnosis.Methods A total of 117 patients with PI-IBS,201 patients with NPI-IBS and 31 healthy controls were prospectively recruited in General Liberation Army Hospital from 2010 to 2013.Plasma samples and clinical data were collected.Serum I-FABP level was measured by an enzyme-linked immunosorbent assay.Results The median age of patients with PI-IBS was 36 years.The median time to diagnosis in PI-IBS group was significantly longer than that in NPI-IBS group [(19.7 ± 10.3) months vs (11.4 ± 5.3) months,P ＜ 0.05].Similarly,the proportion of anxiety [58.1％ (68/117) vs 28.9％ (58/201),P ＜ 0.05] and the value of I-FABP[(42.6 ± 14.8) μg/L vs (17.3 ± 11.5) μg/L,P ＜ 0.05] in PI-IBS group were significant higher than NPI-IBS patients.The level of I-FABP of healthy controls [(10.6 ± 8.2) μg/L] was also significantly lower than that of PI-IBS patients (P ＜ 0.05),yet no difference from that of NPI-IBS group.The I-FABP value of subgroup PI-IBS patients with diarrhoea (IBS-D) was significant higher than that of NPI-IBS group [(54.8 ± 9.3) μg/L vs (12.3 ± 6.2) μg/L,P ＜ 0.05].However,other parameters including gender,age,GSRS score,and I-FABP value of subgroup constipation (IBS-C) and mix (IBS-M),were not different between PI-IBS group and NPI-IBS group (all P ＞ 0.05).Conclusion PI-IBS is an occult intestinal inflammation disease with mucosa injury.I-FABP might be a potential testing marker for the diagnosis of PI-IBS.

The value of serum intestinal fatty acid binding protein measurement in discriminating intestinal ischemia in patients with acute abdomen / 中华内科杂志

ObjectiveTo assess the differential diagnostic value of serum intestinal fatty acid binding protein (I-FABP)in distinguishing intestinal ischemia patients from acute abdomen patients.MethodsA total of 151 patients with acute abdomen and 17 healthy controls from the PLA General Hospital were enrolled from November,2009 to August,2011. Serum I-FABP levels were measured by ELISA.According to the ROC curve,the cut-off value,sensitivity,specificity,positive likelihood ratio (PLR),negative likelihood ratio ( NLR),positive predietive value (PPV) and negative predictive value (NPV) were calculated. ResultsOf the 151 acute abdomen patients,there were 24 intestinal ischemia patients and 127 without intestinal ischemia.Serum I-FABP level in intestinal ischemia group [( 109.67 ±48.82) μg/L]was significantly higher than those in patients without intestinal ischemia [(36.78 ± 11.25) μg/L]and healthy controls[(8.33 ±6.25) μg/L]( all P values ＜0.01 ).The serum I-FABP cut-off value for the diagnosis of intestinal ischemia was 87.52 μg/L.Serum I-FABP was efficient in terms of sensitivity (0.762),NPV(0.963),PLR(3.05) and NLR (0.24) in the diagnosis of intestinal ischemia.ConclusionI-FABP is potentially useful for discriminating intestinal ischemia from acute abdomen.

Analysis of Recurrent Pattern of Colorectal Cancer after Radical Treatment / 中国肿瘤临床

Objective: To study the influence of clinicopathologic factors on the recurrent pattern of colorectal cancer after radical treatment. Methods: There were 464 consecutive patients with colorectal cancer treated with radical surgery between January 1998 and December 2002 in our hospital. The clinicopathologic features of 90 patients with relapse of colorectal cancer after radical surgery were analyzed. According to the interval between radical surgery and recurrence, these 90 patients were divided into subgroups, the early recurrent group (within 30 months after surgery) and the late recurrent group (more than 30 months after surgery). Chi-square test was used for univariate analysis, and the Logistic regression model was performed for multivariate analysis. Result: There were 78 (86%) patients in the early recurrent group and 12 (14%) patients in the late recurrent group. The median time of recurrence was 17.4 months. The median recurrent time in stage I patients was 35.1 months, 13.6 months in stage II patients, and 12.9 months in stage III patients, respectively. Univariate analysis showed that the depth of penetration, the number of positive lymph nodes, and the gross appearance of tumor were predictors for early recurrence. Multivariate analysis revealed that the depth of penetration (T category) of the primary tumor significantly predicted for early recurrence (P= 0.049). Conclusion: A great proportion of recurrence in patients with colorectal cancer occurred within 30 months after radical treatment, but the late recurrence which occurs at more than 30 months after radical surgery should not be neglected. Patients with different patterns of recurrence had different intervals between radical surgery and recurrence. DM (distant metastasis) occurs earlier than LR (local recurrence). The depth of penetration of the primary tumor is an independent predictor for early recurrence of colorectal cancer patients after radical surgery.

Analysis of influence factors for the prognosis of 272 patients with rectal cancer / 解放军医学杂志

Objective To analyze the clinicopathologic characteristics and evaluate the influence factors for the prognosis of rectum carcinoma patients who had undergone surgical resection. Methods A retrospective analysis of data of 272 patients with rectum carcinoma in TNM stage Ⅰ, Ⅱ, Ⅲ was made, all these patients underwent R0 surgical resection from 1998 to 2002 in the General Hospital of PLA. The survival rate was analyzed by Kaplan-Meier method. The clinical characteristics and pathologic features were compared with the aid of monofactorial and multifactorial Cox regression analyses. Results The median survival time was 58.5 months, and the 1-, 3- and 5-year survival rates of rectum carcinoma after surgical resection were 79%, 70% and 62%, respectively. With monofactorial analysis, preoperative CEA level, diameter of tumors, differentiation degree of tumor, depth of tumor invasion, the number of metastatic lymph nodes and TNM staging were found to be significant factors influencing the prognosis. Adjuvant chemotherapy after surgery had influence over the survival rates of stage Ⅱ and Ⅲ rectal carcinoma. Age, gender, histological type and infiltration of canalis haemalis were uncorrelated with prognosis. Preoperative CEA level, depth of tumor infiltration and the number of metastatic lymph nodes were proved independently to be the risk factors influencing prognosis by multifactorial analysis. Conclusions The tumor site was not the prognostic factor of rectal carcinoma after R0 surgical resection. Preoperative CEA level, infiltration and the number of metastatic lymph nodes were independent prognostic factors in predicting the postoperative outcome. Careful preoperative assessment, early radical surgery and adjuvant chemotherapy after operation can improve the survival rate in rectum carcinoma patients.