Email Alert RSS

2022 Vol. 13, No. 1

column
  Previous Issue | Next Issue 
Display Method:
Editorial
Insist on Reform and Innovation, To Achieve the New Development of Eight-year Medical Education
LIN Huiqing, XIE A'na
2022, 13(1): 1-4. doi: 10.12290/xhyxzz.2022-0011
HTML (112) PDF(153)
Abstract:
Since 2001, in order to speed up the cultivation of top-notch and innovative medical talents, China has established an eight-year medical educational program in some universities, which has achieved remarkable results after years of exploration. Based on the summary of the existing achievements, taking the reformed practice of Peking Union Medical College as an example, this paper systematically expounds how to reform and innovate more vigorously and promote the accelerated development of eight-year medical education in China in the new development stage. It stresses that we should make greater progress in the accuracy of training, the advanced nature of the training mode and the integrity of training system, in order to form a high-level eight-year medical educational system with Chinese characteristics, and play a greater role in the cultivation of top-notch and innovative medical talents.
Specialist Forum
Exploration and Practice of the Training System of Comprehensive Medical Talents at Peking Union Medical College Hospital
ZHANG Shuyang
2022, 13(1): 5-8. doi: 10.12290/xhyxzz.2021-0535
HTML (111) PDF(225)
Abstract:
With the significant improvement of China's social and economic level, people's demand for high quality medical services is growing rapidly. There is an urgent need for more clinicians with solid foundations, excellent technology, and highly comprehensive quality. Peking Union Medical College Hospital (PUMCH) has continuously inherited and innovated the training model of outstanding medical talents. Based on previous experience, literature, and results of pilot research, PUMCH has explored and implemented the "Clinical Postdoctoral Program" since 2016, which is one of the innovations in postgraduate medical education in China, aiming at highly efficiently and continuously strengthening the students' ability of clinical practice, scientific research and teaching. This program cultivates high-level medical elite by optimizing the course system, innovating training mode, regrouping the faculty team, building effective evaluating and examining system, which provides a new train of thought and experience, and plays a significant role in the reserve forces of the development of national medical talents for the strategic goal of "Healthy China".
Iterative Innovation Empowers the Training of High-level Interdisciplinary Medical Talents in the New Era: Experiences from School of Medicine, Zhejiang University
FANG Xiangming, HAN Wei, XU Shiqi, RUAN Hengchao, CHEN Lei, DU Yue, XU Lingxiao, YU Fang, XIA Biaoquan
2022, 13(1): 9-12. doi: 10.12290/xhyxzz.2021-0718
HTML (237) PDF(77)
Abstract:
COVID-19 highlights the lack of interdisciplinary medical talents. The international history of medical education shows the urgent need of high-level interdisciplinary medical talents. Anchoring the goal to develop a global center of talents and highland of innovation, this article takes medical education of Zhejiang University as an example, focusing on and exploring the training mode of high-level interdisciplinary medical talents in the new era. It includes: firstly, optimizing the training mode of eight-year program for medical doctors with non-medical bachelor degree followed with complete education for a medical doctorate that innovates the curriculum system of clinical medicine; secondly, creating the training system of postdoctor of clinical medicine and integrating medical resources that include high-quality talents and health care system, in order to build a high-quality teaching staff with a interdisciplinarity background and innovative bases. It not only strengthens the residents' competency and frontier creativity, but also ensures the sustainable development of interdisciplinary medical talents. The reform of training mode, curriculum system, teaching staff and clinical teaching bases all contribute to the goal of building a country with interdisciplinary talents that serve the frontier of science and technology in the world, the major needs of the country and people's health in the new era.
Exploration and Practice of the Mode of Training Top-notch and Innovative Medical Talents in the First Affiliated Hospital of Sun Yat-sen University
LI Huiyan, XIAO Lihua, KUANG Ming
2022, 13(1): 13-16. doi: 10.12290/xhyxzz.2021-0724
HTML (176) PDF(106)
Abstract:
The emerging challenges of global health constantly puts forward new requirements for cultivating medical talents. From the perspective of great health, the First Affiliated Hospital of Sun Yat-sen University aims at cultivating top-notch and innovative medical talents for the future. Since 2018, the hospital has been inheriting and innovating the model of training medical elites and has explored and implemented the clinical postdoctoral program. This program relies on the platform of progressive medical training of the relatively mature "college system" initiated by our hospital. By regrouping the high-quality interdisciplinary faculty team, the platform optimizes the "outcome-based" advanced training system and builds effective evaluation and the assessment system, to comprehensively strengthen clinical postdoctoral trainees' abilities of clinical and scientific research and teaching. The program provides reference for the cultivation of high-level medical elites.
Guideline and Consensus
Consensus on Core Competency Framework for Residency Education Among China Consortium of Elite Teaching Hospitals for Residency Education
China Consortium of Elite Teaching Hospitals for Residency Education
2022, 13(1): 17-23. doi: 10.12290/xhyxzz.2021-0755
HTML (1317) PDF(531)
Abstract:
With the continuous worldwide development of the 3rd generation of reformation in medical education, China is in urgent need to develop its own core competency framework for residency training that conforms to China's conditions. For the purpose of supporting and facilitating the reformation of medical education, educational experts, educational administrators and frontline faculties from China Consortium of Elite Teaching Hospitals for Residency Education formed this consensus after repeated discussion, argumentation and modification according to domestic and international research. The framework consists of six core competences: professionalism, medical knowledge and skill, patient care, communication and collaboration, teaching and life long learning. Each core competency has 3 to 4 specific items. In this consensus, all the items were definied to help readers understand the core competency framework. A hexagonal logo with 6 different colors was designed to illustrate the framework. This consensus can provide an important basis for future exploration of reform in residency education on aspects such as setting training goal, curriculum design, assessment and evaluation, faculty development and teaching-resources improvement, etc.
Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes
PHURBU Droma, CHEN Huan, CHEN Wenjin, DU Wei, LIN Guoying, PAN Wenjun, CHENG Li, GUI Xiying, CAI Xin, CHODRON Tenzin, FU Jianlei, LI Qianwei, TSE Yang, JI Lyu, TSERING Samdrup, DA Wa, GUO Juan, QIU Cheng, WANG Xiaoting, CHAO Yangong, LIU Dawei, CHAI Wenzhao, ZHU Shihong
2022, 13(1): 24-38. doi: 10.12290/xhyxzz.2021-0584
HTML (194) PDF(211)
Abstract:
Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a "triad" monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).(3) It is recommended to grade patients quickly, and the "5-avoids" approach based on "brain protection" theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the "super critical" stage, with the protection of "446"targets, choose the window for analgesia and sedation (8.4 points).(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the "super critical" period (8.2 points).(7) In the "super critical" period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points).
China Healthcare Big Data
Advances in Rare Diseases in China (2020—2021)
HE Shan, GAO Shiqi, HE Xinyue, LIU Peng, JIN Ye, LI Xiangyan, ZHU Yicheng, CHEN Limeng, ZHU Weiguo, ZHANG Shuyang
2022, 13(1): 39-45. doi: 10.12290/xhyxzz.2021-0248
HTML (337) PDF(265)
Abstract:
In 2020 and 2021, great progress was made in the field of rare diseases in China. In the aspect of rare disease related policies, China built the National Key Laboratory of Rare Diseases and prepared for the National Quality Control Center of Rare Diseases. China has granted zero tariffs on raw materials and drugs for rare diseases since 2021, and the number of rare diseases included in health insurance in local areas has increased. In the aspect of drugs for rare disease, during the past two years, 14 drugs for rare diseases were included in the system of national health insurance; 13 were approved by China National Medical Products Administration; and more gained the qualification for prior review. In the aspect of patient registration and epidemiological study of rare diseases, China enabled the National Rare Diseases Registry System and set up the registry regime. The first epidemiological study of myasthenia gravis in China was published. The screening programof lysosomal storage syndrome and the first cohort study on achondroplasia in China were started. Besides the official policies and channels, organizations and informational platforms for patients also played an important role in the field of rare diseases.
Teaching and Research
Exploration of Education for Complex Elite Medical Talents in the Department of Internal Medicine at Peking Union Medical College Hospital: A Summary of Clinical Medical Postdoctoral Project Since 2016
LI Jing, LI Hang, YANG Yingyun, XIA Peng, LI Xiaoqing, LI Yue, YAN Xiaowei, ZHU Huijuan, PAN Hui, ZHANG Fengchun, ZHANG Shuyang
2022, 13(1): 46-50. doi: 10.12290/xhyxzz.2021-0463
HTML (265) PDF(149)
Abstract:
The clinical medical postdoctoral project is a complex elite national project of post-graduation supported by the Ministry of Human Resources and Social Security. Since the 2016 academic year, the department of internal medicine at Peking Union Medical College Hospital has launched, modified and developed this project on multiple aspects, including the stratified training mode, 360 degree evaluating system, system of evaluation and feedback for progressive training, and program of simulation. During the process of implementing this project, we continued the improving process according to the feedback from multiple aspects. In this article, we demonstrated the innovation of this project and summarized our experience during the implementing process, hopefully to provide reference for cultivating a complex medical elite with international vision.
Development of the System of Training Surgical Skills Based on Hierarchical Progressive Training for Clinical Postdoctoral Trainees
GUO Chao, LIU Lei, ZHAI Jiliang, PAN Bo, LIANG Naixin, TIAN Feng, YI Jie, LIAO Quan, ZHU Huijuan, WENG Xisheng
2022, 13(1): 51-55. doi: 10.12290/xhyxzz.2021-0754
HTML (41) PDF(103)
Abstract:
  Objective   Postdoctoral program in clinical medicine is a new approach to China's exploration of medical elite training. Since 2016, the Department of Surgery of Peking Union Medical College Hospital has explored and gradually established an advanced training system in order to cultivate clinical post-doctoral skills. The purpose of this research is to review and analyze the construction process and training effects of the advanced skill-raining system, and discuss the advantages of the training system and the direction of further improvement.  Methods  Postdoctoral students of surgical clinical medicine from 2016 to 2019 were evaluated and analyzed on surgical skills, results of the establishment of the system, and the output of scientific research.  Results  With the currently established preliminary system of progressively training surgical skills, three generations of 26 clinical postdoctoral trainees of surgery have been successfully trained. The surgical postdoctoral students trained by this system have significantly higher annual assessment results of surgical skills than training residents of the same year. In addition, during the establishment of this system, 19 teaching-related reform projects have been established, and 14 papers related to this system have been published.  Conclusions  The advanced training system of surgical skills has shown obvious advantages in the training process of surgical postdoctoral doctors. The construction and perfection of the system still needs to be further improved in combination with the actual needs of postdoctoral surgeons in surgery and the goal of standardized training for residents.
Exploration and Practice of the Collaborative Program in Postdoctoral Trainees of Clinical Anesthesiology
RUAN Xia, TAN Gang, WANG Lin, CAI Jingjing, XUE Qinghua, XU Mingjun, ZHANG Jianmin, YAN Fuxia, ZHENG Hui, DENG Xiaoming, SHEN Le, HUANG Yuguang
2022, 13(1): 56-60. doi: 10.12290/xhyxzz.2021-0459
HTML (32) PDF(63)
Abstract:
  Objective  To explore the advantage and feasibility of the program of training anesthesiologists that is based on the clinical postdoctoral program of Peking Union Medical College Hospital (PUMCH) with collaboration between general hospitals and specialized hospitals.  Methods  We analyzed the operational volume of the operation platform in PUMCH and the clinical characteristics of the specialized hospitals in Beijing, and built a collaborative standardized training base that combines general hospitals with specialized hospitals. Before and after the implementation of the collaborative training program, the number of training cases of each sub-specialty and the trainees' scores of the assessment of clinical abilities were compared.  Results  After implementation of the collaborative standardized training program, the number of training cases of pediatric anesthesia, obstetrics anesthesia, and cardiovascular surgery anesthesia were significantly increased (all P < 0.01) with the total number of clinical anesthetic cases unchanged. Meanwhile, the scores of medical knowledge and skills, communication and collaboration, and patient care of the trainees were significantly improved (all P < 0.05).  Conclusion  The collaborative standardized training program can optimize the disease resources and improve the core competency of trainees, and is feasible for standardized postdoctoral training of clinical anesthesiology.
Application of Differentiated Training Program for Ophthalmic Postdoctoral Trainees in Peking Union Medical College Hospital
CHEN Di, YU Weihong, ZHANG Xiao, ZHANG Yang, ZHANG Meifen
2022, 13(1): 61-65. doi: 10.12290/xhyxzz.2021-0537
HTML (94) PDF(43)
Abstract:
  Objective  To establish a differentiated training program for ophthalmic postdoctoral students and explore its teaching effects in the Department of Ophthalmology, Peking Union Medical College Hospital.  Methods  All of the in-training clinical postdocs were evaluated. The differentiated training program and the stepwise surgical training system were established based upon different education backgrounds. The results of the theoretical examination of clinical postdocs and other students were analyzed by horizontal comparison, and the development of theory and skill levels was analyzed by longitudinal comparison. The progress of postdocs in the past three years was also evaluated through the competence model in six dimensions of professionalism, skills of communication and cooperation, patient care, knowledge and skills, teaching ability, and lifelong learning.  Results  The median scores of theoretical examination of the first- and third-year postdocs were higher than those of other students, and the levels of theory and skill of the postdocs improved year by year. The postdocs effectively developed in all six dimensions of the competence model in the third year.  Conclusion  The differentiated training program can effectively improve the integrated skills of postdocs and creates favorable conditions for the cultivation of high-level medical talents.
Analysis of Integrating Training in Scientific Research and Clinical Practice among Current Medical Postgraduates of Three Academic Systems
XU Haojie, WANG Lu, LIU Mingjuan, ZHAO Lidan
2022, 13(1): 66-73. doi: 10.12290/xhyxzz.2021-0623
HTML (46) PDF(79)
Abstract:
  Objective  To explore the situation of training in scientific research and clinical practice among medical postgraduates of different academic systems, analyze the advantages and shortcomings of each academic system in the mode of training medical postgraduates, and provide reference for future planning, adjustment and reform to medical education.  Methods  Using the methods of questionnaires and individual interviews, information from senior graduate students in clinical medicine at the School of Clinical Medicine, Peking Union Medical College (Peking Union Medical College Hospital) in 2021 were collected. These participants included doctoral students in the traditional master-doctor system(TMD) from the 2018 doctoral class and 2016 direct and transfer class, graduates of class 2021 from eight-year program of clinical medicine (8YCM), and medical students from the new academic "4+4" pilot class (NAPC) entering in 2018 and 2019. Their information about research training and clinical practice was summarized and analyzed.  Results  A total of 55 valid questionnaires were collected, including 33 (60.0%) from TMD, 15(27.3%) from 8YCM, and 7 (12.7%) from NAPC. Eleven people were willing to be interviewed, including 6 from TMD, 3 from 8YCM, and 2 from NAPC. 97.0%, 93.3%, and 71.4% of participants from TMD, 8YCM and NAPC respectively planned to commit to clinical work upon graduation. Regarding motivation for scientific research, 84.8% of TMD students believed that the drive was the needs of career development. 53.3% of 8YCM and 57.1% of NAPC students held the same view. During the training in scientific research, the main problem faced by TMD students was their weakness in scientific research design (60.6%) while 8YCM and NAPC students claimed that their main problem was the insufficiency of time for scientific research (73.3%, 71.4%). The proportion of those who were satisfied with or enjoyed the current status of scientific research was the highest among NAPC students (57.1%), followed by TMD students (39.4%) and 8YCM students(26.7%). The proportion of those who were satisfied with scientific research output was the highest among TMD students (54.5%), followed by NAPC (42.9%) and 8YCM students (33.3%). As for time committed to research, TMD, 8YCM and NAPC students who spent more than 20 hours per week accounted for 63.7%, 26.7% and 14.3%, respectively, and accounted for 24.2%, 20.0%, and 42.9%, respectively for clinical practice of over-20-hour's commitment. 84.8% of TMD, 100% of 8YCM, and 85.7% of NAPC students established their directions of scientific research under the guidance of their mentors. When the progress of scientific research encountered difficulties, 48.5%(TMD), 53.3%(8YCM), and 42.9%(NAPC) of the students of the three academic systems turned to their supervisors for help. The proportions of students who had more than 8 hours of contact with their supervisors each week were 12.1%(TMD), 20.0%(8YCM) and 14.3%(NAPC). Among the three educational systems, the proportion of postgraduates who were satisfied with or enjoyed current clinical practice was highest in NAPC (71.4%), followed by TMD(42.4%) and 8YCM (40.0%).  Conclusions   The cultivation of scientific research thinking and clinical ability is a gradual process, requiring time investment and the guidance of tutors. The three systems of graduate education have their own advantages and disadvantages. The resources of clinical practice and scientific research of hospitals and medical schools should be integrated, and the time allocation for clinical practice and scientific research should be rationally planned to stimulate the initiative of graduate students, so as to cultivate more high-level and top-notch innovative medical talents with international perspectives that meet the needs of society.
Application of Flipped Classroom Combined with Case-based Collaborative Learning in Medical Teaching in the Experimental Eight-year Medical Doctor Program
YU Si, LI Yue, LI Ji, TAN Bei, YANG Yingyun, QIAN Jiaming, LI Hang
2022, 13(1): 74-78. doi: 10.12290/xhyxzz.2021-0751
HTML (79) PDF(70)
Abstract:
  Objective  To evaluate the effect of flipped classrooms combined with case-based collaborative learning (CBCL) in teaching internal medicine in the experimental eight-year medical doctor program[new academic "4+4" pilot class(NAPC)].  Methods  Medical students from the class 2019 and class 2020 of NAPC in Peking Union Medical College were selected as the objects. A teaching method of flipped classroom combined with CBCL was applied in the course of internal medicine (inflammatory bowel disease). Through the knowledge test before and after class discussion, the students' mastery of relevant knowledge was evaluated, and the Likert scale was used to give quantitative feedback on the teaching effect.  Results  A total of 45 medical students from NAPC were enrolled, including 20 students from class 2019 and 25 students from class 2020.A total of 42 students completed the knowledge test before class and 45 students completed the knowledge test after class.After the flipped classroom combined with CBCL, the students' correct answer rate had significantly increased on questions about the age of inflammatory bowel disease onset, severity of ulcerative colitis endoscopy, lesion range, differential diagnosis, treatment principles, clinical manifestations of Crohn's disease, and treatment principles(all P < 0.001); the median correct answer rate of all questions significantly increased [33.3(26.2, 85.7)% vs. 93.3(71.1, 95.6)%, P=0.001]. Thirty students(66.7%, 30/45)completed the post-class feedback; the overall satisfaction score of the teaching mode of flipped classroom was (4.00±0.74) points.  Conclusions  The teaching mode of flipped classroom combined with CBCL can significantly improve learning outcome in medical students of the experimental eight-year program. Students are generally satisfied with the teaching mode.
Application of the CITE Mode of Ward Rounds in Teaching Critical Clinical Thinking
ZHOU Yuankai, HE Huaiwu, LONG Yun
2022, 13(1): 79-81. doi: 10.12290/xhyxzz.2021-0713
HTML (32) PDF(200)
Abstract:
With the rapid development of critical care medicine (CCM), the particularity and professionalism of critical clinical thinking has become increasingly apparent. To grasp critical clinical thinking quickly and accurately is a key and difficult point in clinical training for young doctors. The CCM team of Peking Union Medical College Hospital summarized the CITE(Case characteristic, Index, Target, Execute) mode of ward rounds. This mode integrated the training of critical clinical thinking into daily bedside rounds and tried to rapidly develop the ability of critical clinical thinking of the young doctors and to achieve continuous and high-quality medical services.
Original Contributions
Correlation between A Body Shape Index and Target Organ Injury of Hypertension
LI Fangtang, YANG Xiaoli, CHEN Ruidan, YANG Yongjian
2022, 13(1): 82-88. doi: 10.12290/xhyxzz.2021-0332
HTML (157) PDF(133)
Abstract:
  Objective  To explore the correlation between a body shape index (ABSI) and target organ injury in patients with hypertension.  Methods  A cross-sectional study was used to collect related clinical indicators of patients with hypertension who were hospitalized in the Department of Cardiology, Daping Hospital, Third Military Medical University from March 2020 to January 2021. ASBI quantile method was used to divide the patients into low ASBI group, medium ASBI group and high ASBI group. Multiple Logistic regression was used to analyze the correlation between ASBI and target organ injury in patients with hypertension.  Results  A total of 685 patients with hypertensive meeting the inclusion and exclusion criteria were enrolled, of which 445 had target organ damage; 229 cases were in the low ASBI group (ABSI≤0.076), 228 cases were in the medium ASBI group (0.076 < ABSI≤0.078), 228 cases were in the high ASBI group (ABSI > 0.078). The detection rate of left ventricular hypertrophy in the high ASBI group was higher than that in the low ASBI group(27.63% vs. 12.66%, P < 0.001). The detection rates of carotid atherosclerosis, and renal function impairment of the high ASBI group were higher than those of the medium ASBI group(39.04% vs. 26.32%, P=0.015;14.04% vs. 5.26%, P=0.007) and low ASBI group(39.04% vs. 25.76%, P=0.008;14.04% vs. 2.62%, P < 0.001). The multivariate Logistic regression analysis showed that ABSI was associated with increased left ventricular hypertrophy (OR=2.08, 95% CI: 1.24-3.50, P < 0.001) and renal injury (OR=6.47, 95% CI: 2.53-16.54, P < 0.001) in hypertensive patients.  Conclusion  The increased ABSI is related to the prevalence of left ventricular hypertrophy and renal damage in hypertensive patients.
The Search for Optimal Pulse Oxygen Saturation Targets in Pulmonary Embolism Patients
WANG Yang, CHEN Hao
2022, 13(1): 89-95. doi: 10.12290/xhyxzz.2021-0212
HTML (39) PDF(53)
Abstract:
  Objective  To determine the association between pulse oximetry-derived oxygen saturation(SpO2) and all-cause in-hospital mortality of patients with pulmonary embolism during oxygen therapy.  Methods  Clinical data of the patients with pulmonary embolism as the primary diagnosis in different American medical institutions from the eICU database during 2014 to 2015 were retrieved. Generalized additive model (GAM) was constructed and the graph was drawn to analyze the association between median SpO2 and all-cause in-hospital mortality. The lowest and smooth area of the curve was the optimal SpO2 range. Moreover, the mult- ivariate Cox regression model was applied to verify the association between SpO2 level during oxygen therapy and all-cause in-hospital mortality of patients with pulmonary embolism.  Results  A total of 422 patients with pulmonary embolism that met the inclusion and exclusion criteria were enrolled. The median score of SpO2 was 97%(95%, 98%) during oxygen therapy.A total of 336 (79.6%) patients were discharged from the hospital and 86 (20.4%) patients died. The GAM indicated a U-shaped relationship between the median score of SpO2 and all-cause in-hospital mortality in patients with pulmonary embolism. In addition, the lowest mortality was observed when the SpO2 range was 96%-98%. Multivariable Cox regression analysis confirmed that the SpO2 level was independently associated with decreased mortality. Taking patients with median SpO2 rang of 96% to 98% as controls, the risk of all-cause in-hospital mortality was increased by 129.8% in patients with median SpO2 < 96% (HR=2.298, 95% CI: 1.268-4.163, P=0.006) and 77.3% in patients with median SpO2 > 98% (HR=1.773, 95% CI: 1.068-2.942, P=0.027).  Conclusions  The relationship between SpO2 levels and all-cause in-hospital mortality followed a U-shaped curve in patients with pulmonary embolism. The risk of all-cause in-hospital mortality was lowest when SpO2 was between 96% to 98% during oxygen therapy, which may be the target range of oxygenation.
Cross-cultural Adaptation of the Document of Advance Care Planning for Chinese Adolescents and Young Adults: Voicing My CHOiCES
CAI Siyu, GUO Qiaohong, NING Xiaohong, LU Guijun, GUO Yanru, LIU Yin, QIN Xinyan, WANG Xianjing, YAN Tianyi, WANG Ruixin, ZHOU Xuan, PENG Xiaoxia, Pediatric Palliative Care Subspecialty Group of the Pediatrics Society of the Chinese Medical Association
2022, 13(1): 96-103. doi: 10.12290/xhyxzz.2021-0162
HTML (91) PDF(51)
Abstract:
  Objective  To describe the cross-cultural adaptation of the document of advance care planning (ACP) Voicing My CHOiCESTM in Chinese, and provide the basis for the practice of ACP in China.  Methods  The process of cross-cultural adaptation involved document translation and synthesis, evaluation of healthcare providers, evaluation of patients, back translation, author revision of the original document, and finalization. The participants were all kinds of healthcare providers involved in ACP practice, including doctors, nurses, social workers, psychologists, hospice volunteers, anesthesiologists, nutritionists, and pharmacists. The heathcare providers were invited to answer a questionnaire about the document's structure, importance, appropriateness, and level of language localization. The evaluation of healthcare providers included three rounds of the process. We revised the document based on the feedback and developed the first draft. The first draft of the document was reviewed by young patients with fatal diseases and their families. They read each page of the document and rated the perceived appropriateness, helpfulness, and stressfulness of each item. After further revision, the final document was formed.  Results  Due to the differences in language, culture, health, and legal system between China and the United States, the cross-cultural adaptations were made in some topics of the document. The Chinese version of the document included 13 topics, involving medical and nursing decision-making, daily life planning, funeral planning, and spiritual support, etc. In total, 91.67% of the patients and 80% of their parents considered all topics covered to be appropriate for age and culture. In total, 75% of patients and 70% of their parents found all the topics to be helpful. In the evaluation of stress, death-related topics brought pressure on patients.  Conclusions  The Chinese version of Voicing My CHOiCESTM is the first ACP document applicable to adolescents and young adults in China. This document can help young Chinese patients to think and express their wishes and preferences, and guide patients, family members, and healthcare providers to fully and deeply communicate with each other about future planning.
Reviews
Advances in Ultrasound-assisted Catheter-directed Thrombolysis for the Treatment of Pulmonary Thromboembolism
ZHANG Yi, LUO Qin, ZHAO Zhihui, ZHAO Qing, LIU Zhihong
2022, 13(1): 104-109. doi: 10.12290/xhyxzz.2021-0029
HTML (86) PDF(88)
Abstract:
Pulmonary thromboembolism(PTE)is the third most common cause of cardiovascular death. However, only about 20% to 30% of patients with high-risk PTE received systemic thrombolysis in real world, due to concerns about the risks such as major bleeding. Although systemic thrombolysis could decrease all-cause mortality of patients with intermediate-risk PTE, the risk of bleeding outweighs the benefits. Ultrasound-assisted catheter-directed thrombolysis (UA-CDT) could directly deliver thrombolytic drugs to the thrombus with lower doses needed. Meanwhile, ultrasound waves could also enhance thrombolysis. Therefore, UA-CDT is emerging as a new tool, with good efficacy and safety records, for the treatment of PTE. In the present review article, we introduce the mechanism, required device, common protocol, efficacy and safety of UA-CDT and discuss directions for future studies.
Research Progress on Pathogenesis and Treatment of Juvenile Localized Scleroderma
YANG Jingyi, XU Qianyue, YU Hong
2022, 13(1): 110-116. doi: 10.12290/xhyxzz.2021-0178
HTML (51) PDF(57)
Abstract:
Juvenile localized scleroderma (JLS) is a rare autoimmune disease in children. The lack of specificity in the early symptoms of JLS makes it easy to be misdiagnosed and missed, which leads to the continuous progression of the lesions, and even causes systemic malfunction and growth disorder. For identifying the etiology of JLS and guiding the development and application of effective therapeutic drugs, we reviewed recent theories about the pathogenesis of JLS and summarized the traditional treatment options and relevant new therapeutic drugs, aiming to further enhance the fundamental understanding of JLS and its therapeutic progress.
Complicated and Rare Disease
Treatment Outcome of Intensity-modulated Radiotherapy for 15 Patients with Giant Pituitary Adenoma
LIAN Xin, SHEN Jing, SUN Xiansong, YANG Bo, SUN Yuliang, SHEN Jie, ZHANG Fuquan
2022, 13(1): 117-123. doi: 10.12290/xhyxzz.2021-0413
HTML (45) PDF(54)
Abstract:
  Objective  To summarize the clinical experience of intensity-modulated radiotherapy(IMRT) for patients with giant pituitary adenoma, and to provide evidence for clinical treatment.  Methods  The data of patients with giant pituitary adenoma who received 6MV-X IMRT with linear accelerator (prescription dose of 56-60 Gy/28-30 fractions, 5 fractions per week) in the Department of Radiation Oncology of Peking Union Medical College Hospital from October 2012 to October 2018 were reviewed. Treatment outcomes were evaluated by the control rate of tumor growth, remission rate of endocrine hormone, and radiation-related complications.  Results  A total of 15 patients were included in this study. There were 8 males and 7 females with a median age of 32 years. The control rate of tumor growth was 93.3% (partial response in 11 cases, stable in 3 cases, and development of pituitary carcinoma in 1 case). Among the 7 patients with functional giant pituitary adenoma, 1 patient achieved complete remission of the level of endocrine hormone and 2 patients achieved partial remission. Four patients treated with radiotherapy plus temozolomide achieved partial remission (median remission time was 5 months), and the remission rate and remission time were better than those who did not receive temozolomide. During the follow-up period after radiotherapy, 4 patients were found having newly pituitary dysfunction. There were no new or aggravating visional impairment and visual field defects.  Conclusion  Intensity-modulated radiotherapy is an effective treatment for giant pituitary adenoma, which can reduce the tumor faster combined with temozolomide.
Regimen of Azacitidine Combined with GemOx in the Treatment of Blastic Plasmacytoid Dendritic Cell Neoplasm: A Case Report
CHEN Xiaojun, LIU Yanquan, HU Xiaomei, HUANG Surong, SHEN Jianzhen
2022, 13(1): 124-129. doi: 10.12290/xhyxzz.2021-0465
HTML (77) PDF(62)
Abstract:
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a highly malignant hematological tumor derived from the precursor cells of plasmacytoid dendritic cells. BPDCN that primarily originates in the nasal cavity is clinically rare and easily misdiagnosed or missed. At present, there is no standard treatment for BPDCN in China and abroad. This article reported a female patient with BPDCN primarily in the nasal cavity. The regimen of Azacitidine combined with GemOx had a good clinical effect on this patient and significantly controlled the condition and improved the clinical symptoms. This article analyzed and discussed the clinical diagnosis and treatment of this patient, aiming to improve clinicians' understanding of rare BPDCN.
Clinical Practice Guidelines
Investigation and Evaluation of Chinese Clinical Practice Guidelines Published in Medical Journals in 2019:the Quality of Evidence and Strength of Recommendations
LU Shuya, ZHAO Siya, WU Shouyuan, LUO Xufei, LIU Yunlan, LYU Meng, YANG Nan, WANG Xiaohui, CHEN Yaolong
2022, 13(1): 130-137. doi: 10.12290/xhyxzz.2021-0784
HTML (128) PDF(71)
Abstract:
  Objective  To investigate the methodological issues related to the quality of evidence and strength of recommendations of 2019 Chinese clinical practice guidelines (hereafter referred to as "guidelines") published in journals, so as to provide reference for standardization of recommendations.  Methods  We searched and analyzed information on Chinese guidelines published in 2019, evaluated the quality of evidence, and graded the strength of recommendations. Information on grading methods, grading descriptions, phrases for the quality of evidence, and the strength of recommendation was extracted.  Results  A total of 226 Chinese clinical practice guidelines were published in journals in 2019, of which 106 guidelines (87 Chinese guidelines, 19 English guidelines) were included in this study. There were 18 grading methods adopted, with the GRADE(Grading of Recommendations Assessment, Development and Evaluation) system being the most used(35.8%, 38/106). A total of 6 grading descriptions were used; the most frequently used symbol for grading the quality of evidence was letters (39.6%, 42/106); the most frequently used symbol for grading the strength of recommendations was text (34.9%, 37/106). The most common word used in the guidelines to describe the recommended strength was "may". Among the 38 guidelines that used the GRADE system, only 15 followed the presentation recommended by the GRADE working group. There were 250 clearly graded recommendations included, with 60.4% (151/250) being strong recommendations and 44.8% (112/250) citing low or very low-quality evidence. There were 96 recommendations(38.4%, 96/250) that were supported by systematic reviews.  Conclusions  Chinese guidelines published in journals in 2019 that used the grading system accounts for a small proportion compared with those that did not use. And the quality of evidence and strength of recommendations used in guidelines remains incomplete, inconsistent and irregular. The GRADE system is underused. Very few guidelines present grading criteria and details in accordance with the requirements of the GRADE Working Group.We recommend the use of the GRADE system to promote the rigorous, transparent and rational development of guideline recommendations.
MDT Case from PUMCH
Decreased Muscle Strength, Type 2 Respiratory Failure, Heart Failure, Positive Anti-mitochondrial Antibodies—Rare Atypical Manifestations of Inflammatory Myopathy
LU Fei, ZHANG Ning, KANG Lin, SUN Xiaohong, TIAN Ran, GUO Xiaoxiao, LIU Yongjian, ZHANG Wen, PENG Linyi, SU Tong, CAO Jian, WANG Yining, QIAN Min, CAO Yuze, YANG Lu, LIU Yuehua, ZHANG Lu, ZHAO Xiaoyi, LENG Ling
2022, 13(1): 138-146. doi: 10.12290/xhyxzz.2020-0109
HTML (95) PDF(169)
Abstract:
An elderly woman with a chronic course of disease presented with progressive weakness of lower limbs, heart failure, carbon dioxide retention, periorbital pigmentation, increased hair around the eyebrows, as well as multiple positive autoantibodies. After multidisciplinary team discussion, restrictive ventilatory dysfunction caused by significantly decreased diaphragm movement was taken as a breakthrough to sort out the etiology step by step. Based on clinical manifestations, serological and imaging features, as well as immunohistochemical staining of quadriceps femoris pathological complement, the final diagnosis of inflammatory myopathy associated with anti-mitochondrial antibodies was established. After correcting heart failure, intermittent non-invasive ventilation and rehabilitation training, clinical symptoms and functional status of the patient were significantly improved. The joint participation of the multidisciplinary team to identify the causes and solve problems in diagnosis and treatment decision-making reflects the great significance of multidisciplinary collaboration in rare diseases.
Clinical Ethics
Autonomy of Patients and Informed Consent in Clinical Practice
XIE Jing, LI Shu, ZHU Ling, ZHANG Shuyang
2022, 13(1): 147-151. doi: 10.12290/xhyxzz.2021-0007
HTML (149) PDF(124)
Abstract:
This article addresses the ethical issues of respect for autonomy and informed consent, focusing on how clinicians should deal with these concepts in clinical practice. We first clarify the concept of respect for autonomy and its practical application, as well as informed consent. We then track the origin and development of informed consent both in western countries and in China. Followed by describing several challenges that limit the practice of informed consent, we make our suggestions so as to help clinicians handle the informed consent in daily practice.
Medical Humanity
Medical Humanities: the Past, Present and Future
GAO Chuan, ZHOU Yuyu, GUO Xufang, HE Zhong
2022, 13(1): 152-157. doi: 10.12290/xhyxzz.2021-0319
HTML (206) PDF(294)
Abstract:
Medical humanities have experienced vigorous development in the past 100 years. Its connotation and research direction have been continuously enriched, and it has provided great help for medical education. This paper reviewed the development history of medical humanities in the past 100 years, focusing on the history of medicine, bioethics, medical anthropology and narrative medicine. At the same time, this paper analyzed the reasons behind the movements of medical humanities, and on this basis, expounded the requirements of future development of medical humanities in China, so as to promote the research and education of medical humanities in China.
History of Medicine
Honor, Responsibility and Mission: A Silhouette of Clinical Teaching in Peking Union Medical College Hospital in 1925
JING Quan, LIU Jihai
2022, 13(1): 158-164. doi: 10.12290/xhyxzz.20200016
HTML (104) PDF(82)
Abstract:
By reviewing and studying relevant historical materials, this study presents the advanced and fruitful clinical teaching in Peking Union Medical College Hospital(PUMCH) nearly a hundred years ago. It proved that the clinical teaching of PUMCH had reached the internationally advanced level in 1925. The bed-side teaching, case discussion, multidisciplinary joint ward round, interdisciplinary teaching, and resident training system still have practical significance presently. As it turns out, many of the teachers who were passionate about teaching and students who were actively involved in teaching went on to become medical masters. The spirit of taking teaching as an honor, responsibility and mission has been passed on and deeply rooted in the spirit of PUMCH and has remained unchanged for a century.
Links: National Health Commission of the People's Republic of China Chinese Academy of Medical Sciences(CAMS) AMLC Check CNKI Database CNKI Term Online Chinese General Practice
Address：Room 302,Third Floor,Building 7, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China
Tel：010-69154261/4262
E - mail：medj@pumch.cn
mjpumch@126.com
Copyright of website：Editorial Office of Medical Journal of Peking Union Medical College Hospital

Supported by: Beijing Renhe Information Technology Co. Ltd