1.Policy barriers and strategies of the two-way referral system
Chinese Journal of Hospital Administration 2015;(4):257-259
The two-way referral system is an inevitable step in the health reform,as it could effectively channel patients,promote rational use of healthcare resources,and improve the quality of care at primary medical institutions.Only by means of resources integration for improvement of existing policies,and building a healthcare system comprising partnering medical institutions of all levels with proper division of responsibilities,can the two-way system come into practice smoothly.This will alleviate the difficulty in seeing doctors and expensiveness of treatment.
2.The assessment of left ventricular function by use of doppler tissue imaging in elderly patients with dilated cardiomyopathy
Jing WU ; Zulun FANG ; Yusi ZHU ; Sisheng ZHANG ; Nianmei GONG
Chinese Journal of Geriatrics 2010;29(7):551-554
Objective To quantitatively assess the left ventricular systolic and diastolic function in the elderly patients with dilated cardiomyopathy (DCM) by using Doppler tissue imaging (DTI) and to explore its clinical value. Methods A total of 20 normal controls and 22 old patients with DCM were enrolled in the study. The left ventricular end-diastolic diameter (LVEDd), left atrial diameter (LAD) and left ventricle ejection fraction(LVEF) were obtained by routine echocardiogram. And the systolic and early diastolic peak velocity (Vs and Ve) were detected by quantitative tissue velocity imaging (QTVI) and the mean value was accounted. The systolic mitral valve displacements (MVD) in 6 sites were determined by tissue tracking technique and the mean value was calculated. Results The LVEDd and LAD were significantly higher in DCM group than in normal group [LVEDd: (67.56±10.27) mm vs. (43.36±4.20) mm; LAD: (49.91± 6.27) mm vs. (32.00+4.53) mm, t=10.229 and 10.359, both P<0.01]. And the LVEF, Vs and MVD were lower in DCM group than in normal group [LVEF: (26.50 ± 8.25)% vs. (64.00 + 4.72)%; Vs:(5.14+1.30) cm/s vs. (8.89+1.87) cm/s; MVD:4.82+1.85 vs. 10.23± 1.95, t=18.502, 7.716 and 8.143, all P< 0.01].The Vs and MVD were significantly positively correlated with LVEF (r=0.78 and 0.89, both P<0.01). Conclusions DTI can quantitatively assess global and regional left ventricular systolic and diastolic function of elderly patients with DCM, and provide the reliable information for the judgment of pathogenetic condition.
3.Effects of Dual-antiplatelet Medication Time on Efficacy and Safety of Postoperative Complications after Transcatheter Aortic Valve Implantation :A Meta-analysis
Yuexin ZHU ; Yusi HUANG ; Huiting CHEN ; Lei ZHANG ; Yang LI ; Qingchun ZENG ; Dingli XU
China Pharmacy 2019;30(13):1847-1853
OBJECTIVE: To systematically evaluate the effects of dual-antiplatelet medication time on efficacy and safety of postoperative complications after transcatheter aortic valve implantation (TAVI), and to provide evidence-based reference for the formulation of antiplatelet therapy after TAVI. METHODS: Retrieved from Cochrane clinical controlled trial registration center, PubMed, Embase, Web of Science, Wanfang database and CJFD, during database establishment to Feb. 2019, RCTs and observational study about efficacy (all-cause mortality and incidence of stroke) and safety (the incidence of major bleeding events) the effects of dual-antiplatelet therapy for postoperative complications after TAVI at different time points were collected. After data extraction of clinical studies met inclusion criteria, quality evaluation with Cochrane bias risk evaluation tool 5.1.0 (for RCT) or Newcastle- Ottawa Scale (for observational study), Meta-analysis was conducted by using Rev Man 5.3 and Stata 14.0 statistical software. Meta-regression analysis was also conducted for outcome and different treatment duration. RESULTS: A total of 3 RCTs and 10 observational studies were included, involving 2 868 patients. The results of Meta-analysis showed that the incidence of all-cause mortality one month and 6 months after medication were 0.05 [95%CI (0.03, 0.07), P<0.001] and 0.07 [95%CI (0.05, 0.08), P<0.001]. The incidence of major bleeding events 1, 3 and 6 months after medication were 0.14 [95%CI (0.08,0.19), P<0.001], 0.11 [95%CI (0.03, 0.19), P=0.007] and 0.13 [95%CI (0.05, 0.22), P=0.002]. The incidence of stroke after one month after medication was 0.04 [95%CI (0.03, 0.05), P<0.001]. Results of Meta-regression analysis showed that the all-caused mortality [regression coefficient=0.005 7, 95%CI (-0.001 6, 0.013 0), P=0.116], major bleeding [regression coefficient=-0.000 5,95%CI(-0.022 4,0.021 4), P=0.959] or the incidence of stroke [regression coefficient=0.001 4, 95%CI (-0.003 8, 0.006 5), P=0.570] were not related to medication duration of dual-antiplatelet therapy. CONCLUSIONS: The prolongation of the medication time of the dual-antiplatelet therapy has no significant effect on the efficacy and safety of TAVI.
4.Meta-analysis of Efficacy and Safety of Single or Dual Antiplatelet Therapy for Short-term Complications after Transcatheter Aortic Valve Implantation
Yuexin ZHU ; Yusi HUANG ; Huiting CHEN ; Lei ZHANG ; Yang LI ; Ziyuan ZOU ; Qingchun ZENG ; Dingli XU
China Pharmacy 2019;30(9):1271-1278
OBJECTIVE: To systematically evaluate effectiveness and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) on short-term complications after transcatheter aortic valve implantation (TAVI), and to provide evidence-based reference for clinical treatment. METHODS: Retrieved from PubMed, Cochrane clinical controlled trials registry, Web of Science, CNKI, Wanfang database, CBM and Chinese Clinical Trial Registry, RCTs and observational studies about effectiveness (all-cause mortality, incidence of stroke and incidence of myocardial infarction 30 days after operation) and safety (the incidence of bleeding events at 30 days after operation) of SAPT versus DAPT on short-term complications of TAVI were collected during the date of database establishment to Jan. 2019. After data extraction of included studies and quality evaluation with Cochrane system evaluator manual 5.1.0 (for RCT) and the Newcastle-Ottawa Scale (NOS) (for observational studies), Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS: Totally 3 RCTs and 7 cohort studies were included, involving 3 188 patients. Results of Meta-analysis showed that the incidence of all-cause mortality 30 days after operation [OR=0.48, 95% CI (0.32, 0.73), P<0.001] and the incidence of bleeding events 30 days after operation [OR=0.43, 95%CI (0.30, 0.59), P<0.001] in SAPT group were significantly lower than DAPT group, with statistical significance. There was no statistical significance in the incidence of stroke 30 days after operation [OR=0.63, 95%CI (0.38, 1.06) , P=0.08] or the incidence of myocardial infarction 30 days after operation [OR=1.09, 95%CI (0.46, 2.59), P=0.85] between 2 groups. CONCLUSIONS: Compared with DAPT, SAPT can decrease the incidence of all-cause mortality 30 days after TAVI and the incidence of bleeding events 30 days after TAVI.