Objective To investigate the clinical effectiveness and adverse event of preventive medicine for severe acute respiratory syndrome (SARS), and provide clinical data for designing prospective clinical trial. Method Retrospective study on medical staffs, that were exposed to SARS patients, was conducted in two main SARS designated hospitals to obtain information such as SARS exposure risk and preventive measures (medical and others). According to the type of preventive medicine, they were assigned to earthworm’s nucleases and protease (ENP) group, interferon group and blank control group respectively. Exposure risk, suspected sub-clinical infection rate and adverse event rate were compared between the three groups. Results Non-medical preventive measures used in each group were consistent, but the exposure intensity to risk factors between groups was statistically different, which biased the evaluation of clinical effectiveness of preventive medicine. The rate of suspected sub-clinical infection in earthworm’s nucleases and protease (ENP) group, interferon group and control group were 4.5%, 4.5%, and 9.9% (Pgt;0.05), respectively; and adverse event rate were 19.6%, 13.6% (Pgt;0.05), and 0%, respectively. Conclusions Suspected sub2clinical infection rate in ENP group, interferon (INF) group were lower than that in control group, which indicated that these two medicines might be effective in preventing SARS. Adverse event rate in ENP group was similar to that of interferon group, and the symptoms were mild in both groups, which was in accordance with the result of in vitro experiments. ENP spray is a kind of biological preparation; further purification may reduce its adverse event rate. However, because there had excessive confounding factors, especially because of the unequal of exposure risk between three groups, the results of this study can only provide insights to design prospective clinical trial in the future.
The research background, way of thinking, research contents and methods of a united research project - "The Clinical Research on the Treatment of SARS with Integrated Traditional and Western Medicine" were reviewed. The latest research achievements on the treatment of SARS with integrated traditional and western medicine and the difficult points in the research were discussed. Furthermore, some tentative ideas were put forward to further the research. The conclusion was drawn that the principles of evidence-based medicine and the research scheme of multi-centered, prospective and randomized controlled trials, as well as the standard statistical and analyzing methods are the best way to assess the effectiveness and safety of treating SARS with integrated traditional and western medicine.
Objective To summarize primary clinical data from Xiao Tang Shan Hospital (XTSH) Information System, to provide evidence for clinical data of emerging diseases. Method The primary data were extracted from XTSH information system, which related to demographic and background information, case history, prescriptions, laboratory tests, physical examination, vital sign, surgery, diagnostics and expenditures. The software for data verification was developed by Delphi language program. The information of SARS management was developed by Oracle Developer. Results XTSH information system for SARS management collected 1.09 million pieces of information covering 680 SARS cases. The database was functionally divided into inquiry window, conditional case list window and case details spread window, which provided information of SARS management and shaped a platform for further investigation. Quality control of clinical data was done by the software of SARS Information Real Control.Conclusions XTSH information system collected complete data of SARS management, which made healthcare, research and policy-making on SARS accessible, and made it possible to share resources and train the professionals.
Objective To investigate the accurateness and rapidity of information on SARS , and to provide evidence for decision-making in the construction of the public health information system of China, including information collection, identification and release. Method SARS related information was systematically collected, from ① databases including Medline, CBMdisc and Cochrane Library; ② official websites including WHO, MOH and CDC; ③ non-governmental websites including Sina, Sohu, Yahoo; ④ eleven Chinese Journals and ⑤ gray literatures, These evidence were graded based on their scientific sense, and were analyzed according to their rapidity of release. Results A total of 11 955 pieces of related information were collected. Non-governmental websites were the agents that released the largest number of information (46.7%). Regarding the scientific sense of evidence, hand searched journal was at the top of the evidence pyramid, and followed by Medline, gray literature, CBMdisc, official and non-governmental websites. Regarding the rapidity, official website achieved the most rapid information release, which was followed by nongovernmental website, journal, and database. 71.8 percent of information from official websites was in Chinese, while 65 percent was from database. Conclusions The SARS information from China has contributed enormously to the global information release. Although the amount and rapidity of the information were satisfied, management and deep processing of information should be improved.
Background 410 Hospital, a hospital in an undeveloped city, identified the first three SARS cases in February, and three more cases in April in Sichuan province. After April 25, it was designated to treat the SARS cases. Objectives This study aims to assess the expenditure for prevention and control of SARS in designated hospital and the impact of SARS on hospital management. Methods With the perspective of SARS designated hospital, a retrospective study was designed. The measures for benefit was healing rate. Medical expenditures of SARS treatment was evaluated, total expenditare were included for assessment in SARS control and management in designated hospital. Sensitivity analysis was applied to explore the range of expenditures when hospital infection rate and healing rate varied. Results All five SARS cases and six suspected cases were cured. The treatment expenditure for SARS confirmed and suspected cases were 7 866 and 4 273 RMB, and their medical expenditures were 14 983.86 and 5 494.92 RMB. Except the expenditure of supporting drugs, no statistical significance was identified in expenditures between confirmed and suspected cases. The total expenditure for designated hospital in control and management of SARS was 1.744 5 million RMB. After designation, the total income of the hospital decreased 33.45 percent compared that before designated. The hospital visits in out-patient and in-patient departments drop 43.62 and 47.33 percent. Conclusions The expenditure of treatment of confirmed and suspected SARS cases were 14 983.86 and 5 490.92 RMB. After designation, the hospital would be great influenced in its management and income.
Objectives About 12.9-50% patients of SARS (Severe Acute Respiratory Syndrome), require brief mechanical ventilation (MV) to save life. All the reported principles and guidelines for therapy SARS were based on experiences from clinical treatments and facts of inadequacy. Neither prospective randomized controlled trials (RCT) nor other high quality evidences were in dealing with SARS. Our objective is to seek safe and rational non-drugs interventions for patients with severe SARS by retrospectively reviewing clinical studies about MV all over the world, which include clinical guidelines, systematic reviews (SR), Meta-analysis, economic researches and adverse events. Methods To search MEDLINE and Cochrane Library with computer. According to the standards of inclucion or exclusion, the quality of the article which as assessed, and relevant data which were extracted double checked. The Meta-analysis was conducted if the studies had no heterogeneity. Results 14 papers were eligible. Due to the significant heterogeneity between these studies, further Meta-analysis could not be conducted, and the authors’ conclusions were described only. Conclusions The outcome of PPV is better than that of VPV. Patients who underwent PPV had a significantly lower mortality than that of VPV. Of course, the volutrauma should be watched. With low tidal volume and proper PEEP, or decreased FiO2, even permissive hypercapnia, the mortality and length of stay were cut down. Non-invasive mechanical ventilation (NIMV) was effective in treating haemodynamical stable patients, minimizing complications and reducing medical staff infection. Patients with serious dyspnea with PaO2/FiO2lt;200, no profit of NIMV, or couldn’t tolerance hypoxaemia were unlikely to benefit from this technique and needed ventilation with endotracheal intubation. Prone position could improve PaO2/FiO2, NO maybe increased pulmonary perfusion, improved V/Q, and raised oxygenation. Furthermore, Inhaled NO sequentially (SQA) was better than Inhaled NO continuouly (CTA). Some studies implied that practice of protocol-directed weaning from mechanical ventilation implemented by nurses excelled that of traditional physician-directed weaning.
Objective To explore and establish a more precise and reasonable classification method which is suitable for clinical treatment and scientific research of SARS patients. Methods ① Establishing a computerized classification method: Analyzing the relationship between variable items on the front page of medical records and severity of disease; Identifying the variable items related to patient’s condition by stepwise identification analysis; Creating a function equation and computerized classification system. ② Comparing and analyzing the difference between computerized and clinical classifications regarding to the general condition of patients, clinical manifestations, laboratorial test results, prognosis, period of hospitalization and medical expenditure, etc. Results ① Clinical classification: general cases 642 (94.41%), critical cases 38 (5.59%); Computerized classification: type A 436 (64.12%), type C 237 (34.85%), type D 7 (1.03%), no type B. ② There were statistical significance among groups between two classifications regarding the items of general condition (age, cure rate, mortality and average length of hospitalization), total protein , Alb, BUN and medical expenditure. ③ Comparative analysis of the two classifications: 99.77% of type A cases (general type) by computerized classification were general cases by clinical classification; 97.36% of critical cases by clinical classification were type Camp;D by computerized classification. Conclusions The results are conformity between two classifications and the differences are analogical among thegroups. The statistical difference is significant between general and critical cases with the number of critical cases by computerized classification 6.42 times more than that by clinical classification; Compared with clinical classification, computerized classification has advantages that there is significant difference between the groups while no difference within the groups. With more critical cases and more objective and logic results, the compauterized classification is suitable for study and application in the fields of health service quality management, health economy management and pharmaceutical economics, etc.
Objective To provide evidence for the establishment and improvement of public health system in China by comparing national public health emergency system of some representative countries.Methods The principle and method of evidence-based science were applied to search and evaluate data from the official websites of China, United States, United Kingdom, Australia and Singapore. The performance of each country’s public health emergency response system in SARS prevention and control, as well as their organization structure and mechanism were compared. The existing problems and corresponding countermeasures were then put forward. Results Public health system showed the best performance was in US, UK and Australia. The responding mechanism of Singapore was highly admired by WHO. The organization structure of China was similar to that of developed countries, but its performance was far lagged behind because of insufficient financial support, poor management and inefficient operational mechanism. Conclusions The public health emergency response system in China needs to be reformed by giving priority to mechanism reinforcement. Different models should be taken into account regarding different regional situations in China.
Objective This study analyzed the medical expenditure and its influential factors, and compared the clinical effectiveness and medical expenditure of three major drugs. Methods We designed the cohort study to compare the difference of medical and pharmaceutical expenditures between patients with and without underlying diseases. Multi-linear regression was applied to analyze the influential factors. Incremental expenditure-effectiveness ratio was applied to study three clinically important drugs. Results The curing rate of non-critical patients was statistically significant than critical patients (73.68%, 99.38%, P=0.000) .The curing rate of non-critical patients without underlying diseases was statistically significant than those with underlying diseases in the cohort (96%, 99.66%, P=0.001 6). No significance was identified in the critical patients cohort. The medical expenditure of non-critical patients with and without underlying diseases were 7 879.22 and 7 172.23 RMB per capita, respectively. Accordingly, the medical expenditure in critical patients was 24 912.89 and 26 433.53 RMB per capita. No significance was identified in the two cohorts. Medical expenditure was positively correlated with age and disease severity, with its equation y=4585.71+79.04X1+17188.87X2 (X1: age, X2: disease severity). Regarding the clinical effectiveness and medical expenditure, no significance was identified in critical patients who administered small and medium dose of Methylprednisolone. The expenditure-effectiveness ratios of Ribavirin that was administered by non-critical patients without underlying dissuades were 6 107 and 4 225 RMB, respectively. Accordingly, the expenditure-effectiveness ratios of Thymosin were 11 651 and 6 107 RMB. Conclusions The curing rate of non-critical patients without underlying diseases was higher than the counterpart in the cohort. No influence of underlying diseases was found in the critical patient cohort. Medical expenditure was positively correlated with age and disease severity. Small-and-medium dose of Methylprednisolone might not influence the curing rate and medical expenditure in critical patients. The effectiveness of Thymosin for non-critical patients with and without underlying diseases was not significantly different. However, additional 5 877 RMB occurred if Thymosin was administrated. Likewise, the effectiveness of Ribavirin for non-critical patients remains the same. However, additional 1 082 RMB was consumed in Ribavirin-administrated patient.