Ankle Arthrodesis in Crippled Cases

The current article provides an algorithm of how to approach crippled ankle by ankle arthrodesis. There is no standard pathology or treatment present, which makes the diagnosis but also surgical correction complex. A surgeon who faces this kind of deformities needs to be skilled and well familiar with the full setting of the foot and ankle armamentarium.

Inappropriate Testing of Streptococcal Pharyngitis in Children Aged Below 3 Years: Application of Statistical Process Control

Group A strep tests in patients aged below 3 years are not recommended unless the patient has appropriate symptoms and a positive contact or signs of complications. The purpose of this quality improvement project was to increase the percentage of appropriately ordered strep tests among providers. Data were collected retrospectively and prospectively from 1163 patient visits. Providers were exposed to educational interventions, an electronic medical record order change, and provider feedback. Proportional control charts characterized the providers' behaviors and determined significant improvement among testing. The result was an increase in appropriate tests (13.7% to 37.8%), and the control charts showed sustainable results over time. This project demonstrates the efficacy of these methods to encourage antibiotic stewardship among providers. Furthermore, the interventions used here can be applied to other areas with low-value diagnostic testing. Future studies should investigate whether parental anxiety and educational programs influence testing and evaluate the efficacy of certain strategies.

[Truth-seeking and innovation for the academic excellence]

The Chinese Journal of Hepatology has a 2020 core impact factor of 1.807, which position it first among the periodicals of gastroenterology. The China Association for Science and Technology classified it as T1 grade and included in the catalogue of high-level scientific and technological periodicals. Since 2021, it has received the special publishing fund of the Chongqing Municipal Bureau of Press and Publications, the High-quality Scientific and Technological Periodicals Funding Project of Chongqing Association for Science and Technology, and the Industry-university-research Cooperation and Collaborative Education Project of the Ministry of Education of the People's Republic of China and won many awards such as "Sichuan-Chongqing First-class Scientific and Technological Periodical" and "Chongqing High-quality Scientific and Technological Periodical", thereby ensuring the development of both qualitative and quantitative effects. Therefore, in 2022, we will work on attracting high-impact research reports, disseminate the academic results timely, efficiently and accurately, highlight the role of digital communication, and pave the way for the establishment of it as a first-class academic journal.

Sensitivity is the dimension of temperament most associated with the progression from ideation to suicide attempts

BACKGROUND

To analyze the association between temperament (emotional and affective) and scrutinize the progression from suicide ideation to attempt, by using data from a large internet-based sample.

METHODS

It is a cross-sectional study, based on the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Temperament was assessed by the Affective and Emotional Composite Temperament Scale (AFECTS), and life-long suicidal behavior was determined by the adapted Suicidal Behaviors Questionnaire (SBQ-17). Odds ratios were obtained through multivariate logistic regression and a multiple linear regression were used in the analysis. According to the "ideation-to-action framework", we performed analyzes using two different reference groups: no suicidal ideation and suicidal ideation.

RESULTS

The affective temperaments that showed the greatest association with suicide attempts were depressive, cyclothymic, and volatile. The temperaments that reflected higher associations for progression from ideation to suicide attempt were cyclothymic, depressive, and euphoric. Sensitivity was manifested as the emotional temperament with the strongest positive association with the severity of suicidal behavior, followed by desire and control. Stability was estimated as the emotional trait with the strongest negative association with the severity of suicidal behavior.

LIMITATIONS

It is not a population based sample. BRAINSTEP is a self-selected sample whose participants are mostly women, who are highly educated and young.

CONCLUSIONS

Our results suggest that temperament assessment using AFECT model may be relevant to assess the risk for the progression from ideation to suicide attempts. These results strengthen the "ideation-to-action" framework that risk factors to suicide ideators can differ from suicide attempters.

Experience and practice of the Emergency Operations Center, Chinese Center for Disease Control and Prevention: a case study of response to the H7N9 outbreak

BACKGROUND

Emergency Operations Center (EOC) is a place to provide response to public health emergencies. Chinese Center for Disease Control and Prevention (China CDC)'s EOC was officially established in 2016, which has been the core department for the public health emergencies and risk response. In recent years, we have been continuously improving the function of EOC through many incidents. In the study, we hope to share the construction status, operation management experience of China CDC's EOC and the response process in the human avian influenza A (H7N9) outbreak.

MAIN TEXT

The China CDC's EOC mainly focus on building the five core elements including sites/places and facilities, information and data, plans and procedures, training and exercises, and logistics. Based on summarizing previous emergency response, the China CDC's EOC established its own incident management and the standardized response procedures. The event-specific data, context-specific data and event management data could be obtained through various source. The logistics department of the EOC also provides comprehensive support. The well-trained staff is another necessary conditions for its operation. Through sharing the response process of H7N9 outbreak, it further explains the EOC's functions in the five phases of outbreak response, such as the formulation of the incident response framework, monitoring, personnel dispatch and resource mobilization.

CONCLUSIONS

The EOC contributes to faster and more efficient responses during emergencies which enable a greater reduction in morbidity and mortality. Compared with the traditional incident response process, under the command and coordination of China CDC's EOC, each group involved in the response has a clearer goal, responsibilities and tasks at each stage. Meanwhile, each group also gave full play to its own expertise and advantages. As a whole, incident response tended to be more specialized and precise, which generally improves the efficiency of incident response. However, different countries and regions have different response processes to the events. We still suggested that appropriate emergency operation plan should be made according to the complexity of incident response in the region when constructing response mechanism, through our experience. And the China CDC's EOC is still at growing and groping phase.

Economic evaluation plan of a RCT of hydroxyapatite-coated uncemented hemiarthroplasty versus cemented hemiarthroplasty for the treatment of displaced intracapsular hip fractures: the WHiTE5 trial

Aim

This paper describes the methods applied to assess the cost-effectiveness of cemented versus uncemented hemiarthroplasty among hip fracture patients in the World Hip Trauma Evaluation Five (WHiTE5) trial.

Methods

A within-trial cost-utility analysis (CUA) will be conducted at four months postinjury from a health system (National Health Service and personal social services) perspective. Resource use pertaining to healthcare utilization (i.e. inpatient care, physiotherapy, social care, and home adaptations), and utility measures (quality-adjusted life years) will be collected at one and four months (primary outcome endpoint) postinjury; only treatment of complications will be captured at 12 months. Sensitivity analysis will be conducted to assess the robustness of the results.

Conclusion

The planned analysis strategy described here records our intent to conduct a within-trial CUA alongside the WHiTE5 trial.

Prevention and preparedness: biosecurity, early warning and contingency planning

Disaster and disaster risk management are described differently by various agencies, but the underlying principles remain the same. Disaster risk management is a continuous and integrated multidisciplinary and multisectoral process of planning and implementing measures that establish a culture of risk avoidance by building resilient communities. Such communities can only be created through a systematic process of education, training and development, involving all stakeholders. A researched comprehensive disaster management plan should be developed, but will only be successful if it sets clear priorities; is practised, tested, adapted and/or amended where necessary; and is practical, feasible and well understood by all those who are involved. Everyone who plays a role in implementing this plan must recognise that role and be well trained in its execution. Capacity building for disaster management is also a multisectoral, multidisciplinary, integrative process, achieved through a system of integrated education, training and public awareness programmes.

Quality improvement programme to improve compliance with initial respiratory support guideline at preterm birth

AIM

CPAP (continuous airway pressure) use as respiratory support from birth increases the proportion of babies who survive without bronchopulmonary dysplasia. Although we introduced a guideline for CPAP use in 2015, our intubation rate remained high (61.7%). We aimed to reduce the intubation rate into the interquartile range for the Vermont Oxford Neonatal (VON) network.

METHODS

A multi-disciplinary team was established. Data relating to resuscitation in all babies born before 32 weeks gestation or with a birth weight below 1500 g during 2017/2018 were collected prospectively. Episodes when CPAP was not used were identified, and series of Plan, Do, See, Act (PDSA) cycles performed. Performance data were displayed graphically to staff along with lessons learnt.

RESULTS

The rate of intubation at birth for VLBW babies fell from 61.7% into the VON interquartile range at 49.6% during the project (P = .02). Intubation rate in babies born between 26 and 30 weeks gestation fell from 66% to 41% (the VON network mean).

CONCLUSION

The NICU is a complex system. Altering clinical practice is challenging, even with good clinical evidence to support change. Quality improvement using frequent PDSA cycles enabled us to alter our practice. Preterm intubation rates are now within the desired range.

Current status and future challenges of high-level biosafety laboratories in China

High-level biosafety laboratories are safe and secure platforms which integrate reliable containment, well-trained personnel, and specific biosafety manuals and practices to protect researchers from being infected while manipulating microbial pathogens and prevent pathogens from being released into the outside environment. During the past decades, laboratories with different protection levels have been constructed and operated, the legal framework and a laboratory biosafety management system have been established, and these operational laboratories have played an essential role in combatting emerging and re-emerging infectious diseases in China. Here, we have summarized the significant achievements of high-level laboratory planning, construction, and operation in China, as well as the challenges that we face in the future. Additionally, we have briefly discussed the national plan for construction of high-level biosafety laboratories from 2016-2025 and “biosafety-motivated” management system. This review might be informative for further understanding the present situation and future function of high-level biosafety laboratories in China.

Promoting self-regulated learning skills in medical students is the need of time

Objectives

Currently, there is a need to develop safe and competent medical graduates. Research reveals that the promotion of learning skills enhances lifelong experience. The objective of this study is to measure medical students' aptitude in four essential components of self-regulation: planning, monitoring, control, and reflection.

Methods

This cross-sectional study recruited 96 MBBS students using a snowball sampling technique. The Internet link to the online survey, designed on Google forms, was shared through Facebook, WhatsApp, and e-mail. A self-regulation questionnaire comprising 22 items was administered to all participants, and the collected data were analysed using SPSS version 20.

Results

Among the respondents, 50 (52.1%) women and 46 (47.9%) men completed the survey. The response rate was 78% (96 out of 123). The mean age of the respondents was 22.5 years. The mean self-regulation score was found to be 71.56 ± 11.19. Among self-regulation components, the lowest score was found for planning, with an average value of 27.01 ± 1.33, and the highest average value was noticed for reflection, 34.08 ± 1.30.

Conclusions

Our conclusions are as follows: although we have included the traits of seven-star doctors in our mission and vision statement, we could not identify the strategies to acquire these traits. One of the strategies involves promoting self-regulation in our students through various teaching methodologies.

Evolution of comprehensive cancer control plans and partnerships

This article explores how comprehensive cancer control plans and partnerships have evolved, over the past 20 years, to meet the ever-changing environment of cancer prevention and control. This evolution has resulted in plans that take a more focused approach in identifying cancer-related priorities and coalitions with structures that have been redesigned to better engage a more wide-ranging group of partners to help address the priorities. Presented in this paper are examples from three states that describe how recognizing the need for change has led to improved processes in updating a cancer plan; strengthened and more diverse partnerships; and coalition sustainment by leveraging and maximizing resources.

[Playing the guiding roles of national criteria and precisely eliminating schistosomiasis in P. R. China]

Schistosomiasis Control and Elimination (GB 15976-2015) and Diagnostic Criteria for Schistosomiasis (WS 261-2006) are the only two national health criteria related to schistosomiasis control program implemented in P. R. China. The roles of criteria to guide and accelerate the transition from schistosomiasis control to elimination are concluded, based on this systematic review how the criteria led the implementation of the medium- and long-term national plan and provided the guidance when drafting the thirteen-five years national plan for schistosomiasis, and the suggestion to draft more criteria related to schistosomiasis elimination program and strengthening the implementation of current criteria, so as to precisely guide the schistosomiasis elimination program in P. R. China.

Diet-derived microRNAs: unicorn or silver bullet?

In ancient lore, a bullet cast from silver is the only effective weapon against monsters. The uptake of active diet-derived microRNAs (miRNAs) in consumers may be the silver bullet long sought after in nutrition and oral therapeutics. However, the majority of scientists consider the transfer and regulation of consumer’s gene activity by these diet-derived miRNAs to be a fantasy akin to spotting a unicorn. Nevertheless, groups like Dr. Chen-Yu Zhang’s lab in Nanjing University have stockpiled breathtaking amounts of data to shoot down these naysayers. Meanwhile, Dr. Ken Witwer at John Hopkins has steadfastly cautioned the field to beware of fallacies caused by contamination, technical artifacts, and confirmation bias. Here, Dr. Witwer and Dr. Zhang share their realities of dietary miRNAs by answering five questions related to this controversial field.

How to approach the acute respiratory distress syndrome: Prevention, plan, and prudence

The acute respiratory distress syndrome (ARDS) is typically manifested by refractory hypoxemia with high mortality. A correct diagnosis is the first step to achieve better outcomes. An early intervention to manage modifiable risk factors of ARDS development and the avoidance of aggravating factors that increase disease severity and progression should be carefully addressed. A management plan is necessary at an early stage of ARDS to determine the level of intensive care. It should be carefully decided which therapeutic measures should be performed depending on the patient׳s underlying clinical condition. The clinician׳s considerate prudence is required in decisions of when to apply intensive measures for an ARDS treatment. Mechanical ventilator support should be carefully used depending on the patient׳s severity and pathological phase. Decreasing inappropriate alveolar strain through a low tidal volume under optimal positive end-expiratory pressure is key for ventilator support in ARDS. The extracorporeal membrane oxygenation applied in the experienced centers seems to improve the survival of patients with severe ARDS. A constellation of physical and psychological problems can develop or persist for up to 5 years in patients with ARDS. Therefore, an early mobilization with rehabilitation, even during an intensive care unit stay, should be seriously considered whenever feasible. Lastly, prevention of aspiration, stress ulcers, deep vein thrombosis, catheter-related infection, overhydration, and heavy sedation is essential to achieve better outcomes in ARDS.

[The wanderings of the communication on the Ebola virus disease]

For two reasons, communication is one of the major tools in the fight against any Ebola epidemics. Firstly, because Ebola is one of the most easily preventable of all infectious diseases and the thorough application of health-protection measures by the community of the sick persons is the best tool to fight any Ebola epidemic. Secondly, because during the two dozens of known Ebola epidemics health care workers have often met with people's skepticism, or even hostility. However, our review of Ebola communication, as defined by WHO since 2013, shows that it has been marked by a series of errors, as well from a strategic perspective as in its concrete deployment. The same communication messages and tools have been used in non-epidemic and epidemic countries. A general ban on hunting has been promoted, while only 2% of sub-Saharan Africans live in areas inhabited by the bats that are the reservoir of the Ebola virus and while it is not proven that hunting is a major risk of infection. Erroneous or inappropriate messages have contributed to doubts and created anxiety. To be effective, Ebola communication should be based on education about the disease, meaning explanation of its cause, its transmission and its prevention.

A comprehensive conceptual framework for road safety strategies

Road safety strategies (generally called Strategic Highway Safety Plans in the USA) provide essential guidance for actions to improve road safety, but often lack a conceptual framework that is comprehensive, systems theory based, and underpinned by evidence from research and practice. This paper aims to incorporate all components, policy tools by which they are changed, and the general interactions between them. A framework of nine mutually interacting components that contribute to crashes and ten generic policy tools which can be applied to reduce the outcomes of these crashes was developed and used to assess 58 road safety strategies from 22 countries across 15 years. The work identifies the policy tools that are most and least widely applied to components, highlighting the potential for improvements to any individual road safety strategy, and the potential strengths and weaknesses of road safety strategies in general. The framework also provides guidance for the development of new road safety strategies, identifying potential consequences of policy tool based measures with regard to exposure and risk, useful for both mobility and safety objectives.

Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies

Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals' chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran's vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5(th) 5-years economical, social and cultural plan (5(th)5YDP:2011-2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5(th)5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5(th)5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization.