China medical news roundup: Monday 11 November

New health minister Li Bin calls for self criticism, rectification and reform

China's newly formed National Health and Family Planning Commission has held a special review meeting to plot its future direction.
Health minister and Commission secretary Li Bin (李斌)chaired the meeting stressed the need to take the topic of democratic life as a starting point, with a focus on rectification and reform implementation, to establish a new system of work, She said it was important to have rigorous thinking so that standards are not reduced, reform intensity is not weakened, and to ensure good educational practice.

    She said the Party attaches great importance to the National Health and Family Planning Commission. It must be fully prepared with in-depth study and improved thinking. Party members have been appointed to make serious systematic study of the central provisions of the the Party's 18th report and General Secretary Xi Jinping’s series of important speeches, for ideological foundation. 

 In her speech, Li Bin stressed the need to pay close attention to the implementation of rectification, addressing outstanding problems, strengthening institutional innovation, and comprehensively promote systems and mechanisms to promote scientific development outcomes. Teamwork and unity are needed to create a new situation in health planning, to achieve the great rejuvenation of the Chinese dream, she said.
Source: Central People's Government

RSV vaccine urgently needed to tackle severe pneumonia

Respiratory Syncytial Virus is responsible for one in four cases of life threatening cases of pneumonia in Chinese children, a study from Suzhou has found.

In a review of 297 cases of children admitted to an intensive care unit with RSV-associated severe pneumonia, researchers found RSV was confirmed in 57% of all children with severe or very severe community acquired pneumonia  and accounted for 24% of all PICU admissions (171/707) during the three year study period. Other viruses identified were influenza (19%; 56/296), para-influenza (5%; 33/707) and adenovirus (1.4%; 10/707). The study found that the mortality rate was 3.5%, with congenital heart disease and Trisomy 21 the main factors associated with death. In most cases the children were under six months of age, all children needed supplemental oxygen and 22% had respiratory failure that required mechanical ventilatory support.

“RSV is a significant cause of life-threatening acute respiratory illness, particularly in the first year of life in this population. Passive immunization is too resource intensive to be feasible preventive strategy for RSV illness in this population. RSVvaccines are under investigation and are urgently needed to protect the very young infant,” the study authors concluded.

Read the full study: BMC Research Notes 

Zhuhai mental health patients dumped by hospital at bus station

Seven female mental health patients, suspected to have been abandoned by their mental hospital at a bus station for more than 25 hours, returned to the hospital in South China on Wednesday afternoon, Guangdong-based Nanfang Metropolis Daily reported.

The hospital head said two medical workers transporting the alleged recovered patients home accidentally "lost" them in the station, and in a flurry, forgot to report the missing patients to police. One patient denied that account.

According to the report, surveillance video shows that at 2 pm Monday, seven people came into the waiting room of the Nancheng Bus Station in Dongguan city of Guangzhou province. No one was seen escorting them. The patients, all in night-gowns and slippers, acted naturally at first and constantly looked at the ticket office. Later some of them began searching for food in the trash can or grabbing food from passengers walking by. They stopped delirious behaviors when someone in uniform appeared, didn't hurt others and slept on the floor, causing no harm but indeed attracting attention, the report said.

A patient in relatively good condition, named A Ying, said the group came from a hospital in Zhuhai, a city in Guangdong province. She said doctors told them they were recovered and could go back home. Medical workers took them to Dongguan city by bus before they left the patients in the waiting room and went to buy tickets. The workers said they were to meet them in the waiting room, but didn't show up again.

With this information, Dongguan police continued their investigation and found that the patients were from Zhuhai-based Baiyun Rehabilitation Hospital.

The hospital said its doctors confirmed they were in sound condition and checked the patients' home addresses before sending medical workers to send them home.

The report said the hospital didn't record any discharge procedure for the seven patients.

The two nurses who sent them to Nancheng Bus Station, Wang Ni and Fan Hong, said they didn't find the patients in the passenger exit, where they had left them when they returned within 30 minutes with tickets and food. The waiting room where the patients were staying is less than 100 meters from the passenger exit, the report said.

Source: China Daily

Cholesterol remains uncontrolled despite use of statins

Only about half of patients treated with statins are achieving heir lipid lowering goals, a Beijing study has shown.

In a cross-sectional study, researchers from Peking University People's Hospital enrolled 25,397 consecutive outpatients aged 45 years and above who had received at least 3 months of lipid-lowering therapy from 120 various tiers of hospitals across China.

Treatment goals for LDL-cholesterol and total cholesterol were assessed based on the Chinese Adult Dyslipidemia Guideline 2007. In an interim analysis of 6386 20% had sedentary lifestyle and 14% were smokers.

The study found that only 62% and 49% of patients reached LDL-cholesterol and total cholesterol goals, respectively, with goal attainment rates decreasing as CV risk increased. Women and patients with diabetes, cerebrovascular disease or CHD were more likely to fail LDL-C goal attainment after adjusting for other patient characteristics.

About 86% patients received statin monotherapy, with simvastatin (37%) and atorvastatin (34%) being the most commonly prescribed. The most common statin potency was equivalent to simvastatin 20-40mg/day. More than half of all patients were considered high or very high CV risk, with hypertension, coronary heart disease (CHD) and diabetes being the most prevalent comorbidities

 “Despite use of lipid lowering drugs, a large portion of patients, particularly those at greater CV risk had persistent lipid abnormalities. There is still an important need to optimize therapy to further bridge the gap between guideline recommendations and current Chinese practice,” the researchers concluded.

Read the full study: European Heart Journal

Distrust of doctors will drive away talent

by Feng Yu

Recent news about doctors in China has not been positive. Medical staff have become victims of violent assaults, sometimes fatal, carried out by patients and their families.

This week pictures of doctors and nurses learning and practicing taekwondo and other self-defense skills at two prominent hospitals in Shanghai drew further public attention to the long-running issue. This is just the latest action implemented following a series of hospital-patient disputes nationwide.

On October 17, an intensive care unit in Shanghai's Shuguang Hospital was smashed and destroyed by the angry family members of a patient.

On October 25, a doctor in First People's Hospital of Wenling in neighboring Zhejiang Province was stabbed and killed by a disgruntled patient who had undergone unsuccessful surgery on his nose in March 2012. Another two doctors were also injured in the attack.

The shocking incident sparked reaction across the country and even drew media attention worldwide.

In the following days, medical staff in Wenling and other cities in Zhejiang gathered in local squares to mourn the deceased doctor and protest violence targeting doctors. On the day of the doctor's funeral, mourning activities nationwide were organized by various medical organizations for people to express their condolences to the doctor's family and their anger toward the attackers.

Hundreds of doctors from Shanghai's Zhongshan Hospital gathered in front of the statue of Sun Yat-sen, after whom the hospital was named, to mourn over the death of their peer in Zhejiang. Some said that conditions are so bad for doctors that they need psychological counseling.

As it turns out, being granted permission to express their emotions publicly was more than what some doctors in Shanghai were allowed. According to anonymous sources, doctors at another major hospital were informed the day before that they would not be allowed to participate in a similar rally in order to maintain stability and harmony at the hospital. In the message, the hospital management warned of possible disciplinary punishment if any staff disobeyed the directive.

We can only imagine how disappointed the doctors at the latter hospital felt.

The different responses of the management at Shanghai's hospitals reflect the difficulties medical staff are currently facing.

A doctor friend told me that quite a number of physicians live with stress. Media reports about extreme examples of corrupt doctors have tarnished the reputation of the profession as a whole and created general public distrust toward hospitals. Doctors are scorned as hongbao receivers, pharmaceutical kickback takers and criticized for being indifferent toward patients. Hospital-patient relations have deteriorated to a very poor level.

My friend told me that with or without hongbao, doctors try their best to save or cure a patient. But the friend also admitted that many doctors are not firm enough to reject hongbao.

At the same time, recent reform of the public health system which encourages hospitals to support themselves through drug sales also plays a negative role in burdening patients, who then direct their discontent and anger at the doctors who treat them. To some extent, doctors are scapegoats of a flawed medical system.

It's therefore understandable that hospitals have organized self-defense classes for staff. Although the burden shouldn't fall on them, unfortunately, doctors are increasingly feeling the need to know how to protect themselves.

Survival tips online recommend that doctors don't leave their back to the door, and, if there is potential trouble, doctors should remove their white lab coats and hide amongst a crowd.

Being a doctor is a respectable and decent career. Only the best and brightest can shoulder the responsibility of healing the wounded and rescuing the dying. Even when a procedure fails or a patient dies - as is sometimes unavoidable - doctors still deserve respect for trying to help others. If being a doctor becomes an unfavorable career choice and elite talents spurn the profession, who will treat us when we are ill? Disgruntled patients should not bite the hand that heals.

What can be done to restore the public's faith in our physicians? Structurally speaking, a good environment is needed to guarantee that doctors can concentrate on medical research and practice. Their income level should match their efforts and expertise. Their earnings shouldn't be tied to the amount of drugs they prescribe. At the same time, doctors ought to practice strict self-discipline when it comes to hongbao or kickbacks.

The media also shouldn't focus solely on negative stories while neglecting the majority of positive cases.

Finally, the general public must be understanding of the pressures and challenges medical staff face and realize that they cannot cure every ailment.

Source: Global Times