China's primary care sector suffers from "Just a GP" syndrome

by Michael Woodhead

While the Chinese government aims to promote primary care and reduce the hospital-centred approach to healthcare, the situation at the coalface suggests this is going to be an uphill struggle. A report from Henan shows that while the city of Zhengzhou has 54 primary care centres, they are unpopular with both patients and doctors. According to an article in the local newspaper, the main problem is 'lack of talent'. The community medical centres fail to attract talented doctors because they are seen as a career dead end with low pay, low status and few if any opportunities for training or promotion.

A former respiratory physician who now works at one of the clinics says the failure to attract and retain reputable doctors to work a primary care centres is a vicious circle. With salaries of only 2-3000 yuan (US$300-400) a month for doctors working in community medical centres, the hospital based staff would rather switch to a remote rural branch of the hospital rather than work in one of the city-based community clinics, says Dr Song Gang, who became a primary care practitioner in 2008.

But it's not just the low wages that deter would-be general practitioners. Dr Song says doctors fear that in community practices they will only see minor problems and will therefore become de-skilled. This in turn will mean that they no longer qualify for promotion and career advancement, he says.
Another problem with the lack of 'medical talent' in community centres is that the few doctors who do work there are overworked, facing long hours for little reward. This again leads to a high rate of burnout and high staff turnover, as well as lack of continuity of care for patients.

Professor  Cui Liuxin, a specialist in public health at Zhengzhou University says the key to building up primary care is investing in talent, and making community centres more attractive to high level doctors. However, he says this is not going to happen overnight. In the meantime, local clinics and village hospitals are shunned by patients and represent a waste of resources and workforce. At the same time, city hospitals are overused by people with minor ailments, leaving them swamped and unable to cope with the high demand.

The Zhengzhou city planning commission says it aims to create a stronger primary care workforce as part of a six year plan  based on training and recruitment for community clinics. However critics say that a six year time schedule is unrealistic, and it will take even longer than this to build up a well-qualified and capable primary care medical workforce.

The workforce planning committee said that pilot programs had shown that doctors could be attracted to work in primary care community clinics with financial bonuses, investment in medical hardware and also with extra support support for ongoing doctor training and education.

It remains to be seen whether local clinics will be able to attract and retain high quality healthcare staff.

Hospital gangster siege reveals the murky side of China's healthcare management

by MICHAEL WOODHEAD
The bizarre 22-day occupation by mobsters of a hospital in Zhengzhou, Henan, is a revealing example of the murky finances and power arrangements behind China's hospitals. 

In late December almost 100 unidentified men invaded the Zhengzhou Meixin Chinese Medicine Hospital and disrupted its operations for more than three weeks. According to Chinese media, the men  - many wearing masks - obstructed the lobby, harrassed medical staff, put up banners and drove patients away. The hospital was thus put under siege by local thugs who stayed in the building playing cards and intimidating anyone who entered.

However, this was not the result of a medical dispute by aggrieved family members of a sick patient, but an extortion attempt to try recoup huge unpaid debts owed by the hospital manager, Wang Guangyu. According to Chinese media reports, the mob had been sent in to force Wang to make good on 17 million RMB funds that he owed to a distant relative, Li Jing. Her husband had previously invested more than 40 million in the hospital via Wang Guanyu, but after the husband died last year, the funds were not repaid in full. After several rebuffs, Li Jing called in the rest of her family to put some muscle on Wang.

In any other country a dispute like this would be settled by the police and the civil courts. However in Henan, amazingly, the ringleader of the occupation gang, Guo Zhiyang, was himself the leader of the local justice department and a former senior policeman.

For someone who is supposed to be upholding the rule of law, Gui Zhiyong appears to be a pretty lawless and criminal character. During his occupation of the hospital staff were threatened by men bearing knives and poles. One pregnant member of staff was so terrorised that she went into premature labour.

The incident ended on 9 Feb after provincial media became interested. When outside journalists first visited the hospital they were rebuffed, but were able to make some reports and take pictures. When this made the news beyond Zhengzhou, the occupiers slipped away, leaving the hospital deserted.

Guo Zhiyong could not be found but he issued statements saying he had been trying in a reasonable and lawful manner to handle personal matters with family. He accused the media of slander through their portrayal of him as a gangster and said he would take appropriate action to defend his reputation.

The whole saga may be an instructive lesson for any foreign companies contemplating running a hospital in China!

[Note: this incident is also reported by a "Gloria Chan" of the SCMP . However, the article so sanitised and anodyne as to be incomprehensible. Presumably this is the SCMP's way of trying to please the Chinese government by not washing China's dirty linen in public.]

Drug sale reforms; Autistic children abused; Tibetan monks don't get hypertension; Guangzhou's first private clinic; Doctors stabbed in Fuzhou; Tax breaks for private health insurance

by MICHAEL WOODHEAD
The move to stop county-level hospitals from deriving their income from 15% markups on pharmaceuticals will severely dent their revenue stream and threaten services, health economists have warned. China has already trialled  drug commission bans in 300 county hospitals and now plans to extend the system to 1000 hospitals nationally, Caixin reports. However, the plan could leave hospitals short of funds and thus reduce the level of services and hurt the morale of medical workers,  academics and doctors say. The State Council has said local governments should help hospitals to make up for the lost income from drug sales. However,Wang Zhen, a research fellow at the Chinese Academy of Social Sciences, said local governments were already strained financially and they don't have extra money for hospitals.Wang said that without government subsidies and other measures in place, scrapping the markup practice might wind up creating other problems because hospitals will find alternative ways to make money.

Children with autism in China face experience high rates of physical abuse from their parents and family members, a study from Henan shows. In a survey of 180 children with autism, Zhengzhou researchers found that 36% had recently experienced severe physical maltreatment such as slapping on the face, being beaten with objects or kicked. Less severe physical maltreatment such as being slapped, or shaken was experienced by 86% of autistic children.

Tibetan monks have low rates of hypertension, according to a study carried out in Gansu. The survey of 984 monks found that 19% had hypertension, compared to 34% of the local population. However, despite having low rates of high blood pressure, there were also low rates of awareness, treatment and control of hypertension among monks, the researchers found.

Encouraged by new government policy a surgical oncologist has opened Guangzhou's first major private clinic. The clinic set up by Dr Lin Feng will offer speedy diagnosis and high quality treatment by a well known surgeon previously practicing at the renowned 3rd Hospital of Guangzhou. The clinic charges about 2-3000 yuan fees, and offers high quality diagnosis and surgery without the long waits and rushed consultations of public hospitals, its operators say.

Two doctors at a Fuzhou hospital were stabbed in an attack by a 66-year old male patient, local media report. One male and one female doctor were seriously injured by the man armed with a 40cm knife who had been attending the Fuzhou hospital to have his haemorrhoids treated. A hospital spokesman said the man was unhappy with the treatment he received for his haemorrhoids and stabbed a female doctor in the hip. The male doctor who tried to restrain him was also stabbed in the arm.

Tax breaks are to be introduced for Chinese consumers who take out private health insurance, the government has announced. People who spend more than 2,400 yuan on commercial health insurance policies per year will now only pay individual taxes on income above 3,700 yuan per month, instead of 3,500 yuan, CCTV has reported. The move is part of a government campaign to encourage Chinese people to  purchase private health policies in addition to their standard government benefits.

Dengue crisis worsens as disease spreads north

by Michael Woodhead
China is now experiencing its worse outbreak of dengue fever in two decades, with almost 1000 cases a day being recorded in south China, and the infection spreading as far north as Henan.
Outbreaks of the serious infection spread by the Aedes mosquito are centred around Guangdong, where almost 43,000 cases have been recorded this year.
However, the disease is now affecting other parts of China, including  Zhejiang, Fujian, Yunnan and Guangxi, according to the National Health and Family Planning Commission (NHFPC).
"The outbreak of dengue fever this year is the worst in China since 1995, when 6,812 cases were recorded," according to Qin Chengfeng, a researcher with the Chinese Academy of Military Medical Sciences.
Alarm bells are ringing because the infection has also been reported as far north as Henan, half way between Shanghai and Beijing. Researchers say this is the first time the disease has been seen so far from the traditional areas of south China. Infectious disease experts said there were more than 50 cases of dengue fever reported in Shenhou township, presumably imported by migrant workers who had been in south China and Laos. They said the findings should act as a warning that the disease is spreading rapidly within China.
Other experts have attributed the spread of dengue to changing weather patterns, pointing to high rainfall that encourages the breeding of the Aedes mosquito.

In China's hospitals, one in three doctors have latent tuberculosis infection

by Michael Woodhead
It's an avoidable occupational hazard that Chinese doctors could well do without: tuberculosis. 

A  study carried out in a general hospital in Henan has found that one in three healthcare staff have latent tuberculosis infection. The figures are even worse for a nearby infectious diseases hospital where almost 60% of doctors had latent tuberculosis infection.

First some clarification: as the CDC points out:

Persons with latent TB infection do not feel sick and do not have any symptoms. They are
infected with M. tuberculosis, but do not have TB disease. The only sign of TB infection is a
positive reaction to the tuberculin skin test or TB blood test. Persons with latent TB infection
are not infectious and cannot spread TB infection to others. Overall, without treatment, about 5 to 10% of infected persons will develop TB disease at some time in their lives.

So, people with latent TB do not pose a serious risk to patients, but they themselves face a high risk of developing active tuberculosis disease.

In the study of 712 healthcare workers at a 1600-bed general hospital and a 600-bed infectious diseases hospital in Zhengzhou, researchers found that the tuberculin skin test-positive prevalence was 34% in the general hospital and 58% in the infectious disease hospital.

Dr Zhou Feng and colleagues who did the study said that health staff faced high risks of tuberculosis if they worked with infected people, such as those with HIV who often have co-infection with tuberculosis. Rates of infection were also highest in staff with longer years of working in the hospitals, presumably due to greater duration of exposure to risk.

Writing in PLOS One they said many staff did not use personal protective equipment such as  face masks and N95 respirators when working with infectious patients, despite this being recommended in guidelines.

Another problem with detecting and treating tuberculosis in healthcare workers was the low rate of tuberculin skin testing for the infection: many healthcare workers refused testing, and the most effective testing kits were too expensive for many Chinese hospitals. The findings also highlighted the limitations of the regular chest X-rays used to screen workers for active tuberculosis disease.

As the authors conclude - more emphasis is needed on observing and adhering to basic infection control and prevention practices in Chinese hospitals:

"Comprehensive guidelines should be developed for different types of medical institutions to reduce tuberculosis transmission and ensure the health of healthcare workers," they suggest.

Police set up 'safe rooms' in 90% of Henan hospitals

Setting up police-supervised safe rooms  has helped curb three major problems in Henan hospitals: violent attacks against staff, organised gangs of scalpers and theft.

The 'independent police service rooms' have been set up primarily to provide a place where frustrated patients can have their grievances attended to without them posing a physical risk of assault to hospital staff. According to CNTV, the rooms are staffed by police with protective gear and the rooms are equipped with panic buttons and camera surveillance equipment in case things get out of hand when emotions run high between doctors and patients.

The police presence also helps to curb the presence of organised gangs of scalpers who lurk around hospitals, selling registration tickets that help those with money jump the queue and avoid waits of many hours to get in to see a doctor. These same gangs also use their 'muscle' to intimidate staff on behalf of aggrieved families in an attempt to extort compensation - from which they take their cut.

"We feel a lot safer now. It provides an open platform for us to communicate with the patients, and it helps us solve medical disputes. Also, there's been less theft,"  said a senior doctor at a hospital in Zhengzhou that had installed a police room.

After a series of high profile assaults and killings of medical staff in recent months, China has increased penalties for violent disputes against health workers. There have also been reports of riot police being brought into hospitals. However, doctors say the root causes of the problem have not been - an overloaded hospital system in which patients wait hours to see a doctor and then only get a few minutes before being over-prescribed medicines with high markups.

Respectable doctor ran an illegal abortion clinic in Henan, now on the run after women died

by Michael Woodhead

A doctor working for the health department of  Nanyang city in Henan is a fugitive on the run after a 32-year old woman died at an illegal abortion clinic she was running as a sideline from a private apartment in the city.

In a story published in a local newspaper, the family of Ms Cui Hengjuan told of how she died after undergoing an abortion at the clinic run by a doctor who they trusted because she was an official at the local health department.

Ms Cui was the mother of a seven-year old girl and when she was almost three months pregnant with a second child she went to the private clinic run by a Dr Cui (no relation) for an ultrasound scan to determine the sex of the fetus. She trusted the clinic because Dr Cui was an official in the local health department, where she worked as a tuberculosis control officer in the Communicable Disease Centre. She also claimed to have run the clinic for 20 years, and told Ms Cui her experience meant she could offer reliable and safe sex determination and abortion services.

When the scan revealed the fetus was a girl, Ms Cui requested an abortion as her family wished for a baby boy. Dr Cui arranged for her to take medication to induce an abortion. Ms Cui went home but began to feel uneasy, so she returned to the clinic, where the doctor put her on a drip. However, Ms Cui felt worse and in the middle of the night she went into shock and stopped breathing.

The family were distraught and went to the health department and police station to complain. However, when they returned to the clinic they found that Dr Cui had slipped away and there were strangers taking the ultrasound equipment away.

According to the newspaper, a journalist went round to the illegal clinic and found only a locked apartment in a block opposite the maternity hospital, with nobody at home. The landlady knew a doctor had rented out the apartment but said she was not aware she was running a clinic on the premises. However, neighbours said the clinic was always busy with women coming and going, , especially on the weekend.

The journalist sought comment on the matter from the local health department, the director said they knew Dr Cui only as a doctor employed in disease control. They had no reports or knowledge of her running any private clinic. The health department said they had no idea of Dr Cui's whereabouts. When informed of the death of the woman, the health department said they would suspend Dr Cui pending an investigation into her clinic.

The police told the newspaper that they had opened a file on the case, but had been hampered because the family had refused to consent to an autopsy on the woman who had died. A spokesman for the police said they were seeking Dr Cui, but they currently did not know where she was.

Africans face health discrimination in China | Cochlear implants success | Fake doctor operates on 1500 women | Psychiatrist says 10 words charges 1000 yuan fee

Africans in China face medical discrimination
With the growing economic links between China and Africa there are as many as 100,000 Africans in Guangzhou but they lack access to healthcare, an article in The Lancet this weeks says. Africans in China face racial discrimination, which fuels mental health problems and also is a barrier to them getting access to needed health services and support. Many Chinese people maintain stereotypes toward Africans viewing them as prone to violence and posing risks to public health through spreading diseases, the article says. While China sends medical teams to Africa, it ignores the Africans living within China.
"Providing Africans medical care is consistent with China's health-care reform, but the system has failed to close the treatment gap. Chinese doctors are not trained in culturally adapted care or in the management of specific diseases affecting Africans, and translation services are unavailable," the article concludes.

More Chinese medical tourists
Affluent Chinese are now seeking medical care overseas, according to CCTV. Their report says more Chinese are going to foreign countries for treatment and the trend is blamed on the lack of access to high quality clinics in China.

No takers for dispute insurance
Few people are choosing to take part in a new surgical insurance program that is designed to reduce medical disputes. The new medical insurance scheme pays only in the event of unsatisfactory results caused by medical malpractice not covered by traditional medical indemnity insurance.

Bionic ears work well in China
Cochlear implants have been used successfully in hundreds of Chinese deaf children and have had few complications, according to a new report from Henan. Cochlear implantation is a safe procedure and early postoperative complications are minor, say clinicians from the Department of Otology at the First Affiliated Hospital of Zhengzhou University.

Fake doctor did nearly 1500 operations
A bogus surgeon working at a gynaecology clinic in Henan performed 1485 operations on women and made almost half a million yuan in profit before being caught, Zhengzhou media report. The Pingdangshan court sentenced bogus doctor Ma Juan to nine years in prison and fined him 300,00 yuan for performing minimally invasive surgery on women at the Third Peoples Hospital gynaecology clinic. The manager of the clinic was also jailed for 12 years for employing the fake doctor and encouraging him to exaggerate illness and overtreat women with unnecessary but profitable operations such as cervical cauterisation and nerve blocks.

Psych clinic has few words of comfort
A Chongqing father has complained of extortionate charges and poor doctor-patient communication at a mental health clinic where he took his uncommunicative 'autistic' daughter for treatment. The man told the Chongqing Evening News that he had to pay almost 1000 yuan for antidepressant medicines after a brief consultation with a doctor who did not speak more than ten words to him or his daughter. The father sad the costs for the questionnaire test and brief consultation were excessive. A medical expert said mental health clinics were under a lot of time pressure and were not designed to provide psychotherapy but to treat psychiatric diseases. If patients want to talk more they should visit a psychologist, he suggested.

Pneumoconiois: China's neglected occupational disease

by Michael Woodhead
Delegates at the National Peoples Congress have called for a compensation fund to be set up for China's leading cause of occupational disease - dust-induced pneumoconiosis. 
Many people were moved recently by the high-profile case of a young Henan man who suffered from the disabling condition, and he was lucky in winning media attention for his case, and securing 30,000 yuan to pay for his treatment costs. However, representatives say that for the vast majority of patients with pneumoconiosis in China there is no such happy ending. Despite being the leading occupational disease, most of the patients are migrant workers, of whom as many as 600,000 are thought to have penumoconiosis. Since most migrant workers are on low wages, few can afford treatment and the disease progresses to the point where they suffer a slow and painful death. For some patients the pain and disability are so much that they commit suicide.
A few local governments have set up schemes to help pay for the treatment of pneumoconiosis, but most patients live in impoverished rural areas where funds are not available for treatment.
At the NPC, one delegate who is the head of the Changsha Hospital, Dr He Binsheng proposed a simple policy that would help end many of the problems with pneumoconiosis patients once and for all. DR He said the answer was to set up a pneumoconiosis treatment fund and also a dust-disease inspection board to supervise high risk industries and prevent further cases from happening. The fund would help pay for the treatment of patients and also provide some social support for their families. Governments could co-operate to set up regional pneumoconiosis treatment and rehab centres for those who are rendered unable to work through pneumoconiosis disability, he said.
Dr He was supported by a Hunan deputy, who said compensation should come from a workplace injury compensation scheme.

China's media lauds the "4 cent prescription doctor"

The Chinese-language version of the China Daily is lauding a Henan doctor who prescribed a treatment for a child's rash (an antihistamine) that cost only 4 cents. The cheap cure is seen as big news at a time when many Chinese are complaining about the high costs of medical treatment. The story is based on the overwhelming web response to the Weibo posting of a mother of a two-year-old child, who posted that she couldn't believe how cheap it had been for her child's treatment.
The Weibo post described how she took her child to see a doctor at the Zhengzhou People's Hospital No 3 paediatrics department. The female doctor there told her the rash was due to an allergy and she would prescribe an antihistamine called chlorpheniramine. Based on her previous experience with hospitals, the mother expected to pay several hundred yuan for a long course of medicines - and so she was very surprised when she only had to pay 4 fen for 4 tablets of the antihistamine. She was so impressed that she took a photo of her hospital bill. She was also doubtful that such a cheap treatment could work, and so was again surprised when her child made a quick recovery from the rash.
When she posted this on Weibo, her story and photo was immediately re-posted thousands of times, with netizens starting an online discussion about the high cost of treatment and the difficulties of getting to see a doctor. Many praised the doctor at the children's hospital and said such doctors were hard to find these days.
When a China Daily reporter tracked down Dr Qin Ruijuan, she said her 4 cent prescription was nothing special and that she had only been doing her duty. "Any other doctor in my position would have done the same thing," she said. Dr Qin said the antihistamine was the most appropriate drug for the condition and only a short course was needed.
Dr Qin said some patients believed that doctors made a lot of money in commissions when prescribing drugs and treatments, but this was not the case. She said there was no link between doctors' incomes and treatments ate her hospital, nor were there any targets or quotas.
The China Daily reporter wrote that this was supposed to be the case at all hospitals and a new directive from the National Health and Family Planing Commission issued in December had re-iterated this rule. This included a new series of prohibited practices in healthcare, known as the 'Nine Forbiddens' included taking commissions or kickbacks from prescribing and having quotas  or targets for treatments and prescriptions.
However, the reporter noted that there was a trend for hospitals to stock newer and more expensive medications at the expense of cheaper medicines . This led to a situation where it was impossible for doctor to prescribe affordable medicines because they were not stocked by the pharmacy. And because the profits were so tiny with cheap drugs "manufacturers don't want to make them, pharmacies don't want to sell them and doctors don't want to use them".

Rabies on the increase in China as pet dog ownership rises

by Michael Woodhead
Cases of rabies are increasing exponentially in China as more dogs are kept as pets, a study from Henan shows.
Dr Li Guowei and co-researchers from the Zhengzhou Center for Disease Control and Prevention say that rabies was unknown in Henan until the 1960s, and there were only about 10 cases a year until the year 2000. However, since then the number of cases of rabies has increased exponentially each year, with more than 100 reported in 2005 . The researchers say the rise in rabies has paralleled the increase in pet ownership as China became more wealthy. About one in four cases is in children who may have been bitten by domestic dogs, the article in Emerging Infectious Diseases notes.
Most patients died within two days of being exposed, and three patients who died had received rabies vaccine after being bitten by dogs.
The high cost of rabies vaccine and the lack of prompt treatment were related to many additional deaths, the researchers said.
“The severity of rabies and its increased incidence present a public health threat, and appropriate control strategies in Henan province are needed. A new rabies control system should be established that includes cooperation of the various health care sectors to provide protection to the public,” they conclude

Henan surgeons remove 0.5kg lump of hair from 12-year-old girl's stomach

Surgeons in Henan have removed a 0.5kg lump of hair from the stomach of a 12-year old girl who had a one year history of wasting. The girl's mother said her daughter used to have long hair down to her waist and often put it in her mouth, but she never imagined she was eating and swallowing it. When she started to lose weight and go off her food, she was taken to the hospital for examination. A CT scan revealed the stomach blockage, and the hair was removed in a one hour operation. 
Source: Dahe Bao

HPV a risk factor for oesophageal cancer as well as cervical cancer: Chinese study

Human papillomavirus (HPV) infection is known to be associated with cervical cancer and now Chinese researchers have shown that HPV plays a similar role in the etiology of oesophageal cancer. According to a study in the Archives of Virology,  researchers in Linzhou, Henan, found that infection with high risk HPV types was the risk for both cervical dysplasia and oesophageal cancer by four fold.

Doctors warn of oestrogen in meat as Henan girl develops puberty at 4 years of age

by Michael Woodhead
Doctors in Henan says the precocious puberty reported in a 4-year-old girl may have been caused by her mother's use of oestrogen-like drugs while breatfeeding or by her intake of foods such as chicken that were high in added hormones.
The girl from  Pingdangshan is reported to have developed breasts and started menstruating at the age of four. She is now undergoing treatment at the local hospital but her family say they cannot afford the 2000 RMB cost of monthly injections that she will need until the age of 12 to counter the condition, according to a report from Xinhua.
The girl comes from a poor farming family in the mountainous and deprived Ruzhou country. Her parents say the puberty effects first started to appear when she was two years old. Her family took her to the local hospital but it was only a very basic clinic and the doctor there did not have the expertise to examine or diagnose a hormonal condition in a small child. She was only diagnosed properly when they took her too the city of Zhengzhou. Even at that early age, doctors said her skeleton resembled one of an 8 or 9 year old. The Zhengzhou hospital clinicians worked out a long term treatment plan for the young girl who was already showing signs of breast development and menstruation. However, her family struggled to find the 30,000 RMB needed to pay for monitoring tests and hormonal treatment.
A doctor involved in the case siad the girl was showing body changes at 3-4 years of age that would normally only start at 8-9 years of age at the very earliest. He feared that f the girl did not get proper inhibitory treatment she would suffer physiological damage and show premature ageing.
As to the cause of the condition, he said it appeared to be due to external factors rather than an inherited or innate disease. he speculated that the premature puberty might have been caused by early exposure of the girl to high levels of sex hormones such as oestrogen. This might have occurred as she was breast fed and her mother had used medicines that contained the hormone. In addition, the precocious puberty may also have been made more likely due to hormones in the food she and her mother consumed.
"We advise families that food such as chicken, beef, soya milk and egg white can all contain high levels of oestrogen and should be eaten in only small amounts by daughters in particular."

Clinical research from China in the medical journals ...

In the Journal of Thoracic Diseases, Dr Xiao Kun and colleagues at the Department of Respiratory Medicine, PLA General Hospital, Beijing, evaluate prognostic indicators for  Community-acquired pneumonia in elderly patients. In their study of 240 patients they found that Pneumonia Severity Index scores were the best indicator in predicting different clinical outcomes of aged patients with CAP, when compared to testing for N-terminal pro B-type natriuretic peptide (proBNP) levels and three other scoring systems. They also found that systolic BP might be as a protective factor for prognosis of CAP.

Celecoxib may be an effective way of preventing the formation of joint adhesions, according to Shanghai researchers. In the journal Experimental and Therapeutic Medicine, 

orthopaedic surgeons from the Sixth Affiliated People's Hospital of Shanghai Jiaotong University report on an animal experiment in which they tested the inhibitory effects of celecoxib and ibuprofen given for 30 days on joint adhesions. Few adhesions were seen in the celecoxib treated animals, suggesting that the drug “may provide a novel and potent approach for their prevention,” they conclude.

In the same journal, cardiologists from the People's Hospital of Zhengzhou University, Henan report that Chinese patients with chronic heart failure have poor outcomes by international standards. Survival rates of 685 patients with chronic heart failure (HF) and reduced ejection fraction (HFrEF) were assessed during follow up of around 30 months.

 The fatality rate was 28%, with most due to pump failure 6% due to sudden deaths. The predictors of mortality were advanced age, BMI, NYHA functional class and lack of oral β-blockers at discharge.

“Patients with heart failure and reduced ejection fraction have poor prognoses in China, particularly those patients with an LVEF of ≤35%. Therefore, cardiologists should strive to improve the prognosis of HF among Chinese patients and focus on the importance of the practical application of HF diagnosis and treatment guidelines,” the researchers said.

In the European Spine Journal, bone specialists from Jinan Military General Hospital, Shandong, show that the most important risk factors for recurrent fractures after vertebroplasty are osteoporosis and treated level at the thoracolumbar junction. In a one year follow up study of 175 patients who underwent vertebroplasty for first-time and single-level osteoporotic vertebral fractures. They found that recurrent fractures developed in 37 (21%) of patients. Higher fracture rates were seen in pateints higher BMD T-score, and treated vertebrae located in the thoracolumbar junction.

Video shows Hebei medical staff protesting against 'barbaric' patients

A video has been uploaded showing what purports to be a demonstration by doctors and nurses in Handan, Hebei, against "barbaric" and rude patients. 
Source: Liveleak