Impressions of an American medic on a Chinese hospital ward round

Blog post by Dr Zachary Sholem Berger: "I sat in on rounds at Peking Union Medical College Hospital, my host and one of the top-ranked hospitals in China. The General Internal Medicine Division is renowned for its ability to treat the hardest cases and consistent high reputation, which becomes a self-fulfilling prophecy in certain respects (sound familiar?).
The similarities are not all that interesting: the team sits round a table and talks about the new patients, then walks through the wards seeing the old patients. Questions are asked to put medical students on the spot (in American English we have a word for that). The differences, however, are somewhat instructive.

Hospital clinicians face infection risk from procedures

Hospital clinicians face a high risk of respiratory infection when performing high-risk procedures such as airway suctioning, a Chinese study has found.
In a prospective study of 481 hospital healthcare workers in China, those who performed a high risk procedure had a threefold increase in the risk of respiratory infections.
The findings should inform occupational health and safety policies, say the researchers from the Beijing Centre for Disease Prevention and Control.
Source: Epidemiology and Infection

Reference values for bone mineral density developed for Chinese infants

Clinicians from Hubei have developed reference values for lumbar bone mineral density in healthy Chinese infants and young children. 
In a study of almost 12,000 healthy children aged 0 to 3 years who underwent regular physical examinations at the Child Health Care Clinic of Hubei Maternal and Child Health, researchers obtained BMD measurements of the lumbar spine (L2–L4) with dual-energy X-ray absorptiometry and a questionnaire. They also obtained BMD values for 379 preterm infants The results showed that lumbar BMD significantly increased with age among both boys and girls, with fastest growth observed during the first postnatal year. There was no significant difference in lumbar BMD between boys and girls of similar age, either among healthy reference children or preterm infants. However, BMD values in preterm infants were significantly lower than those in term infants 3 to 8 months old after adjustment for gestational age.
There were significant positive associations between lumbar BMD of healthy children and the child's age and current weight, mother's weight gain during pregnancy, birth weight, children's outdoor activity duration and children's physical activity duration.
Source: PLOS One

'Cancer street' set up by Hunan outpatients having treatment

Half a kilometer in length, the narrow Jiatong Street that cuts through the Hunan Provincial Tumor Hospital and Hunan Normal University Medical College has been dubbed "Cancer Street," as it is populated by hundreds of cancer patients seeking treatment at the hospital. 
It began with some patients who rented apartments in the street for long-term medical treatment, and after some time it naturally developed into a neighborhood accommodating hundreds of patients, most of whom live here for a couple of months at a time.
The street has fully adapted to its population. Small hotels full of tenants occupy this area, with groceries, eateries and pharmacies serving their needs. It looks like a common, rundown yet lively backstreet seen in most cities, but look closer and the vegetable shops here also sell stoves and woks to tenants, clothing shops offer wigs to those losing hair from radioactive treatment, and pharmacies and clinics are also a source of psychological support for patients fighting the fear of cancer.
On a fine day, tenants spread white bedding under the sun, like those in the hospital. Coming from all over the province, the tenants usually share their experiences in combating the diseases and try to encourage each other.
Some patients who have recovered and left Jiatong Street call it the "old place" that they will visit again, but not everyone will be fortunate enough to reminisce about this place.
Source: Global Times

No H7N9 mutation: health ministry

No mutation of H7N9 bird flu has been monitored yet and transmission from animals remains the only way in which humans have picked up the virus, China's health authority said on Tuesday.
Speaking at a press conference, Yao Hongwen, spokesman for the National Health and Family Planning Commission, noted that there have continued to be sporadic reports of H7N9 infections.
China confirmed three new cases this month, with two in Hong Kong and one in east China's Zhejiang Province, and Yao said that local authorities have tightened prevention measures.
The spokesman promised that the commission will continue to strictly control infection sources and release relevant information on a timely basis.
The mainland has so far reported a total of 140 H7N9 cases, including 87 patients who have recovered.
Source: Global Times

Six Guangzhou hospital staff injured in dispute over pregnancy death

Six hospital staff members were injured, three seriously, when they were attacked with sticks over a medical dispute on Monday, Nanfang Daily reported.
The incident occurred around 3 pm on Monday at a mourning hall in Elizabeth Women’s Hospital in Guangzhou, Guangdong province.
An officer with health bureau in the city’s Liwan district told the paper that relatives of an eight-month expectant mother caused damage to the hospital and injured six medical workers after 26-year-old expectant mother, surnamed Peng, suffered complications. Doctors were unable to save the baby. The distraught family blamed the doctors and became violent.
A witness, surnamed Li said the disturbance lasted more than 20 minutes and relatives and friends of the family beat hospital staff with sticks, the report said.
Police detained suspects and an investigation is underway.
Source: China Daily

Police station set up in Zhejiang hospital to deter attacks on doctors

by Yan Yiqi
Police in Taizhou, Zhejiang province, have started patrols at hospitals in the city to ensure the safety of medical staff and to maintain order.
The patrols follow increased doctor-patient disputes that include a doctor in the city being fatally stabbed by a disgruntled patient in October.
Taizhou Municipal Hospital is the first one where police officers and security equipment have been stationed.
Three police officers are assigned per 100 medical staff and security guards at the hospital are equipped with stab-proof vests and gloves and tear gas in case of emergencies, said Xu Guocai, deputy director of the Jiaojiang district police department in Taizhou.

Coeliac disease widespread in China

Coeliac disease is more common than has been reported in China, according to a new study by researchers from Nanchang University.
Coeliac disease is an autoimmune disorder caused by genetically susceptible individuals consuming food and drinks made from wheat, barley or rye and therefore containing gluten. Gluten proteins can induce inflammation in the small intestine, hindering the uptake of nutrients, and can also disturb the normal functioning of other organs. In the Western world, prevalence of the disease is between 0.5 and 2 percent of the population. Despite the fact that China is the world’s largest wheat producer and has a high and rapidly increasing consumption of wheat and gluten-containing products, coeliac disease was considered to be rare in China and had not been studied thoroughly.

One in four Chinese households face 'catastrophic' medical bills

by Michael Woodhead
Up to one in four households in some parts of China  experience catastrophic medical expenses, a study from Shanghai has found.
Dr Li Xiaohong and co-researchers from the School of Public Health, Fudan University analysed data from a survey of 11,577 households conducted in eastern China in 2008.
They found the incidence of household catastrophic medical expenses ranged from 9% to 25%. Households were more likely to experience catastrophic medical expenses if they were in rural areas, had a family member with chronic diseases, had a child younger than five years old, had a person at home who was at least 65 years old, and had a household member who was hospitalised.

Shanghai Family Planning official arrested in GSK corruption investigation

A family planning official of Shanghai has been suspended from his job amid claims he is connected to an ongoing investigation into UK drug company GlaxoSmithKline.
Huang Fengping was vice director of the city's Commission of Health and Family Planning, but his name was removed from the commission's official website late last week.
A source with knowledge of the matter told Shanghai Daily yesterday that Huang had been taken away by the Ministry of Public Security and that its investigation was in connection with economic issues related to the GSK bribery scandal.
Officials from the commission declined to comment yesterday.

Telehealth trialled in Xinjiang regional hospitals

Liu Xiaohong, deputy director of the cardiovascular medicine department of Karamay Central Hospital, successfully worked with Wang Yan, an expert from Wuhan Tongji Hospital, through a teleconsultation platform to develop ideal treatment plans for two cardiovascular patients.
The two elderly patients have been diagnosed with coronary heart disease and chronic obstructive pulmonary disease, respectively, and have been given proper treatment after a series of check-ups, including electrocardiograms and CT scans, and teleconsultation video conferences.
This is not the first time that Karamay Central Hospital has integrated telecommunication technology with diagnosis and treatment. It is cooperating with more than 20 famous hospitals from around China to deliver high-quality medical service and care.
Source: China Daily

Fujian man hijacks ambulance to take girlfriend to hospital

A man named Shi was detained in Fujian province last week after he hijacked an ambulance in an effort to get his ill girlfriend to the hospital, according to reports.
Police said the man will be serving 20 days' detention for "disturbing order at a workplace" after he attacked the ambulance's driver so that he could steer the vehicle.
Netizens are now debating whether or not the man's actions were just, with many praising his determination to help the girl, who was suffering from gas poisoning.
"This just goes to prove that in China you have to do things yourself," one user said.
The woman had originally been admitted to the Xiamen Hospital of Traditional Chinese Medicine but had to be transferred to another hospital with more suitable equipment. Shi, who was impatient after filling out lengthy paperwork, assaulted the ambulance driver so that he could get her to the next location more quickly.
The doctor in the ambulance said in reports that the woman's life had not been in danger.
Source: Shanghaiist

A gloomy future for medical students in China

Article in The Lancet by Dr Zeng Jie of the Mental Health Institution of the Second Xiangya Hospital, Central South University, Changsha, Hunan

 

in The Lancet:According to the Chinese Medical Doctor Association, there were 17 243 cases of violent attacks against health-care workers in 2010, in China. On Oct 25, a patient beat a senior doctor (head of the Ear, Nose, and Throat department) to death, adding a new victim on this too-long list.

Hospitals in China are deemed as dangerous working places, and being a medical practitioner has turned into a life-threatening job. The deteriorated relationship between health-care providers and patients not only affects the present generation of professionals, but also the future generation of doctors. National medical colleges warn that the number of medical students is decreasing, and medical students in their last year of MD or PhD programmes are hesitating to continue their career.

Harvard's Brigham and Women's Hospital to manage hospital in China

Harvard's Brigham and Women's Hospital had partnered with a Chinese real estate firm to build and manage a hospital in Guangdong.
Evergrande Group said on December 4 it has reached agreement with Harvard University to build a hospital in China, the real estate giant's latest effort to diversify its business structure.
Evergrande and Harvard have already started picking a location for the hospital, a source close to the partnership said. Shenzhen and Guangzhou, both in the southern province of Guangdong, were the top choices.
The new hospital will partner with Harvard's Brigham and Women's Hospital (BWH). Evergrande said it will provide the funding, and BWH will provide management and medical teams.
Elizabeth Nabel, head of BWH, will visit China soon to discuss the location and other details, Evergrande said.

Bad news for medical device companies in China

by Damjan Denoble
“Taking kickbacks has become a de facto rule in China’s grassroots health centres.”
On Tuesday, Xinhua attributed the above quote to Wang Rusheng, deputy director of a prefecture-level city in the Southern province of Guangxi, within an article devoted to highlighting a tide of corruption allegations involving medical device sales and rural health officials.
Medical device companies, watch out. If you are affiliated with a medical device company in any way this should cause for concern, given both that Xinhua, the official news agency of the PRC, is doing the reporting, and the GSK and related scandals have cast a light on foreign healthcare companies.

Workload and authorship criteria deter Chinese clinicians from doing research

Letter from Dr Zhang Han of the Second Military Medical University, Shanghai in The Lancet:

"With a growing burden of surgical procedures and very large numbers of patients, Chinese surgeons should have an important role in seeking consensus on global strategies through participation in international collaboration. However, many obstacles are hindering their enthusiasm for joint studies, including considerable extra workload in clinical research besides a heavy clinical burden, difficulties in participant enrolment due to the deteriorated doctor—patient relationship, language barriers, and limited opportunities to communicate and cooperate with international colleagues.
We appeal to health administrators in China for an increased awareness of the importance of collaborative research and for supportive policies. For instance, appropriate assessment of the achievement of these research collaborations is an important issue. The present academic evaluation system in China recognises and rewards the position of first and corresponding authors for published studies, and the contributions of other participants tend to be neglected. Hence, how to encourage the active participation of more surgeons in future international research collaboration is an issue worthy of discussion for health policy makers in China and worldwide."

Source: Lancet

Electromagnetic radiation not linked to miscarriage - Guangdong study

by Michael Woodhead
Exposure to extremely low-frequency magnetic fields does not seem to increase miscarriage risk, a Guangdong study has suggested.
Dr Wang Qiang and co-researchers from the Department of Environmental Epidemiology, Institute for Environmental Health and Related Product Safety, Chinese Center for Disease Control and Prevention, Beijing, studied pregnancy outcomes among women in two towns in the Pearl Delta region with densely distributed power supply constructions. From 2010 to 2012, 413 women in the region who were at approximately 8 weeks of gestation or who planned to have a baby within one year were selected as candidate subjects. Exposure to magnetic fields was estimated by measurements at their front doors and in the alley in front of the subjects’ houses
The average residential exposure to magnetic fields was 0.099 µT. Miscarriage risk was found to be significantly associated with maximum levels of exposure to magnetic fields in alleys. After adjustment, the risk of maximum alley exposure to magnetic fields for miscarriage was 72% higher. However, No significantly increased risk of miscarriage was seen with the average front-door exposure to magnetic fields.,
The researchers said that although the miscarriage incidence was shown to be positively associated with the maximum alley magnetic field exposure, the association between miscarriage risk and the exposure to magnetic fields was not confirmed in the study. They noted that the intensities of exposure were relatively low. The average exposure level was only approximately 2 times higher than that of the general public (0.05μT). Among all 413 pregnant women, only 34 subjects (8.2%) were exposed to MFs above 0.4µT.
“We can’t confirm 50 Hz MF as one of the possible risks of miscarriage,” they conclude.
Source: PLOS One

Shenzhen the source of Hong Kong's H7N9 infections

by Lisa Schnirring
Health officials in Hong Kong today said they detected a second imported H7N9 flu case, in an 80-year-old man from the mainland, while mainland China reported another new infection, which sickened a 30-year-old man from Zhejiang province.
Both of the H7N9 cases reported this week have travel ties to Shenzhen, a major city just north of Hong Kong in China's Guangdong province. The new case in Zhejiang, about 800 miles northeast of Guangdong province, further boosts the province's status as China's hardest hit by the H7N9 virus.
Meanwhile, new scientific findings released today suggest that the virus doesn't latch on to human cells strongly enough to pose a pandemic threat, though the virus bears close monitoring for further changes.

Armed with SARS lessons, China fights H7N9 influenza

by Shannon Tiezzi
10 years after SARS, China is fighting another viral outbreak – and seems to be winning.
Hong Kong reported its second case of the avian flu strand known as H7N9 today, showing that the virus which first appeared in mainland China back in February continues to spread. To date, H7N9 has infected 138 in total. Of those, 45 have died.
According to reports, the first reported H7N9 case in Hong Kong was a 36 year old Indonesian domestic helper, while the latest case was an 80 year old man from Shenzhen. The Indonesian had also recently traveled to Shenzhen, leading Dr. Leung Ting-hung, Hong Kong’s controller of the Centre for Health Protection, to believe that both cases were contracted in the mainland city.
H7N9 has not been shown to spread easily from person to person, meaning the risk of a large-scale epidemic is fairly low. Still, Hong Kong is taking no changes. The city has increased its border checks and the government isolated 17 people who had been in close contact with the first H7N9 victim. To date, none of the quarantined group had tested positive for the virus.

Respiratory hospital admissions up with Shanghai smog

Shanghai's hospitals all reported a rise in the number of patients with respiratory problems over the past few days.
Huadong Hospital said there had been a 30 percent increase.
Dr Zhou Min of Ruijin Hospital’s respiratory disease department said outpatients increased 20 to 30 percent, with emergency cases up 50 to 60 percent. “Winter is always the peak time for patients with respiratory syndromes due to the cold weather, while the poor air quality can trigger asthma and lung infections,” she said.
Children, the elderly and people with weak immunity should stay indoors, she said.
Shanghai Children’s Hospital said it had seen more than 5,000 outpatient and emergency cases this week, a quarter more than the same period of last year.
A recent cold front and the haze were said to be the major cause of respiratory infections and asthma in children while almost a third of them suffered from diarrhea.
Doctors say children under 7 usually have weak immunity and are more likely to develop symptoms in winter. They advise parents to make sure their children stay warm.
Source: Shanghai Daily