新医改中医院文化作用的再认识

医院文化不仅是医院生存和发展的重要战略资源和宝贵的物质及精神财富,也是提高医院整体素质和核心竞争力的重要因素和构建和谐医患关系的关键因素,特别是在新医改方案出台的大环境下,医院管理者更要充分认识到医院文化的作用。该文集中阐述目前医院文化建设现状,医院文化建设的主要作用和医院文化的实践三个问题。     

Assessing the effects of the introduction of the New Zealand Smokefree Environment Act 2003 on Acute Myocardial Infarction hospital admissions in Christchurch,New Zealand

Objective: To examine trends in Acute Myocardial Infarction (AMI) hospital admissions in Christchurch, New Zealand before and after the implementation of the New Zealand Smokefree Environments Act 2003 in December 2004. Methods: Data on AMI hospital admissions to Christchurch Public Hospital were extracted for the period 2003 to 2006. Poisson regression was used to calculate rate ratios by comparing for AMI rates of hospital admissions before (2003/04) and after (2005/06) the introduction of the Smokefree legislation, and to assess whether there was a significant change over time. Results: The introduction of the smokefree legislation was associated with a 5% reduction in AMI admissions. The 55‐74 age group recorded the greatest decrease in admissions (9%) and this figure rose to 13% among never smokers in this group. Reductions were more marked for men. Adding the effects of area deprivation increased the reduction to 21% among 55‐74 year olds living in more affluent (quintile 2) areas. Overall however, the statistical association of changing levels of AMI admissions with smoking status and with deprivation was not consistently significant. Conclusion: At this early stage following the smokefree legislation, there are hints emerging of a positive impact on AMI admissions but these suggestions cannot yet be treated with certainty. Further research could usefully evaluate the longer‐term effects of smoking legislation on the prevalence of smoking and exposure to second hand smoke, especially in more deprived urban communities.     

Hierarchical linear models for the development of growth curves: an example with body mass index in overweight/obese adults

When data are available on multiple individuals measured at multiple time points that may vary in number or inter-measurement interval, hierarchical linear models (HLM) may be an ideal option. The present paper offers an applied tutorial on the use of HLM for developing growth curves depicting natural changes over time. We illustrate these methods with an example of body mass index (BMI; kg/m(2)) among overweight and obese adults. We modelled among-person variation in BMI growth curves as a function of subjects' baseline characteristics. Specifically, growth curves were modelled with two-level observations, where the first level was each time point of measurement within each individual and the second level was each individual. Four longitudinal databases with measured weight and height met the inclusion criteria and were pooled for analysis: the Framingham Heart Study (FHS); the Multiple Risk Factor Intervention Trial (MRFIT); the National Health and Nutritional Examination Survey I (NHANES-I) and its follow-up study; and the Tecumseh Mortality Follow-up Study (TMFS). Results indicated that significant quadratic patterns of the BMI growth trajectory depend primarily upon a combination of age and baseline BMI. Specifically, BMI tends to increase with time for younger people with relatively moderate obesity (25 BMI <30) but decrease for older people regardless of degree of obesity. The gradients of these changes are inversely related to baseline BMI and do not substantially depend on gender.     

军队医院适应国家医药卫生体制改革的对策

国家深化医药卫生体制改革各项政策颁布以来,各地区域医改稳步推进,军队医院建设发展的外部环境发生明显变化。为主动适应国家医改形势,军队医院应采取立足实际、抓住机遇、突出特色、强化管理的发展策略。     

急诊集束化治疗急性心力衰竭患者的效果及对心肺功能的影响

目的探讨急诊集束化治疗急性心力衰竭患者的效果及对心肺功能的影响。方法选取我院2016年6月至2018年6月收治的120例急性心力衰竭患者,分为对照组和观察组各60例。对照组采用常规急诊治疗,观察组采用急诊集束化治疗,比较两组患者的急诊室治疗时间、短期症状改善时间、住院时间和治疗前后心肺指标水平。结果观察组的急诊室治疗时间、短期症状改善时间、住院时间均明显短于对照组(P <0.05)。治疗前,两组的心率、血氧饱和度、动脉血氧分压、收缩压比较无统计学差异(P>0.05);治疗后,观察组的心率、血氧饱和度、动脉血氧分压、收缩压均明显优于对照组(P <0.05)。结论急诊集束化治疗急性心力衰竭患者的效果显著,可有效改善患者的心肺功能,值得临床推广。     

The Effect of a Housing First Intervention on Acute Health Care Utilization among Homeless Adults with Mental Illness: Long-term Outcomes of the At Home/Chez-Soi Randomized Pragmatic Trial

We assessed the effects of the Toronto Site Housing First (HF) intervention on hospitalizations and emergency department (ED) visits among homeless adults with mental illness over 7 years of follow-up. The Toronto Site is part of an unblinded multi-site randomized pragmatic trial of HF for homeless adults with mental illness in Canada, which followed participants up to 7 years. Five hundred seventy-five participants were recruited and classified as having high (HN) or moderate need (MN) for mental health support services. Each group was randomized into intervention (HF) and treatment as usual groups, and 567 (98.6%) consented to link their data to health administrative databases. HF participants received a monthly rent supplement of $600 (Canadian) and assertive community treatment (ACT) support or intensive care management (ICM) support based on need level. Treatment as usual (TAU) participants had access to social, housing, and health services generally available in the community. Outcomes included all-cause and mental health-specific hospitalization, number of days in hospital, and ED visit. We used GEE models to estimate ratio of rate ratios (RRR). The results showed HF with ACT had no significant effect on hospitalization rates among HN participants, but reduced the number of days in hospital (RRR = 0.32, 95% CI 0.16-0.63) and number of ED visits (RRR = 0.57, 95% CI 0.34-0.95). HF with ICM resulted in an increase in the number of hospitalizations (RRR = 1.69, 95% CI 1.09-2.60) and ED visit rates (RRR = 1.42, 95% CI 1.01-2.01) but had no effect in days in hospital for MN participants. Addressing the health needs of this population and reducing acute care utilization remain system priorities. Trial registration: http://www.isrctn.com/identifier: ISRCTN42520374Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-021-00550-1.     

Effect of Crocus sativus (Saffron) Intake on Top of Standard Treatment,on Disease Outcomes and Comorbidities in Patients with Rheumatic Diseases: Synthesis without Meta-Analysis (SWiM) and Level of Adherence to the CONSORT Statement for Randomized Controlled Trials Delivering Herbal Medicine Interventions

Rheumatic diseases (RDs) are often complicated by chronic symptoms and frequent side-effects associated with their treatment. Saffron, a spice derived from the Crocus sativus L. flower, is a popular complementary and alternative medicine among patients with RDs. The present systematic review aimed to summarize the available evidence regarding the efficacy of supplementation with saffron on disease outcomes and comorbidities in patients with RD diagnoses. PubMed, CENTRAL, clinicaltrials.gov and the grey literature were searched until October 2021, and relevant randomized controlled trials (RCTs) were screened for eligibility using Rayyan. Risk of bias was assessed using the Cochrane’s Risk of Bias-2.0 (RoB) tool. A synthesis without meta-analysis (SWiM) was performed by vote counting and an effect direction plot was created. Out of 125 reports, seven fulfilled the eligibility criteria belonging to five RCTs and were included in the SWiM. The RCTs involved patients with rheumatoid arthritis, osteoarthritis and fibromyalgia, and evaluated outcomes related to pain, disease activity, depression, immune response, inflammation, oxidative stress, health, fatigue and functional ability. The majority of trials demonstrated some concerns regarding overall bias. Moreover, the majority of trialists failed to adhere to the formula elaborations suggested by the CONSORT statement for RCTs incorporating herbal medicine interventions. Standardization of herbal medicine confirms its identity, purity and quality; however, the majority of trials failed to adhere to these guidelines. Due to the great heterogeneity and the lack of important information regarding the standardization and content of herbal interventions, it appears that the evidence is not enough to secure a direction of effect for any of the examined outcomes.