基于住院病案首页数据的全国部分医院心血管临床专科评估探索

目的运用“基于住院病案首页数据的心血管临床专科评估框架”,对全国部分医院的心血管临床专科进行评估。方法梳理112所医院心血管专科重点疾病和重点手术操作的编码情况,计算评估框架中的各个指标,根据医院纳入标准,运用基于数据的多指标综合评价方法,对医院进行打分排序。结果112所医院2010—2012年心血管疾病患者出院人次、重点疾病和重点手术/操作缺失数量均呈偏态分布。按照综合评价医院的纳入标准共56所医院纳入排序,前十位是YN05、SD04、BJ14、SH02、ZJ01、HN01、SX09、YN08、SD01、SX08。重点疾病和重点手术操作均完整的医院共12所,其排序是:BJ14、SH02、HN02、BJ01、TJ01、SH05、SC01、NA03、GD02、SH08、YN03、HL01。本研究综合评价的56所医院中,有30所在国家公布的名单之内,26所不在国家公布的名单之内。结论运用“基于住院病案首页数据的心血管临床专科评估框架”进行心血管临床专科评估是科学、可行的,为专科评估方法提供了新的思路,为专科对口支援建设提供了数据支持。     

关于我国中药行业加入WTO的市场分析

我国入世之后 ,既对中药行业有不利的一面 ,也有十分有利的一面。中药产业如何应对入世后的挑战 ,使中药产品在世界医药市场中占有一席之地 ,是中医药界必须直面以对的重大课题。本文分析了内外医药市场以及中药走向国际市场的主要门槛障碍 ,并就调整中医药产业格局进行了探讨     

临床营养专科护士培训实践与成效

目的 探讨临床营养专科护士培训实践方法,为国内临床营养专科护士的培养提供参考.方法 基于临床营养专科护士核心能力构建培训体系,对115名学员采用理论授课(4周)与临床实践(8周)相结合方式分阶段进行培训.结果 学员总成绩(90.69±2.28)分;学员对培训的总体满意度为98.26％.结论 临床营养专科护士培训可提高专科护士营养相关知识和技能,促进专科护士持续成长.     

An Unusual Case of Periosteal Glomus Tumor at the Metacarpal Base Presenting as Type II CRPS: Case Report

Background: An unusual case involving a middle-aged male with a 9-year history of presumptive chronic regional pain syndrome (CRPS) and ulnar neuropathy was referred for failure in treatment. Methods: On presentation, the patient was requesting an amputation of his arm. However, work-up uncovered a periosteal extra-digital glomus tumor on the base of the small finger metacarpal. Results: Surgical excision of the lesion resulted in rapid resolution of his pain and normal hand function was ultimately restored. Conclusions: Glomus tumors account for up to 5% of all soft tissue tumors of the upper extremity, occurring most frequently within or adjacent to the nail bed. Time from onset of symptoms to correct diagnosis may not be established for many years, especially with atypical tumor locations. Although glomus tumors have been widely reported, atypical locations of these tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy. Furthermore, when evaluating a chronic pain patient, our findings support the opinion that assignment of the diagnosis of CRPS should only be a diagnosis of exclusion.     

Predictors of Hand Function Following Digit Replantation: Quantitative Review and Meta-Analysis

Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.     

Examining how changes in provincial policy on vape marketing impacted the distribution of vaping advertisements near secondary schools in London,Ontario

ObjectivesOn January 1, 2020, the Government of Ontario passed a regulation banning vaping advertisements by retailers, apart from specialty shops. A motivation for this ban was to limit youth exposure to vaping advertisements. The primary goal of this research was to evaluate the impact of this ban on the number and density of vaping advertisements surrounding secondary schools. Additionally, we examined whether the number of vaping advertisements varied by school socio-demographic characteristics.MethodsThis study used a pre-post design. Audits were conducted December 2019 (pre-ban) and again January to February 2020 (post-ban), to identify vaping advertisements within 800 m surrounding secondary schools (n = 18) in London, Ontario.ResultsPrior to the ban, there were 266 vaping advertisements within 800 m of secondary schools. After the ban, this was reduced to 58, a 78.2% reduction. The mean number of vaping advertisements surrounding schools significantly decreased from 18.1 before the ban to 3.6 after the ban (p < 0.001). A significant positive correlation was found, prior to the ban, between the number of vaping advertisements surrounding schools and school-level residential instability (r = 0.42, p = 0.02). After the ban, no significant correlations were found between the number of vaping advertisements and school socio-demographic characteristics.ConclusionThe provincial ban of vaping advertisements in select retail settings significantly reduced the number of vaping advertisements in the areas surrounding secondary schools in London, Ontario. The ban also reduced socio-demographic inequities in youths’ potential exposure to marketing of vaping products. Continued monitoring of the geographic accessibility and promotion of vaping products is warranted.     

DRG在深圳市某区临床重点专科评估中的应用

目的评价并遴选深圳市某区临床重点专科,为该区临床重点专科的发展以及我国临床重点专科的评估提供借鉴。方法将DRG相关指标与传统指标相结合作为该区临床重点专科评估指标体系,运用TOPSIS法计算该区11家医院41个临床专科2016—2018年的总排名。结果该区排名前5位的临床重点专科分别是I医院显微外科、J医院产科、K医院鼻科、K医院耳鼻咽喉科以及D医院骨科,排名后5位的专科分别是H医院风湿病科、D医院泌尿外科、C医院儿科、C医院眼耳鼻喉科以及F医院神经外科。结论该区应加快重点专科发展,形成区域专科优势;促进专科均衡发展,满足基本医疗需求;提高专科服务效率,优化医疗资源配置;依托医疗集团做强专科特色品牌,促进专科差异化发展;进一步提高病历首页质量管理水平。     

营销理论在医院管理中的应用

营销存在于一切社会经济活动当中 ,医院也需要开展营销管理工作。医疗服务产品、顾客和市场具有不同于其他行业的特点 ,将营销管理理论应用于医院经营工作要有灵活性。制定营销策略 ,确定竞争优势需要考察医疗服务产品的五个层次 ,核心利益、基础产品、期望产品、附加产品、潜在产品。产品的核心利益是营销的目的和任务 ;第二至第五层次是产品差异的范围 ,也是产品竞争优势所在范围。在准确进行市场定位后 ,应当集中资源和努力在差异优势上 ,满足顾客 (患者及其陪同人员 )的需要和欲望。医疗服务产品具有服务产品的四个主要特点 ,无形性、不可分离性、可变性、易消失性 ;同时也具有其他服务产品所没有的两个特点 ,一是患者与医生在医疗服务信息上的不对称性 ,二是医疗服务的高风险性。制定营销方式需要考虑到这些特点。医院营销还在文化、法律和市场环境方面与其他行业有所差异。根据以上论述 ,提出了创建医院品牌 ,搞好医院营销管理的措施。医院要兼顾顾客和社会的利益 ,树立社会营销观念 ,以求得与社会的协调发展 ,争取最大利益。     

三籽两型豆生长发育特性及栽培技术研究

目的 :探明两型豆的种子萌发、植株生长发育特性及主要栽培技术措施 ,为人工栽培提供依据。方法 :采用室内种子萌发、田间播种观察、光照处理及小区栽培方法。结果 :试验表明地上种子存在硬实现象 ,地下、地上种子播种都能正常出苗、开花、并都结出地上、地下正常发育的种子 ;在河北东部地区 5月初播种 ,九月初开花 ,10月下旬收获 ;两型豆的幼苗属于子叶不出土类型 ;地下种子的发育来自于子叶节部位着生的地下茎及分枝 ;两型豆是耐阴、怕高温的短日照植物 ,短日处理可大幅度提早开花、结实 ;栽培时注意种子处理、遮光、充足土壤水分供应及搭架等措施。结论 :初步明确了三籽两型豆地上、地下种子萌发、植株生长发育等特性和相关栽培技术措施。     

对高等中医药院校人才培养的几点看法

高等中医药院校担负着人才培养、科学研究、社会服务的三大职能.对高等中医药院校人才培养要求必须具有必要的西医学基础知识及临床诊疗技能;具有一定的社会人文科学知识和自然科学基础知识;不是单纯的培养中医治疗人才,而是培养为中医药行业服务的各类人才;培养目标与模式应是多样化、多元化.对人才培养应重视以人为本的思想,招生应采取按类招生模式,以充分调动学生的兴趣,发挥学生的个性;减轻学生负担,给其更多的自由空间、更多的课程选择机会;坚持主辅修,为学生开拓发展的空间.人才培养应强调动手能力、创新意识,使学生学会学习,应注重课内与课外相结合;教师的授课要多样化;应重视临床实践能力.