“四方联动”医疗卫生服务模式初探——以深圳市宝安区人民医院集团为例

深圳市长期以来一直沿用“院办院管”的社区卫生管理运作模式,但随着社康中心的发展,该模式的弊端逐渐显现。为推动医院院本部与下属社康中心深化合作,促进专科、全科高度融合发展,落实国家分级诊疗政策,宝安区人民医院集团创新探索“居民-社区-社区健康服务中心-医院(集团)”专病健康管理模式的四方联动,实现医院和社康中心共同管理患者,提高社区居民健康水平。通过对“四方联动”模式的概念、建设方案、实施效果进行介绍,为进一步完善“四方联动”发展模式提出政策建议。     

从在用医疗设备存在的电气安全风险谈其质量控制

根据四川省医疗器械检测中心从2015年~2019年对四川省内94家医院所使用的245台医疗设备进行抽验的结果,探讨目前在用医疗设备潜在的电气安全风险,并针对这些风险提出如何进行医疗设备质量控制的建议。     

彩超设备的故障维修与维护保养

由于应用十分频繁以及工作人员应用不当等多种原因,医用彩超设备在应用的过程中经常会出现各种各样的故障与风险,对医疗工作的正常开展形成了十分严重影响。文章就医用彩超设备的故障维修以及维护保养做出探究,以望参考。     

血站与医院信息共享基本数据集研究

目的探讨血站与医院信息共享基本数据集构建,为制定地方标准提供依据。方法通过分析临床用血规范化管理的需求,确定信息共享方案;通过用例分析和功能建模,明确需采集的基本数据集内容与数据结构;提取数据元,并对数据元和数据元代码集内容进行规范化描述。结果建立了6个主题数据集,梳理了42个通用数据元,自定义4个数据元值域代码表。结论制定了适合浙江省实际的血站与医院信息共享基本数据集,较好解决了全省血站与医院信息系统的互联互通、数据共享等问题。     

目标管理在医疗设备维修管理中的应用与效果分析

分析目标管理在医疗设备维修管理中的应用效果,选取2019年1月至2020年12月医疗设备维修数据,对比分析实施目标管理前后的设备整体平均维修时长、维修关单良好率、基础性设备(病床、监护仪及泵类)平均维修时长和工程师维修关单良好率,为医院维修管理精细化实践提供参考。     

The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation

High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006 to 2016, 85 067 liver transplants were recorded, including 5581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0–10. Low-risk (0–3), medium-risk (4–5), and high-risk (6–10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95% CI 52.8–60.7%), 46.3% (95% CI 41.1–51.4%), and 32.1% (95% CI 23.5–41.0%), respectively (P < 0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision-making on liver acceptance for reLT.     

Outcomes of status 1 liver transplantation for Budd-Chiari Syndrome with fulminant hepatic failure

There is a paucity of data on the outcome of liver transplantation (LT) in Budd-Chiari Syndrome (BCS) patients who are listed as status 1. The objective of our study was to determine patient or graft survival following LT in status 1 BCS patients. We utilized United Network for Organ Sharing (UNOS) database to identify all adult patients (> 18 years of age) listed as status 1 with a primary diagnosis of BCS in the United States from 1998 to 2018, and analyzed their outcomes and compared it to non-status 1 BCS patients. Four hundred and forty-six patients with BCS underwent LT between 1998 and 2018, and of these 55 (12.3%) were listed as status 1. There was no difference in long-term post-liver transplant or “intention-to-treat” survival from the time of listing to death or the last day of follow-up between status 1 and non-status 1 groups. Graft and patient survival at 5 years for status 1 patients were 75% and 82%, respectively. Cox regression analysis showed that patients listed as status 1 (aHR: 0.45, p < .02) were associated with a better survival. BCS patients listed as status 1 have excellent survival following emergency LT.     

Life underneath the VCA umbrella: Perspectives from the US Uterus Transplant Consortium

The parallel emergence of uterus transplantation (UTx) and other transplantation innovations including face and hand transplantation led to the categorization of the uterus as a vascular composite allograft (VCA). With >60 transplants and >20 births worldwide, UTx is transitioning rapidly from a research endeavor to an effective treatment option for women with uterine factor infertility. While it originally made sense to group the innovations under one umbrella, it is time to revisit the designation of UTx as a VCA. We describe how UTx needs unique policy, procedural codes, insurance contracts, and educational initiatives. We contend that separating UTx from VCAs may become necessary in the future to avoid hindering the growth and regulation of this field.     

Personal protective equipment related skin reactions in healthcare professionals during COVID‐19

Since the outbreak of COVID‐19 pandemic, clinicians have had to use personal protective equipment (PPE) for prolonged periods. This has been associated with detrimental effects, especially in relation to the skin health. The present study describes a comprehensive survey of healthcare workers (HCWs) to describe their experiences using PPE in managing COVID‐19 patients, with a particular focus on adverse skin reactions. A 24‐hour prevalence study and multi‐centre prospective survey were designed to capture the impact of PPE on skin health of hospital staff. Questionnaires incorporated demographics of participants, PPE type, usage time, and removal frequency. Participants reported the nature and location of any corresponding adverse skin reactions. The prevalence study included all staff in intensive care from a single centre, while the prospective study used a convenience sample of staff from three acute care providers in the United Kingdom. A total of 108 staff were recruited into the prevalence study, while 307 HCWs from a variety of professional backgrounds and demographics participated in the prospective study. Various skin adverse reactions were reported for the prevalence study, with the bridge of the nose (69%) and ears (30%) being the most affected. Of the six adverse skin reactions recorded for the prospective study, the most common were redness blanching (33%), itchiness (22%), and pressure damage (12%). These occurred predominantly at the bridge of the nose and the ears. There were significant associations (P < .05) between the adverse skin reactions with both the average daily time of PPE usage and the frequency of PPE relief. The comprehensive study revealed that the use of PPE leads to an array of skin reactions at various facial locations of HCWs. Improvements in guidelines are required for PPE usage to protect skin health. In addition, modifications to PPE designs are required to accommodate a range of face shapes and appropriate materials to improve device safety.