Population-based study on practice variation regarding preoperative systemic chemotherapy in patients with colorectal liver metastases and impact on short-term outcomes

IntroductionDefinitions regarding resectability and hence indications for preoperative chemotherapy vary. Use of preoperative chemotherapy may influence postoperative outcomes. This study aimed to assess the variation in use of preoperative chemotherapy for CRLM and related postoperative outcomes in the Netherlands.Materials and methodsAll patients who underwent liver resection for CRLM in the Netherlands between 2014 and 2018 were included from a national database. Case-mix factors contributing to the use of preoperative chemotherapy, hospital variation and postoperative outcomes were assessed using multivariable logistic regression. Postoperative outcomes were postoperative complicated course (PCC), 30-day morbidity and 30-day mortality.ResultsIn total, 4469 patients were included of whom 1314 patients received preoperative chemotherapy and 3155 patients did not. Patients receiving chemotherapy were significantly younger (mean age (+SD) 66.3 (10.4) versus 63.2 (10.2) p < 0.001) and had less comorbidity (Charlson scores 2+ (24% versus 29%, p = 0.010). Unadjusted hospital variation concerning administration of preoperative chemotherapy ranged between 2% and 55%. After adjusting for case-mix factors, three hospitals administered significantly more preoperative chemotherapy than expected and six administered significantly less preoperative chemotherapy than expected. PCC was 12.1%, 30-day morbidity was 8.8% and 30-day mortality was 1.5%. No association between preoperative chemotherapy and PCC (OR 1.24, 0.98–1.55, p = 0.065), 30-day morbidity (OR 1.05, 0.81–1.39, p = 0.703) or with 30-day mortality (OR 1.22, 0.75–2.09, p = 0.467) was found.ConclusionSignificant hospital variation in the use of preoperative chemotherapy for CRLM was present in the Netherlands. No association between postoperative outcomes and use of preoperative chemotherapy was found.     

Los ingresos ectópicos y su relación con la aparición de complicaciones y estancias prolongadas

Objective

To analyze the relationship between the type of hospital admission (outlier and non-outlier admissions) and the appearance of clinical complications and the average stay.

Factors influencing the implementation of clinical pharmacy services for hospitalized patients: A mixed-methods systematic review

BackgroundDespite the evidence of benefits, clinical pharmacy services (CPS) are not uniformly implemented across healthcare institutions. Understanding the influencing factors and identifying the domains in which they act is the first step to a successful implementation.ObjectiveTo identify the factors that affect the implementation of CPS for inpatients and to categorize them.MethodsCochrane Library, Embase, CINAHL, IPA, Medline/PubMed, and Lilacs databases were researched up until January 2018. The search strategy was developed using text words or MESH terms related to the following four domains: “clinical pharmacy,” “influencing factors,” “implementation,” and “hospital.” Two reviewers selected original research articles that reported the factors influencing the implementation of CPS in hospitals, extracted data, and assessed the quality of the studies. After framework synthesis and categorization of the factors, a diagrammatic approach was used to present the results.ResultsFifty-three factors were identified in the 21 studies that were included in this review. The most cited influencing factors were uniformly distributed across the following four domains: Attitudinal, POlitical, TEChnical and Administrative (APOTECA domains). However, in terms of level (pharmacist, healthcare team, patient, institution, and national organization), the “pharmacist” group had the highest concentration of factors. “Clinical skills and knowledge” was the most frequently cited implementation factor, followed by “time to implement CPS.”ConclusionOur findings showed the multifactorial nature of CPS implementation process. We suggest that factors from all four APOTECA domains need to be fully considered and strategies need to be addressed for all five groups of interest to successfully implement CPS in hospitals. Future studies on the influence of implementation stages, interrelationships of implementing factors, and strategies to overcome barriers could accelerate the successful adoption of these services.RegistrationPROSPERO register CRD42016050140.     

Diagnostic blood loss from phlebotomy and hospital acquired anemia in patients with severe burns

PurposeThe study was performed to estimate the diagnostic blood loss (DBL) volume during hospitalization and investigate its relationship with the development of moderate to severe hospital acquired anemia (HAA) and increased number of red blood cell (RBC) transfusion following extensive burns.Materials and methodsThis was a retrospective study of adult burned patients with total body surface area (TBSA) burn larger than 40%, who were admitted to burn center of Changhai hospital between January 2005 and December 2017.ResultsWe included a final number of 157 patients in the present study. Moderate to severe HAA within the fourth week postburn was developed in 46 of 121 patients who stayed over 28-day hospitalization. Patients with moderate to severe HAA had both significantly higher total DBL volume [245 (IQR: 183.75, 325.25) mL vs 168 (119, 163) mL ; P = 0.001] and DBL volume per day [10.22 (IQR: 8.57, 12.38) mL vs 6.63 (5.22, 10.42) mL/day; P = 0.005]. Logistic regression analysis revealed that both DBL volume per day and TBSA burn were independent risk factors for the development of moderate to severe HAA.ConclusionsSeverely burned patients appear to be prone to develop HAA during hospitalization. The DBL volume contribute to the occurrence of moderate to severe HAA, which might be a modifiable target for preventing HAA.     

基于医院业务信息系统的脑血管病临床数据中心建设实践

新时期医院的业务信息系统数量日益增长，医院积累了多种业务系统的大量临床数据，但 大量数据不等于大数据，大数据是大量有内在逻辑关系的数据，是可用于统计分析的标准化数据。 临床数据中心是通过集成平台将疾病资料标准化处理，按照逻辑关系分类存储的数据仓库。根据不 同主题建设临床数据中心，可使数据更为有效地得以利用。本文对建设脑血管病临床数据中心的经 验进行介绍，针对不同主题进行设计建设，可以高效、可靠和方便地对脑血管病诊疗数据进行集中管 理和使用，从而改善医疗流程，提高医疗质量，促进医院的管理决策和科学研究。     

刍议医院纪检监察在医院建设中的作用和实施

随着社会经济的快速发展,国内医疗事业的竞争日益激烈,医疗机构需要积极提高自身的业务水平和管理水平,才能强化医疗技术水平,获得更多的社会经济效益。在国内医疗体制深化变革的趋势下,纪检监察在医院建设中发挥着越来越重要的作用,主要职责是管理和监督医院各项制度的落实、健康环境的建设等,旨在规范机构医疗服务,提高机构服务质量,促使医院树立良好的社会形象,保障医院的社会经济效益。该文针对医院纪检监察在医院建设中的作用和实施展开分析。     

基于SWOT模型分析下天津市医联体模式实施现状及对策研究

目的:结合我国医疗卫生现状及相关政策分析天津市开展医联体工作的实施现状,为医联体模式在天津市全面开展提供理论依据,对医疗卫生服务体系整体格局平衡具有现实的指导意义。方法:目的性选取天津市16个建立医联体的三级医院和基层医疗机构的20名人员进行半结构式访谈,采用Colaizzi内容分析法将资料整理分析,应用SWOT模型,归纳总结出天津市医联体模式在实施过程中的优势、劣势、机遇和挑战。结果:天津市开展医联体的优势包括提高基层医生医务能力,应用信息网络搭建沟通平台,提升社区整体水平;劣势包括基层医生工作繁多、压力大、积极性不高,药品管理制度限制患者基层就医,医保制度限制医联体运行;机遇包括医联体建设有国家政策支持,设立专人专岗从事医联体工作;挑战包括基层缺乏吸引人才的机制、区域发展不平衡、缺乏统一管理。结论:天津市医联体模式在实施过程中应加强用经济激励医务人员积极性、建立医联体统一管理制度、完善相关医保政策和药品管理制度,维持医疗卫生服务体系整体格局平衡,促进天津市医联体的全面开展。     

浅谈医院行政管理人员绩效考核

行政管理人员绩效考核是医院人力资源管理的重要内容,也是医院建立现代管理制度的客观要求,在规范医院内部运行机制、创新医院用人制度、提高人力资源管理水平方面发挥着不容忽视的作用。该文从分析医院行政管理人员绩效考核存在的问题入手,提出完善绩效考核的对策建议,期望对提升行政管理人员工作效率,助力医院稳定持续发展有所帮助。