不完全契约理论视阈下某跨区域医联体核心医院运行效率评价研究

目的对某跨区域医联体核心医院的运行效率进行评价，以不完全契约理论为分析视角探讨影响因素，为深化医联体建设提供借鉴和参考。方法收集2014年-2021年核心医院相关数据，采用DEA数据分析方法，计算运行效率变化情况。结果核心医院各项投入明显增加，医疗业务产出同步增长，医院运行效率经历了动态波动后持续向好。结论通过构建管理共同体，逐步优化契约，争取医保政策支持，合作共建初见成效。     

A characterisation of established unilateral transfemoral amputee gait using 3D kinematics,kinetics and oxygen consumption measures

BackgroundPersons with unilateral transfemoral (UTF) amputation are known to walk with less efficiency than able-bodied individuals, therefore understanding the gait deviations that drive this inefficiency was considered to be important.Research questionsWhat are the differences in gait outcomes between persons with UTF amputation and able-bodied persons? What is the prevalence of specific gait deviations within this group?MethodsUsing a cross-sectional study design, the level over ground gait of established prosthetics service users with UTF amputation using mechanical knee joints (n=60) were compared with able-bodied persons (n=10). Gait profile score, walking velocity, step length, step length symmetry ratio, step time symmetry ratio, vertical ground reaction force symmetry index, base of support, centre of mass deviation and metabolic energy expenditure were measured. All data were captured during walking on level ground at a self-selected speed. Prevalence of gait deviations for each UTF participant were assessed by inspection, using a predefined list of lower limb kinematic, upper body kinematic, ground reaction force and lower limb kinetic gait deviations.ResultsStatistically significant between-groups differences across all outcome measures were found, with all p-values <0.005, and effect sizes ranging from 'large' to 'huge'. The most prevalent gait deviations included: lack of prosthetic knee flexion in early stance (98%); lack of hip extension on the prosthetic side in late stance (82%): increased trunk side flexion range of motion across the gait cycle (92%); reduced anterior propulsion force on the prosthetic side in late stance (100%) and reduced prosthetic hip adduction moment in early stance (96%).SignificanceThe results of this study indicate that the magnitude of the differences between UTF amputees and able-bodied persons, across a comprehensive range of gait measures, are such that significant research into all aspects of prosthetic rehabilitation to reduce these differences is clearly justified.     

昂丹司琼预防麻醉后寒战有效性和安全性的Meta分析

目的评价昂丹司琼预防麻醉后寒战的有效性和安全性。方法计算机检索Cochrane Library、PubMed、Embase、CNKI、万方、维普等数据库,检索时间为建库至2018年8月,纳入以昂丹司琼预防麻醉后寒战为研究目的,研究组为昂丹司琼,对照组为生理盐水或哌替啶或曲马多的随机对照试验,采用RevMan 5.3对数据进行Meta分析,根据不同对照组、不同麻醉方式及不同剂量进行亚组分析。结果共纳入16项研究,1 443例受试者。有效性方面,研究组寒战发生率明显低于生理盐水组(RR=0.42,95%CI 0.35～0.51,P0.001);与哌替啶组(RR=0.68,95%CI 0.44～1.05,P=0.09)及曲马多组(RR=2.07,95%CI 0.90～4.75,P=0.09)差异无统计学意义;在3个不同麻醉方式亚组(RR=0.44,95%CI 0.36～0.54,P0.001),2个不同剂量亚组(RR=0.41,95%CI 0.34～0.49,P0.001)中,研究组寒战发生率明显低于生理盐水组。安全性方面,研究组术后恶心呕吐发生率明显低于生理盐水组(RR=0.27,95%CI 0.16～0.46,P0.001)。结论昂丹司琼可有效预防麻醉后寒战的发生,其效果与哌替啶、曲马多相当,并且可明显减少术后恶心呕吐的发生。     

静态心电设备与HIS系统的接口设计及应用研究

目的探讨静态心电设备与HIS系统的接口设计及应用。方法我院自2018年6月开始采用医院信息系统,将静态心电设备信息进行统一化应用,选取我院2017年1月至2018年5月收治的25 000例患者作为应用前组,选取我院2018年6月至2020年1月收治的25 000例患者作为应用后组。对比两组患者检查治疗所用时间与满意度。结果与应用前组比较,应用后组的检查治疗所用时间明显较短,满意度明显较高(P <0.05)。结论在医院患者进行检查与治疗的过程中,静态心电设备与HIS系统的接口设计及应用能够有效节省时间,同时也提升医院检查治疗的效率与患者的满意度。     

Measuring the performance of patient-specific solutions for minimally invasive transforaminal lumbar interbody fusion surgery

Pre-surgical planning using 3D-printed BioModels enables the preparation of a “patient-specific” kit to assist instrumented spinal fusion surgery. This approach has the potential to decrease operating time while also offering logistical benefits and cost savings for healthcare. We report our experience with this method in 129 consecutive patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) over 27 months at a single centre and performed by a single surgeon. Patient imaging and surgical planning software were used to manufacture a 3D-printed patient-specific MIS TLIF kit for each patient consisting of a 1:1 scale spine BioModel, stereotactic K-wire guide, osteotomy guide, and retractors. Pre-selected pedicle screws, rods, and cages were sourced and supplied with the patient-specific kit. Additional implants were available on-shelf to address a size discrepancy between the kit implant and intraoperative measurements. Each BioModel was used pre-operatively for surgical planning, patient consent and education. The BioModel was sterilised for intraoperative reference and navigation purposes. Efficiency measures included operating time (153 ± 44 min), sterile tray usage (14 ± 3), fluoroscopy screening time (57.2 ± 23.7 s), operative waste (19 ± 8 L contaminated, 116 ± 30 L uncontaminated), and median hospital stay (4 days). The pre-selected kit implants exactly matched intraoperative measurements for 597/639 pedicle screws, 249/258 rods, and 46/148 cages. Pedicle screw placement accuracy was 97.8% (625/639) on postoperative CT. Complications included one intraoperative dural tear, no blood products administered, and six reoperations. Our experience demonstrates a viable application of patient-specific 3D-printed solutions and provides a benchmark for studies of efficiency in spinal fusion surgery.     

时效激励结合绩效考核管理模式在内分泌科护士管理中的应用研究

目的 探讨时效激励结合绩效考核管理模式在内分泌科护士管理中的应用效果。方法 选取2017年10月-2018年10月我院36名内分泌科护士为研究对象。比较实施时效激励结合绩效考核管理模式前后,病区护理质量和护士工作倦怠情况。结果 实施后,护士的情感枯竭、去人格化倾向评分均低于实施前(t=8.613,P=0.029; t=5.495,P=0.020),而个人成就评分高于实施前(t=3.626,P=0.031);护理工作质量评价量表各维度评分均高于实施前。结论 时效激励结合绩效考核管理模式可有效缓解内分泌科护士的工作倦怠感,提高护理质量,值得临床推广应用。     

Antiplatelet therapy and outcomes following endovascular therapy for acute ischemic stroke: A systemic review and meta-analysis

ObjectiveThe outcomes of antiplatelet therapy (APT) in patients with acute ischemic stroke (AIS) receiving endovascular therapy (EVT) remains controversial. Thus, we sought to make a systematic review and meta-analysis of recent clinical trials to confirm the safety and efficacy of APT.MethodsAll of clinical trails were systematically retrieved from PubMed, Embase and Cochrane. The endpoints or main outcome measures included symptomatic intracranial hemorrhage (sICH), 3-month mortality, successful recanalisation (SR) and 3-month functional independence (FI). Odd ratios (ORs) with their 95% confidence intervals (CIs) were calculated to synthesize effect size by using random-effects models. Sensitivity analysis was performed via calculation of rest data owiting one by one.Results23 articles were included after screening. APT as an adjunct to EVT was associated with a higher likelihood of pooled successful recanalisation (OR 1.46, 95% CI 1.07–2.00) and 3-month FI (OR 1.24, 95% CI 1.01–1.51), no associated with sICH and 3-month mortality. However, Sensitivity analysis indicated that the association between APT and SR and 3-month FI were unstable. For patients with prior use of APT or receiving intravenous thrombolysis before EVT, no associated were found between APT and all of endpoints above.ConclusionAlthough adjuvant APT appears to increase the number of SR and 3-month FI, the results were unstable. Randomised controlled trials are needed to confirm the efficacy.