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1.
探索重大突发公共卫生事件中以亚定点医院为代表的医疗管理模式。从上海新国际博览中心W1亚定点医院的实际运行情况出发,对其医疗供需、收治标准、运行效果、存在问题等逐一分析,结合本医疗队的经验,提出新的工作模式和管理思路。亚定点医院为普通型和有基础疾病的新冠病毒阳性感染者提供及时有效的救治,缓解了定点医院的运行压力,但也暴露出人员配置、信息化支撑、院感防控等方面的问题。采取“两级缓冲、双向转诊”的工作模式和“三个快、三个准、三个稳、三个全”的管理方案,可为患者提供及时、有效、适宜的医疗服务,缓解定点医院运行压力。  相似文献   
2.
ObjectivesInitial studies of individuals with coronavirus disease 2019 (COVID-19) revealed that obesity, diabetes and hypertension were associated with severe outcomes. Subsequently, some authors showed that the risk could vary according to age, gender, co-morbidities and medical history. In a nationwide retrospective cohort, we studied the association between these co-morbidities and patients' requirement for invasive mechanical ventilation (IMV) or their death.MethodsAll French adult inpatients with COVID-19 admitted during the first epidemic wave (February to September 2020) were included. When patients were diagnosed with obesity, diabetes or hypertension for the first time in 2020, these conditions were considered as incident co-morbidities, otherwise they were considered prevalent. We compared outcomes of IMV and in-hospital death according to obesity, diabetes and hypertension, taking age, gender and Charlson's co-morbidity index score (CCIS) into account.ResultsA total of 134 209 adult inpatients with COVID-19 were included, half of them had hypertension (n = 66 613, 49.6%), one in four were diabetic (n = 32 209, 24.0%), and one in four were obese (n = 32 070, 23.9%). Among this cohort, IMV was required for 13 596 inpatients, and 19 969 patients died. IMV and death were more frequent in male patients (adjusted oods ratio (aOR) 2.0, 95% CI 1.9–2.1 and aOR 1.5, 95% CI 1.4–1.5, respectively), IMV in patients with co-morbidities (aOR 2.1, 95% CI 2.0–2.2 for CCIS = 2 and aOR 3.0, 95% CI 2.8–3.1 for CCIS ≥5), and death in patients aged 80 or above (aOR 17.0, 95% CI 15.5–18.6). Adjusted on age, gender and CCIS, death was more frequent among inpatients with obesity (aOR 1.2, 95% CI 1.1–1.2) and diabetes (aOR 1.2, 95% CI 1.1–1.2). IMV was more frequently necessary for inpatients with obesity (aOR 1.9, 95% CI 1.8–2.0), diabetes (aOR 1.4, 95% CI 1.3–1.4) and hypertension (aOR 1.7, 95% CI 1.6–1.8). Comparatively, IMV was more often required for patients with the following incident co-morbidities: obesity (aOR 3.5, 95% CI 3.3–3.7), diabetes (aOR 2.0, 95% CI 1.8–2.1) and hypertension (aOR 2.5, 95% CI 2.4–2.6).ConclusionsAmong 134 209 inpatients with COVID-19, mortality was more frequent among patients with obesity and diabetes. IMV was more frequently necessary for inpatients with obesity, diabetes and hypertension. Patients for whom these were incident co-morbidities were particularly at risk. Specific medical monitoring and vaccination should be priorities for patients with these co-morbidities.  相似文献   
3.
BackgroundAdverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs.ObjectivesThis trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12–24 months following hospital discharge.MethodsThe study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression.SummaryIt is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge.  相似文献   
4.
目的:探索真实世界中生脉注射液治疗冠心病心绞痛的临床特征及合并用药规律。方法:对2214例冠心病心绞痛患者医院信息系统中的临床特征数据进行描述性分析,并利用关联规则算法挖掘生脉注射液治疗冠心病心绞痛的联合用药规律。结果:男性患者共996例(44.99%),少于女性的1196例(54.02%);患者的平均年龄(72.1±12.36)岁,其中66~85岁的患者最多,共1544例(69.74%);住院病情以一般者为最多,共945例(42.68%);患者的平均住院天数为(21.96±16.26)d,其中住院天数在15~28 d的患者最多,共865例(39.07%);本研究中生脉注射液用药途径主要为静脉滴注(共1768例,占79.86%);通过静脉滴注的用药方式应用生脉注射液的单次剂量平均为(54.09±18.09)mL;其中41~60 mL者最多,共1008例(57.01%);生脉注射液的平均用药(5.4±6.49)d;生脉注射液治疗冠心病心绞痛最常用的合并用药组合为丹红注射液→单硝酸异山梨酯、速效救心丸-丹红注射液→单硝酸异山梨酯、阿伐他汀→乙酰水杨酸、单硝酸异山梨酯-美托洛尔→乙酰水杨酸。结论:经过对冠心病心绞痛患者医院信息系统(HIS)数据的严格清洗以及标准化,可通过数据挖掘技术对其进行临床特征及用药规律的挖掘分析,并为临床医生提供一定的参考,具有重要的研究意义。  相似文献   
5.
IntroductionTextbook outcome (TO) is a composite outcome measure covering the surgical care process in a single outcome measure. TO has an advantage over single outcome parameters with low event rates, which have less discriminating impact to detect differences between hospitals. This study aimed to assess factors associated with TO, and evaluate hospital and network variation after case-mix correction in TO rates for liver surgery.MethodsThis was a population-based retrospective study of all patients who underwent liver resection for malignancy in the Netherlands in 2019 and 2020. TO was defined as absence of severe postoperative complications, mortality, prolonged length of hospital stay, and readmission, and obtaining adequate resection margins. Multivariable logistic regression was used for case-mix adjustment.Results2376 patients were included. TO was accomplished in 1380 (80%) patients with colorectal liver metastases, in 192 (76%) patients with other liver metastases, in 183 (74%) patients with hepatocellular carcinoma and 86 (51%) patients with biliary cancers. Factors associated with lower TO rates for CRLM included ASA score ≥3 (aOR 0.70, CI 0.51–0.95 p = 0.02), extrahepatic disease (aOR 0.64, CI 0.44–0.95, p = 0.02), tumour size >55 mm on preoperative imaging (aOR 0.56, CI 0.34–0.94, p = 0.02), Charlson Comorbidity Index ≥2 (aOR 0.73, CI 0.54–0.98, p = 0.04), and major liver resection (aOR 0.50, CI 0.36–0.69, p < 0.001). After case-mix correction, no significant hospital or oncological network variation was observed.ConclusionTO differs between indications for liver resection and can be used to assess between hospital and network differences.  相似文献   
6.
目的评估CHA2DS2-VASc评分对急性心肌梗死(AMI)患者院内结局事件的预测价值。方法回顾性分析冠心病医疗结果评价和临床转化研究(China PEACE)回顾性急性心肌梗死研究中23728例AMI患者的病历信息,按CHA2DS2-VASc评分分为低(0~3分)、中(4~6分)、高(7~9分)分值组。院内结局包括主要不良心血管事件、死亡、死亡或放弃治疗、再发心肌梗死、缺血性卒中等。采用多因素Cox回归分析CHA2DS2-VASc评分对AMI患者院内结局的影响。通过受试者工作特征(ROC)曲线,评估CHA2DS2-VASc评分对AMI患者院内死亡与死亡或放弃治疗的预测价值。结果入组患者年龄66(56,75岁)岁,女性占30.7%。CHA2DS2-VASc评分高分值组患者院内结局事件发生率更高,基础疾病更多(P值均<0.001);多因素logistic回归中,院内病死率(OR=6.13,95%CI 4.77~7.87,P<0.001)、院内死亡或放弃治疗率(OR=6.43,95%CI 5.16~8.00,P<0.001)、主要心血管事件发生率(OR=4.94,95%CI 4.06~6.01,P<0.001)明显高于其他两组。ROC曲线分析显示,无论院内病死率,还是死亡或放弃治疗率,CHA2DS2-VASc评分与简化版全球急性冠状动脉事件登记(global registry of acute coronary events,mini-GRACE)评分相比差异无统计学意义(ROC曲线下面积:0.699与0.696,P=0.752;0.708与0.713,P=0.489)。结论CHA2DS2-VASc评分是一种有效预测AMI患者院内风险的评估工具,该评分操作简单,预测价值与mini-GRACE评分相当。  相似文献   
7.
8.
目的: 通过介绍新西兰药师处方权发展及处方药师培训体系构建情况,为探索我国处方药师培训体系提供建议。方法: 检索相关文献,通过比较研究法,将新西兰同我国的处方模式和相关培训设置进行对比。结果: 目前我国药师的药物治疗水平普遍不足,且缺乏对处方药师核心能力的培养。结论: 我国可借鉴新西兰的经验,通过改善本科教育结构,提高处方药师资格要求,并开展处方培训,以保障处方药师药学服务能力。  相似文献   
9.
BackgroundTo enable services to be provided at a distance during the COVID-19 pandemic, outpatient pharmacy services in Australia underwent near-immediate reform by moving to telehealth, including telephone and video consults.ObjectiveTo investigate how telehealth was used in a metropolitan outpatient pharmacy setting before and after the start of the COVID-19 restrictions and the various influences on the uptake of phone and video modalities.MethodsA multi-methods approach was used including: (1) quantifying administrative activity data between July 2019 to December 2020 and, (2) semi-structured interviews with key stakeholders (n = 34).ResultsActivity data: Between July 2019 to December 2020 16,377 outpatient pharmacy consults were provided. Of these, 13,543 (83%) were provided in-person, 2,608 (16%) by telephone and 226 (1.4%) by video consult. COVID-19 impacted how these services were provided with telephone activity more than four-times higher in April 2020 than March 2020 and slight increases in video consults. Pharmacists have heavily favoured using the telephone despite the recommendation that video consults be used as the primary mode of contact and that telephone only be used when a video consult was not possible. As soon as COVID-19 restrictions eased, clinicians gradually returned to in-person appointments, maintaining some use of telephone and very limited use of video consult. Semi-structured interviews: Whilst clinicians recognised the potential benefits of video consults, challenges to routine use included the additional administrative and planning work required pre-consult, perceptions that patients were unable to use the technology, and the belief that in-person care was ‘better’ and that the telephone was easier.ConclusionOrganisational strategies that encouraged the use of video over telephone (e.g. through financial incentives) did not appear to influence clinicians’ choice of care modality. Implementation studies are required to co-develop solutions to embed telehealth options into outpatient pharmacy settings that provide the best experience for both patients and clinicians.  相似文献   
10.
目的分析四川省内中医医院医疗费用结构变动情况,为促进中医医院医疗费用精细化管理提供依据。方法采用描述性分析法和结构变动度方法对四川省内中医医院2014年-2019年门诊和住院医疗费用结构变动情况进行分析。结果门诊收入中,中药收入平均占比最高(31.46%),手术收入平均占比最低(1.32%);检查收入在2016年-2019年、中药收入和其他收入在2018年-2019年为负向变动;治疗收入贡献率呈先上升后下降特点,手术收入的贡献率和拉动力处于最小状态。住院收入中,其他收入平均占比最高(34.88%),手术收入平均占比最低(5.41%);检查收入从2016年起、治疗收入从2017年起、手术收入从2018年起为正向变动;中药收入贡献率和拉动力不断增强,手术收入的拉动力在2019年明显提升。结论住院中药收入占比较低,应拓展中医药服务项目;治疗收入和手术收入结构变动贡献率较小,要加强中医医院服务能力建设;检查收入和其他收入拉动力较大,要加强对医务人员医疗行为的监管。  相似文献   
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