区域互联网医院建设与运营服务思考

全民健康信息化进入新阶段,结合卫生健康行业现状的梳理及政策走向,积极探索利用新兴信息技术引领医疗服务模式的变革.本研究提出区域互联网医院建设的概念界定、主要建设内容,以及建设运营和服务模式.旨在通过区域卫生专网和5G移动网络,利用最新信息技术成果,创建并利用区域互联网医院建设,优化配置医疗资源,缓解三级医院服务压力,提...     

西南地区军队医院放射影像学高档设备相关文章的现状分析

目的 通过对放射影像学高档设备相关文章发表情况的回顾性分析,了解该领域内西南地区军队医院的现状与不足,并对相应的对策进行初步探讨。方法 通过中文生物医学期刊文献数据库(CMCC)1994年到2003年一季度数据,查阅近年来放射影像学中与高档设备相关研究的文章,包括磁共振、磁共振波谱(MRS)、功能磁共振(fMR)、电子束CT、多层螺旋CT和计算机X线摄影(CR),归纳其中全军和西南地区军队医院文章数,分析文章的分布趋势。结果 相关文章中全军/西南地区军队医院情况:磁共振(907/76)、MRS(16/0)、fMR(11/0)、电子束CT(32/0)、多层螺旋CT(40/3),CR(8/0)。结论 高档设备相关文章的缺乏可能是影响西南地区放射影像学界在全军医学界的地位的重要因素。除更新设备外,充分应用现有设备联合临床进行研究及更多开展非设备依赖性研究是西南地区军队医院放射影像学发展的出路之一。     

教学医院实习护生信息平台的构建及应用

目的对实习护生进行科学管理,提高带教质量和实习护生的综合素质。方法将2009年的实习护生设为对照组(121人),采用传统方法带教;2010年的实习护生设为实验组(121人),在传统带教基础上,构建实习护生信息平台用于临床教学管理。结果实验组护生理论、操作技能、综合能力考试成绩显著高于对照组(均P<0.01)。结论构建实习护生信息平台有利于医院对实习护生进行科学的管理,提高带教质量和实习护生的综合素质。     

Comparative study on transradial approach vs. transfemoral approach in primary stent implantation for patients with acute myocardial infarction: results of the test for myocardial infarction by prospective unicenter randomization for access sites (TEMPURA) trial.

Transradial coronary intervention (TRI) can be performed in elective patients with low incidence of access site complications. However, the feasibility of primary stent implantation by TRI is still not clear in patients with acute myocardial infarction (AMI). We prospectively randomized 149 patients out of 213 patients with AMI within 12 hr from onset into two groups: 77 patients treated by TRI (TRI group) and 72 patients by transfemoral coronary intervention (TFI; TFI group). We compared the incidences of major adverse cardiac events (MACE; repeat MI, target lesion revascularization, and cardiac death) during the initial hospitalization and 9-month follow-up periods in both groups. There were one patient who crossed over to the opposite arm, and two patients with severe bleeding complications in the TFI group. Background characteristics of patients were similar between the two groups. The success rate of reperfusion and the incidence of in-hospital MACE were similar in both groups (96.1% and 5.2% vs. 97.1% and 8.3% in TRI and TFI groups, respectively). In selected patients with AMI, primary stent implantation by TRI is feasible as compared to TFI.     

Relation between renal function,presentation, use of therapies and in‐hospital complications in acute coronary syndrome: data from the SWEDEHEART register

Abstract. Szummer K, Lundman P, Jacobson SH, Schön S, Lindbäck J, Stenestrand U, Wallentin L, Jernberg T, for SWEDEHEART. (Karolinska Institute, Karolinska University Hospital, Stockholm; Karolinska Institute, Danderyd Hospital, Danderyd; Ryhov County Hospital, Jönköping; University Hospital, Uppsala and University Hospital, Linköping; Sweden) Relation between renal function, presentation, use of therapies and in‐hospital complications in acute coronary syndrome: data from the SWEDEHEART register. J Intern Med 2010; 268 :40–49. Objective. To examine clinical characteristics, presenting symptoms, use of therapy and in‐hospital complications in relation to renal function in patients with myocardial infarction (MI). Design. Observational study. Setting. Nationwide coronary care unit registry between 2003–2006 in Sweden. Subjects. Consecutive MI patients with available creatinine (n = 57 477). Results. Glomerular filtration rate was estimated with the Modification of Diet in Renal Disease Study formula. With declining renal function patients were older, had more co‐morbidities and more often used cardio‐protective medication on admission. Compared to patients with normal renal function, fewer with renal failure presented with chest pain (90% vs. 67%, P < 0.001), Killip I (89% vs. 58%, P < 0.001) and ST‐elevation myocardial infarction (STEMI) (41% vs. 22%, P < 0.001). In a logistic regression model lower renal function was independently associated with a less frequent use of anticoagulant and revascularization in non‐ST‐elevation MI. The likelihood of receiving reperfusion therapy for STEMI was similar in patients with normal‐to‐moderate renal dysfunction, but decreased in severe renal dysfunction or renal failure. Reperfusion therapy shifted from primary percutaneous coronary intervention in 71% of patients with normal renal function to fibrinolysis in 58% of those with renal failure. Renal function was associated with a higher rate of complications and an exponential increase in in‐hospital mortality from 2.5% to 24.2% across the renal function groups. Conclusion. Renal insufficiency influences the presentation and reduces the likelihood of receiving treatment according to current guidelines. Short‐term prognosis remains poor.     

利钠肽与急性心肌梗死后心功能不全和住院病死率相关性研究

目的探讨急性心肌梗死(AMI)患者血浆利钠肽浓度与其急性期心力衰竭和住院病死率之间的相关性。方法选择初发AMI患者294例,其中住院期间存活272例,死亡22例;LVEF≥40%262例,<40%32例;Killip分级Ⅰ级152例,Ⅱ级99例,Ⅲ～Ⅳ级43例。记录发病14～18h血浆利钠肽浓度,发病24～48 h超声心动图检查测定LVEF和左心室二尖瓣舒张早期血流峰值(E)和舒张晚期血流峰值(A)比值(E/A),对各因素间的利钠肽浓度进行比较。结果血浆利钠肽随着Killip分级Ⅰ、Ⅱ、Ⅲ～Ⅳ级逐渐升高,差异有统计学意义(P<0.01)。AMI后急性期心功能Killip分级及肌酸激酶同工酶峰值与利钠肽呈正相关,E/A与利钠肽呈负相关。死亡患者血浆利钠肽明显高于存活患者[(2399.0±1626.0)ng/L vs(480.8±676.0)ng/L,P<0.01]。利钠肽是AMI患者住院死亡的强预测因素(OR=1.259,P=0.028)。结论血浆利钠肽在AMI后的高危患者中明显升高,与急性期心功能Killip分级、舒张功能及死亡均显著相关,可以尝试用于AMI后心功能不全及死亡危险性的早期预后评估。     

个案管理师主导的MMC随访平台在2型糖尿病患者院内外护理中的应用

目的 探讨个案管理师主导的MMC随访平台在2型糖尿病患者院内外护理中的应用效果.方法 选择本院内分泌科2018年10月—2019年3月收治的105例2型糖尿病患者作为研究对象,采用随机数字表法将其分为试验组(n=52)和对照组(n=53),对照组患者实施常规的健康教育和随访工作,试验组患者实施由个案管理师主导的MMC平...     

S市按病种分值付费对公立医院绩效考核病种质量的影响

目的：分析S市国家公立医院绩效考核关注病种在2019年7月实施按病种分值付费改革后医疗服务质量的变化情况。方法：收集2017年7月—2021年6月S市公立二、三级医院的职工保险参保患者住院病案首页数据,采用双重差分法比较改革前后首批DIP付费试点医院(干预组)和非DIP付费试点医院(对照组)的4个典型诊断和2个典型手术操作的住院天数、院内死亡率、30天内全因再入院率变化情况。结果：试点医院相比非试点医院,改革后国家公立医院绩效考核关注的典型诊断和手术操作的住院天数分别上升0.228天、下降0.568天,但均无统计学意义。典型诊断和典型手术操作的院内死亡率分别下降0.5个百分点(P=0.047)、1.1个百分点(P=0.000);30天内全因再入院率分别下降2.0个百分点(P=0.017)、4.9个百分点(P=0.014)。结论：S市按病种分值付费改革后国家公立医院绩效考核关注病种的住院天数变化方向不一致;院内死亡率和再入院率提示的服务质量改善。按病种付费改革中需密切监测多病种、多维度的服务质量变化。     

新疆179家医院突发事件医疗应急救援管理体系现状调查

目的 评价新疆医院突发事件医疗应急救援管理体系建设现状,为提高突发事件医疗应急救援能力提供依据.方法 2019年3-5月,采取整群抽样的研究方法,对新疆二级及以上医院的应急管理现状、应急制度、应急预案、应急专家组、应急演练等情况进行调查,并对结果进行汇总分析.结果 共有179家医院参与调查并回收有效问卷,占新疆所有二级...     

某三甲妇幼保健院超长住院日患者的分布特征分析与对策

目的:回顾性分析2019年江苏省某三甲妇幼保健院全年的超长住院日分布特征,探讨超长住院日的影响因素,并为医院管理提供数据支持.方法:分析该三甲妇幼保健院2019年全部出院患者并按照病案首页信息,将住院超过30天出院患者按性别、年龄、出院科室、疾病分类、费用等情况进行分类,利用Stata采用多元线性回归分析探讨超长住院日...