Objective To analyze the proportions of interhospital and intrahospital consultation cases of chief residents in the Department of Endocrinology and Metabolism in West China Hospital of Sichuan University, and summarize the distribution characteristics of endocrine and metabolic diseases in other specialized departments, in order to promote the routine work optimization and the cultivation of specialists in endocrinology and metabolism. Methods A total of 1 299 cases were completed by the chief residents in the Department of Endocrinology and Metabolism between July 2012 and June 2013. Distribution of departments, composition and distribution of consultation cases were analyzed retrospectively. The characteristics of endocrine and metabolic diseases were summarized, and the difference of endocrine and metabolic consultation demand was compared among different departments . Results Among the 1 299 consultation patients, there were 612 males (47.11%) and 687 females (52.89%) aged between 14 and 96 years averaging at 56.3. There were 747 (57.51%) interhospital consultation cases and 552 (42.49%) intrahospital consultation cases. The most common reason for emergency consultation was stress hyperglycemia in diabetic patients after surgery or trauma, followed by thyroid diseases and electrolyte disturbances. Most consultation applications were from the Emergency Department, and the consultation purpose was mainly blood glucose control. The main consultation purpose of surgical and gynecologic departments was perioperative assessment and treatment adjustment in patients combined with endocrine diseases such as diabetes and thyroid diseases. Meanwhile,the purpose of obstetric consultation was mainly treatment for patients with hyperthyroidism complicated with pregnancy, gestational diabetes treatment and perioperative blood glucose control. Conclusions Clinical consultation work is challenging, which also provides an excellent chance for chief residents to study and review professional knowledge and accumulate clinical experiences. Chief residents should have the knowledge of the proportions and distribution of consultation cases in order to optimize daily work. They should also summarize consultation experiences so as to promote their knowledge of diagnosis and treatment.
From the perspective of the new institutional economics, the institutional change of hospital accreditation & evaluation in China was summarized and the experiences of hospital accreditation & evaluation from international organizations and other countries were refined to put forward the counter-measures for institutional innovations of accreditation & evaluation in China. First, it’s urgent for the government to issue the standards of hospital accreditation and discriminating hospital evaluation; second, these standards should pass the certification by the International Society for Quality in Health Care External Evaluation Association; finally, China should construct the commission on certification and accreditation administration for healthcare to supervise the social or third part organizations.
By dividing the evolution of the U.S. clinical trial registration system into three phases—emergence, inception, and maturity—this study systematically traces its half-century development and reveals the underlying tensions and institutional logic. The U.S. clinical trial registration system is not merely a technical instrument, but a comprehensive institutional platform reconciling the conflicts among scientific rationality, commercial interests, and the public’s right to know. The emergence phase (1971—1985) originated from the establishment and public disclosure of the International Cancer Database to meet cancer research needs and safeguard patients’ survival rights. The inception phase (1986—2004) unfolded against the backdrop of the FDA’s drug approval crisis, with the construction of major disease registration systems breaking the regulatory deadlock and achieving an “incremental revolution”. The maturity phase (2004—2016) centered on controlling publication bias and advancing institutionalization and legalization. The 2004 paroxetine incident galvanized global consensus on trial registration, and the 2007 U.S. Congressional mandate marked the pivotal turning point toward a fully mature system. Today, China still faces low registration rates and insufficient legal constraints. Drawing on the U.S. experience, China should prioritize institutional publicness, legal enforceability, and the containment of publication bias to strategically upgrade its clinical trial registration system.
摘要:目的:探讨临床教学的全程制度化管理及其效果。方法:通过健全组织,完善制度,加强教学、临床及实习生管理、建立激励机制等措施,进行全程制度化的规范管理。结果:教学质量显著提高,不良事件鲜见,无恶性事件发生。近来医院已有6篇教学论文公开发表,4个先进集体和8名先进个人受到医院表彰,5名优秀带教教师和8名实习生受到各学院奖励。结论:临床教学全程制度化管理是提高教学质量的切实有效途径。Abstract: Objective: To investigate system management during the entire clinical teaching process and its effect. Methods: To robust organization, perfect rules, strengthen management of clinical teaching and intern student, and establish encouragement mechanism,and other measures, so as to conduct standard system management during the entire process. Results: Quality of teaching improved notably, bad event was scarce, no malignant event occurred. There were six teaching articles issued publicly, four advanced collectives and eight advanced individuals had been praised by hospital, and five excellent teachers,eight intern students had been rewarded by each college. Conclusion: System management during the entire clinical teaching process is an effective way to improve teaching quality.
Objectives Through a systematic review, to summarize and describe various health security mechanisms of protecting financial risk from illness in low and middle income countries (LMICs), and to analyze causes that lead to different effects in financial risk protecting. Methods Search words were chosen by both health policy experts and search coordinators after discussion and pilot. Twenty-four electronic databases, websites of 11 health institutions, and the search engine Google were searched. Any original study to evaluate the role of financial protection of health security mechanism in LMICs was included. Pre-designed data extraction form was used for collecting strategies and study method of included studies, and extracted information was analyzed and described. Results Fifty-two studies were included, and 56 specific health security mechanisms were categorized into 6: community-based health insurance, social health insurance, health sector reform, subsidy, user fee, and new rural cooperative medical scheme (NRCMS) in China. Forty-two mechanisms had positive effect in financial protection, 6 were negative, 5 had no effect and the effect of the other 2 was unclear. Conclusion Mechanisms that produced positive effect can be summarized as: setting up of co-payment rate, design of benefit packages, providing free care for vulnerable population, delivering primary health care directly in remote area, and Chinese NRCMS. Mechanisms to protect the poor from financial risk of illness include: government provides health insurance, providing free care and setting up different co-payment rate according to income. The failure of health security mechanisms can be ascribed the deviation from its original goal of health security mechanism design, due to various inner or external causes.
The operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University is closely connecting individual needs with organizational objectives, and coordinating and adjusting again through communication and feedback. It can play an incentive role continuously and actively promotes the development of hospital scientific research. But the incentive mode, research funding management, research output rate, strengthening of effective communication and other aspects need to be constantly optimized and improved. Based on Porter Lawler’s comprehensive incentive theory, this paper explores and summarizes the operation mode of scientific research incentive mechanism in West China Hospital of Sichuan University. Finally, the paper puts forward suggestions, which aims to provide reference for the construction of scientific research incentive mechanism in large general hospitals.
Through reviewing the regulations on the right of emergency treatment of hospitals, we analyzed reasons of emergency treatment of hospitals, including uninformed patients and informed patients without consent in emergency situations, as well as the risk of emergency rescue of hospitals. We put forward how to consider the judgment of emergency situations, justification of emergency treatment of hospitals, and risk attribution. We suggested improving the related legislation and regulations, developing compulsory medical insurance and a medical rescue system on emergency treatment.