ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement. MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management. ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium. ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
Non-directly affiliated hospitals are an important supplement to directly affiliated hospitals of medical colleges in China. Considering the problems of teaching consciousness, school running form and teachers construction in non-directly affiliated hospitals, this paper takes the medical personnel training of a non-directly affiliated hospital which is subordinate to Shenzhen Luohu Hospital Group as an example, in order to analyze the related exploration methods of non-directly affiliated hospitals under the development of hospital collectivization, and put forward a trinity training mode of general practitioners, which is “medical college-non-directly affiliated hospital-community health center”. This paper further discusses the challenges and possible solutions faced by non-directly affiliated hospitals in the new era.
目的:了解绵竹市社区卫生服务系统震后现状,同时分析社区医疗震后居民满意度和社区卫生服务机构震后灾害干预能力,以期为社区卫生服务体系地震应急恢复和重建提供参考意见。方法:采用随机抽样的方法,抽取绵竹市剑南社区卫生服务中心和天河社区卫生服务中心进行访谈,采取方便抽样的方法,抽取2.4‰的绵竹城区居民采用面对面访谈的方式用自制问卷进行调查,并用Epidata 3.0 进行数据录入、SPSS13.0进行统计分析。结果:共发放问卷240份,收回有效问卷229份(有效回收率95.4%)。当地社区卫生服务系统在地震中受损严重。社区卫生服务系统灾后工作居民满意度为45.4%,社区卫生服务机构对居民进行抗灾/防灾知识教育的比例为33.6%,灾后是否有持续而足够的常见病药品供应及是否有持续而足够的慢性病药品供应是影响当地居民对当地社区卫生服务体系灾害应急工作的满意度的影响因素(P值分别是0.033,0.001)。结论:震后社区卫生服务居民满意度较低,服务体系地震灾害干预能力不足。居民在在灾前接受抗灾教育的比例较低,加强药品储备能提高社区卫生机构灾害应急工作的效果。在社区卫生服务体系重建的过程中,应注重社区医疗基础工作的恢复,基础设施的重建和健全社区急救体系。
社区获得性肺炎( CAP) 是严重威胁人类健康的常见疾病之一, 但在其诊断和治疗仍存在相当大的差异。临床路径( clinical pathway, CP) 是一种新的临床诊疗规范管理方式,近年来开始应用于CAP 的临床诊治, 陆续有协会组织开始制定关于CAP 的临床路径, 并应用于临床。
ObjectivesTo explore the impact of the medical consortium of a tertiary grade A hospital on the economic benefits and business levels of the community hospitals, to summarize the problems of the current medical joint mode, and to provide suggestions for promoting the medical association model.MethodsWe collected the data of economic benefit and business level of a tertiary grade A hospital and its affiliated community hospitals before and after the implementation of the medical consortium model [2016 (pre-implementation) and 2017 (post-implementation)], and analyzed the differences between the two groups. Patients were selected by stratified sampling method before and after the implementation, investigations and follow-up were conducted. The satisfaction and compliance were analyzed.ResultsCompared with the data in 2016, in 2017, the total income of community hospitals increased by 25.13% (2.671 2 million yuan vs. 2.134 7 million yuan), the number of outpatients increased by 15.55% (7 496 vs. 6 487 cases), the number of hospitalizations increased by 59.49% (1 673 vs. 1 049 cases), and the number of students increased the most, reaching 366.67% (14 vs. 3). Finally, a total of 472 patients were included, including 213 in pre-implementation group and 259 in post-implementation group. There was no significant difference in the general data between the two groups (P>0.05). The patients’ satisfaction and compliance in post-implementation group were better than those in pre-implementation group (P<0.05). In June and December 2017, the hospital’s medical staff business test level increased significantly compared with those in the same period in 2016 (t=−7.467、−9.998, P<0.001), and the results in December 2017 were significantly higher than those in June 2017 (t=−4.719, P<0.001). But there was no significant difference in the performance of business level assessment between the results in June 2016 and in December 2016 (t=−1.158, P=0.250).ConclusionAn effective “Three Construction and One Management” model can promote the advancement of medical standards in community hospitals while promoting the effective improvement of economic benefits and improving the patients’ satisfaction.
摘要:目的: 观察免费治疗社区精神分裂症患者的疗效。 方法 :纳入贫困家庭精神分裂症患者140例,随机分为免费服药组和对照组,每组70例。随访1年,采用精神分裂症阳性与阴性症状量表(PANSS)\社会功能缺陷量表(SDSS)等评估。 结果 :对实验组与对照组的基线、6个月后及1年后随访的PANSS总分、各因子分、SDSS总分分别进行比较,结果显示基线、6月后均无统计学差异;1年后SDSS总分、PANSS总分、阳性因子分、一般病理因子、思维障碍、偏执因子分差异有显著性;免费治疗组1年后各指标与入组前相比分值降低(P＜001)。 结论 :精神分裂症患者免费服药后精神症状缓解明显,同时其社会功能缺陷也得到改善。Abstract: Objective: To observe the effect of the free treatment on schizophrenics from community. Methods : Totally 140 subjects from poor family were divided into the free treated group and the control group at random. They were followed up for 1 year. The treatment effects were evaluated by PANSS and SDSS. Results : There were no significant difference in all examinations at baseline and after 6 months; at the following end point, significant difference existed in the score of SDSS, the total scores of the PANSS, the positive factor, the general pathology factor, the thinking factor and the paranoid ideation factor between two groups. There was decrease in the scores for all examinations in the free treated group. Conclusion : The symptoms of schizophrenics by free treatment relieve significantly, and the social function improves.
Objective To explore the referral patterns for rehabilitation of patients with spinal cord injury (SCI) in community hospitals and establish green channel for SCI rehabilitation between community hospitals and large comprehensive hospitals. Methods Thirty SCI patients who were referred from the Center of Rehabilitation Medicine, West China Hospital to community hospitals between February 2013 and June 2014 were selected for this study. All the patients were assessed with American Spinal Injury Association (ASIA 2011), activities of daily living (ADL), and instrumental activities of daily living (IADL). Based on the assessment results, rehabilitation plan was made and the patients underwent community rehabilitation treatment. Results After rehabilitation treatment in community hospitals, the scores of ASIA, ADL and IADL in all the SCI patients were significantly higher than those at the time of referral (P<0.001). Conclusions SCI patients can accept rehabilitation treatment in community hospitals with good conditions. This practice can provide a new type of seamless referral pattern between large comprehensive hospitals and community hospitals for rehabilitation of SCI patients.
ObjiectiveTo obtain reliable evidence of diagnosis and treatment through evaluating the validity of pneumonia severity index (PSI), CURB-65 and acute physiology and chronic health evaluationⅡ(APACHEⅡ) scores in predicting risk stratification, severity evaluation and prognosis in elderly community-acquired pneumonia (CAP) patients.MethodsClinical and demographic data were collected and retrospectively analyzed in 125 in-hospital patients with CAP admitted in Shanghai Dahua Hospital from January 2012 to April 2015. The severity of pneumonia was calculated with PSI, CURB-65 and APACHEⅡgroups during 1 to 3 days after admission. Mortality and intensive care unit (ICU) admission rates were evaluated among patients in each scores and was categorized into three classes, namely mild, moderate and severe groups during 1 to 3 days after admission. Mortality and ICU admission rates were evaluated among patients in each severity level. Through evaluating the sensitivity, specificity, the predicting values and the area under receiver operating characteristic (ROC) curve (AUC) among PSI, CURB-65 and APACHEⅡ, the validity and consistency of these three scoring systems were assessed.ResultsUsing PSI, CURB-65 and APACHEⅡ scoring systems, the patients were categorized into mild severity (48.8%, 64.0% and 52.8%, respectively), moderate severity (37.6%, 23.2% and 32.0%, respectively) and severe severity (13.6%, 12.8% and 15.2%, respectively). In PSI, CURB-65 and APACHEⅡ systems, the mortality in high risk groups was 41.3%, 62.5% and 47.4%, respectively; The ICU-admission rate in high risk groups was 88.3%, 100.0% and 94.7%, respectively. The sensitivity of PSI, CURB-65 and APACHEⅡ was 50.0%, 71.4% and 64.3% in predicting mortality, and was 46.8%, 50.0% and 59.3% in predicting ICU-admission, respectively. PSI, CURB-65 and APACHEⅡ showed similar specificity (approximately 90%) in predicting mortality and ICU admission. ROC was conducted to evaluate the sensitivity of PSI, APACHEⅡ and CURB-65 in predicting mortality and ICU admission. The AUC had no significant difference among these three scoring systems. The AUC of PSI, CURB-65 and APACHEⅡwas 0.893, 0.871, 0.880, respectively for predicting mortality, and was 0.949, 0.837, 0.949, respectively for predicting ICU admission. There was no significant difference among these three scoring in predicting mortality and ICU admission (all P>0.05).ConclusionsPSI, CURB-65 and APACHEⅡ performed similarly and achieved high predictive values in elderly patients with CAP. The three scoring systems are consistent in predicting mortality risk in elderly CAP patients. The CURB-65 is more sensitive in predicting the risk of death, and more early in identifing patients with high risk of death. The APACHEⅡ is more sensitive in predicting the risk of ICU admission, and has good value in identifying severe patients and choosing the right treatment sites.