ABSTRACT
Objective:To explore the driving mechanisms of doctors′ collaborative willingness and behavior in the tiered diagnosis and treatment system, in order to provide reference for promoting the construction of the tiered diagnosis and treatment system.Methods:Based on the harmonious management theory, a theoretical framework for the driving mechanisms of doctors′ collaborative behavior in the tiered diagnosis and treatment system was developed. Through random sampling, a questionnaire survey was conducted among doctors from 40 medical institutions in five prefecture-level cities in Zhejiang province between April and May 2022. The t-test, variance analysis, and non-parametric tests were employed to analyze the differences in collaborative willingness and behavior among doctors based on various demographic characteristics. The structural equation model and stratified linear regression were used to assess the impact of collaborative factors (professional environment and work expectations) and harmonious factors (perception of policy support and perception of management mechanism) on doctors′ collaboration willingness and behavior. Results:A total of 1 959 doctors participated in the survey. Doctors′ collaborative behavior scored 2.13±1.12, indicating a slightly below-average level, whereas their willingness to collaborate scored 3.88±0.79, falling between neutral and somewhat willing. Significant differences in collaborative behavior scores were observed based on the medical institution′s ranking, age, years of experience, monthly average income, and professional titles ( P<0.05). Both collaborative and harmonious factors directly influenced the doctors′ willingness to collaborate, with standardized path coefficients of 0.428 and 0.139, respectively. Similarly, these factors directly impacted their collaborative behavior, with standardized path coefficients of 0.104 and 0.366. The perceptions of policy support and management mechanisms demonstrated a significant positive moderating effect on the relationship between doctors′ collaborative willingness and behavior, with effect values of 0.047 and 0.043 respectively ( P<0.05). Conclusions:The collaborative and harmonious elements serve as positive drivers for collaboration among doctors in the tiered diagnosis and treatment system at both the cognitive and behavioral levels. Enhancing and optimizing policy support and management mechanisms can facilitate the transition from intention to actual collaborative actions among doctors from different levels of medical institutions.
ABSTRACT
The tiered medical treatment system stands as a cornerstone in the deepening reforms of China′s medical and health sectors, playing a crucial role in building a healthy China. Exploring the harmonious coexistence mechanism of multiple entities on the supply and demand sides of the tiered diagnosis and treatment system, and promoting the formation of a scientific and reasonable tiered diagnosis and treatment order, has become an urgent public proposition that needs to be answered and has significant social impact. Addressing the challenges in China′s tiered medical treatment system, particularly its need for a more systematic, comprehensive, and collaborative approach, this study is informed by a thorough literature review. Based on the harmonious management and symbiosis theories, the authors proposed a theoretical concept and future research path for the formation of a harmonious symbiotic mechanism in the tiered diagnosis and treatment system, in order to pave the way for exploring the harmonious symbiotic mechanism in the tiered diagnosis and treatment system.
ABSTRACT
To evaluate the efficacy and safety of drug-eluding beads transarterial chemoembolization (DEB-TACE) in treatment of unrecectable hepatocellular carcinoma (HCC).The clinical data of 42 consecutive HCC patients undergoing TACE were retrospectively analyzed, including 20 cases received conventional TACE (cTACE group) and 22 cases received TACE with epirubicine-loaded microspheres (CalliSpheres) (DEB-TACE group). MRI scans were performed 1 week before and 1, 3 and 6 months after initial therapy. The response to treatment, disease recurrence, complications and adverse effects were documented and compared between two groups.There were no significant differences in 1-month, 3-month and 6-month objective response rate (CR+PR) and disease control rate (CR+PR+SD), disease recurrence, complications and adverse effects of interventional therapy between cTACE group and DEB-TACE group. Additionally, there were no significant differences about locoregional biliary injuries, intrahepatic biloma, and newly detected intra- or extrahepatic HCC on MRI between cTACE group and DEB-TACE group.There were no statistically significant differences between cTACE group and DEB-TACE group with regard to the short-term response, disease recurrence, complications and side effects. Hepatic-locoregional complications may be more frequent in DEB-TACE group than those in cTACE group.
Subject(s)
Humans , Carcinoma, Hepatocellular , Diagnostic Imaging , Therapeutics , Chemoembolization, Therapeutic , Methods , Comparative Effectiveness Research , Drug Delivery Systems , Methods , Epirubicin , Therapeutic Uses , Liver Neoplasms , Magnetic Resonance Imaging , Microspheres , Neoplasm Recurrence, Local , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To evaluate the outcome of super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy (PCNL) and its effect on renal function. Methods From May 2008 to Feb 2010,severe bleeding occurred in 7 patients after PCNL in our hospital.(5 males and 2 females,average age of 54.9 years ).All cases were treated with super-selective renal angiography and 6 cases underwent microcoil embolization. Results Renal angiography showed pseudoaneurysm in 5 cases,pseudoaneurysm with arteriovenous fistula in 1 case and no severe bleeding in 1 case.Successful coil embolization was confirmed in 6 cases by angiography,and bleeding stopped within 3 -7 days after embolization.Serum creatinine and blood urea nitrogen were 59 -98 μmol/L(mean,78.3 μmol/L) and 1.86 -6.92 mmol/L( mean,4.8 mmol/L) 2 weeks after embolization,respectively. Conclusions Super-selective embolization of renal artery for severe hemorrhage after percutaneous nephrolithotomy has the advantages of remarkable hemostatic effects and mild impaired renal function,which is of the first choice.
ABSTRACT
Objective To prospectively investigate superselective renal arterial embolization (SRAE) in the treatment of iatrogenic renal hemorrhage MethodsFrom November 2005 to November 2010,19 patients with iatrogenic renal hemorrhage in the Affiliated Hospital of Hangzhou Normal University underwent diagnostic renoarteriography to reveal the site and degree of renal artery rupture,then superselective embolization by coins,or coins combined with spongia gelatinosa were performed for these patients.Results Renal arteriography showed hemorrhage was located at the renal segmental arteries and/ or their branches ( 9 cases at segmental renal artery,6 cases at interlobar artery and 4 cases at arciform artery),two cases were found with simple hemorrhage of segmental renal artery ( SRA ),9 cases with pseudoaneurysm,5 cases with arterio- venous fistula (AVF),3 cases with pseudoaneurysm combined with AVF.Seventeen cases received embolization with coins,while 2 cases with pseudoaneurysmes received embolization with coins and spongia gelatinosa at the same time.Bleeding was successfully ceased immediately and did not recur in all cases.Conclusions Superselective renal arterial embolization could be considered as a safe and effective method to treat hemorrhage of iatrogenic renal vascular injuries..
ABSTRACT
Objective To determine the value of MR cholangiography(MRC)in the preoperative evaluation of biliary anatomy of living liver donors.Methods Fifty eight consecutive donors underwent MRC examinations and living liver transplantation.MRC was performed on a 1.5 T scanner with breath-hold rapid acquisition of T_2WI slab and breathing-gating 3D FSE T_2WI.Images of MRC and IOC were compared and classified according to the modified Huang's classification.Results Thity four(58.6%)liver donors showed normal biliary anatomy on IOC,and 24(41.4%)donors revealed variant bile anatomy.MRC correctly depicted biliary anatomy in 91.4%(53/58)donors.The sensitivity,specificity,positive predictive value and negative predictive value of MRC in distinguishing normal and difierent types of variant biliary anatomy were 83.3%(20/24),100%(34/34),100%(20/20),89.5%(34/38)respectively.Conclusion MRC can accurately assess the biliary anatomy in living liver donors and may guide the preoperative planning of liver transplant.