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Furthering healthcare reform calls for public hospitals to curb unreasonable growth of medical expenses,reduce drug proportion,and lower the costs of medical materials consumed per 100 RMB medical income.In view of the hospital,the authors established a data-based monitoring system for key indicators of medical consumables,formulated an evaluation scheme of rational use,and implemented the corresponding control measures,which provide a reference for scientific control of clinical rational use of the medical consumables.
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Objective@#To explore characteristics of general inter-departmental consultations in a hospital and put forward management strategy suggestions.@*Methods@#A large tertiary general hospital in Beijing was cited as the research object. Data were extracted from the EMR of the in-hospital inter-departmental consultations from July 1, 2017 to June 30, 2018, including information such as applying departments, submission time, invited departments, consultation completion time among others. Also collected were data such as discharges, case combination index(CMI), and preoperative average hospitalization days of clinical departments. Pearson and Spearman methods were used to perform correlation analysis, and independent sample Wilcoxon rank sum test was performed for the mean comparison.@*Results@#The ratio of consultations to discharged patients was 0.44, while consultation workload of cardiovascular medicine, ophthalmology and neurology was higher, and consultation applications issued by neurology, rheumatology and endocrinology departments were higher.For surgical departments, the correlation between demand of consultations and CMI was strong, r=0.63(P<0.05). The completion rate of consultation within 24 hours was 90.08%, and 64.79% of overtime consultations were caused by 35.63% of the consultation physicians.@*Conclusions@#It is imperative to enhance infrastructure support and information system construction to meet huge demands of inter-departmental consultations and to ensure patient safety; To further examinations of consultation purposes and improve doctors′ integrative abilities of diagnosis and treatment by introducing HIM mode to the training system, for the purpose of reducing unnecessary consultations; Optimize the process, shorten preoperative average length of stay by bringing forward inpatient-consultations to outpatient department; Inspire consultation enthusiasm and ensure consultation quality through performance appraisal mechanism.
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Objective@#To analyze cases in different groups of DRGs mortality risk ranking regarding overall medical dispute cases of the hospital from 2012 to 2017, and to study various groups of such ranking for these disputes as faced by different clinical departments, for the purpose of targeted intervention into medical risk exposures.@*Methods@#Inpatient medical dispute cases in 2012-2017 period were selected, and classified into the various mortality groups by the standards and definition of BJ-DRGs. These data were used to calculate medical dispute incidence in each group, and analyze the difference between internal medicine and surgery departments.@*Results@#Medical disputes of the hospital were mostly found in case groups of mortality free and those of low mortality risks, accounting for 66% of the total cases. This figure was the highest in surgical departments, having a percentage as high as 72%, and the CMI values of these cases were low as well (0.765 and 1.416 respectively).@*Conclusions@#As case groups of mortality free and low risks tend to attract disputes, the hospital is recommended to enhance the risk awareness and training of its medical staff and key medical regulations.
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Laparoscopic inguinal hernia repair has been widely used in adult inguinal hernia.The spermatic cord,as an important reproductive organ in male patients,should be deperitonealized to avoid injury in order to prevent fertility from being affected.However in female patients,the uterine round ligament not the spermatic cord goes across the inguinal canal,which extends from intraperitoneal and extraperitoneal,banding tightly with the peritoneum.It is difficult to completely strip the uterus round ligament from peritoneum to achieve deperitonealization.Hence there is still controversy about how to handle the uterus round ligament.There is no uniform guidance document for the handling of the uterus round ligament in laparoscopic inguinal hernia repair around the world.Handling methods are investigated in this article based on the summary of related literatures.
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Objective To investigate and analyze the status quo of the patients of extended stay at 11 clinical hospitals of a general university in Beijing, and explore the countermeasures and solutions.Methods Contact with the medical affairs departments of these hospitals to collect information about such patients of extended stay.Results A total of 43 cases of patients were identified as extended stay at these hospitals, accounting for 0.00% to 0.93% of total beds.Their stay ranged from 1 month to 15 years, including 17 cases with medical disputes (39.5%), and 26 cases without (60.5%).Conclusions The phenomenon of extended stay at hospitals deserve enough attention and appropriate actions accordingly.
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BACKGROUND:Artificial electronic cochlear (AEC) is a high-tech product used as a therapeutic substitute for pathological cochlear, and the implantative state of AEC can be assessed with the aid of imaging techniques.OBJECTIVE: To investigate the significance of CT and X-ray examination in the evaluation of preoperative selection and postoperative therapeutic result of patients with AEC implantation.DESIGN: Self-control observaton.SETTING:Auditory Rebuilding Ward of Otolaryngology Department, Zhujiang Hospital, Southern Medical University.PARTICIPANTS:Forty-four patients prepared for AEC implantation because of severe sensorineural hearing loss or extremely severer sensorineural hearing loss were recruited from the Otolaryngological Department, Zhujiang Hospital, Southern Medical University from January 1999 to June 2003.Thirty-two patients were with prespeech hearing loss, aged 2.5-12 and 12patients with postspeech hearing loss, aged 10-42.METHODS: Axial high-resolution temporal bone CT and three-dimensional reconstruction of inner ear were performed on 44 patients. They lay in supine position and received bilateral symmetric scanning with view of 9.6 cm. The baseline was set at the level of upper limit of auditory frame, and temporal bone was axially scanned. The scanning parameters were:thickness of 1 mm,spiral distance of 1.0 and interval of 0.5 mm; inserting rebuilding was performed after scanning with thickness of 1mm and interval of 0.1 mm. The improved routine cochlear axial stenves-X-ray image was performed after operation, and three patients underwent spiral CT temporal volume scanning due to suspicious postoperative complications.Postoperative inner ear and the arrangement and depth of implanted AEC.RESULTS: Totally 44 patients were remained in the result analysis perstructure: Of the 32 patients with prespeech deafness, 1 case (2 ears) was diagnosed as type Ⅰ Mondini malformation and 2 cases (4 ears) as type ⅡMondini malformation. Of the 12 patients with postspeech deafness, chronic suppurative otitis meadia was observed in 2 cases (4 ears ) , inner ear ossification in 1case (2 ears ), large vestibular aqueduct syndrome in 3 cases(6the arrangement and depth of implanted AEC :image of X-ray indicated that the electrode was implanted right in cochlea,displaying planar spiral shape and located at the bottom of inner-ear channel. Postoperative CT scanning was performed on 3 cases and revealed that electron was implanted into the bottom surroundings through round window and the electrode got twisted and infected in one cases.three-dimensional reconstruction of inner ear can be adopted before AEC implantation for screening out acute and chronic suppurative and severe ray image can afford clues to know the position and depth of implanted AEC and find out the twist and olithy of electrode, if any CT and cochlea image are supplemented for preoperative case selection and postoperative therapeutic evaluation, helping AEC to exert auditory function to the maximual degree.
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Based on the practical reconstruction of Ultrasonograph Information Management System in Nanjing General Hospital,this paper expounds the hardware architecture,software function and main technology characteristics in detail. The practical application shows that Ultrasonograph Information Management System can realize high-quality display,rapid capture,replay and storage for images,and can provide the functions of quick & accurate research,retrieval and auto statistics,thus effectively improving the work efficiency of ultrasonic diagnoses.
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Based on the practical running state of the computer-based patient record system in Nanjing General Hospital of Nanjing Military Command,PLA,this paper elaborated the soft structure? function and characteristics of the computer-based patient record system in detail,and the technical implement method of the computer-based patient record system was also introduced in the paper,which has the guidance significance for developing the computer-based patient record system in other hospital.
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We have developed an out-patient/emergency information system with the collaboration of Haitai Information Technology Co,Lth,and the out-patient medical workstaion have been put into full application.As our main experiences,we think that the on-line application of the workstation should be implemented step-by-step,in coordination with related departments,and with efficient safeguarding.
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Objective To investigate the value of CT as preoperative and postoperative imaging technique for cochlear implant candidates.Methods Axial high-resolution temporal bone CT and three-dimensional reconstruction of inner ear were performed in 44 patients with sensorineural hearing loss. Cochlear view radiography was performed routinely in postoperation cases. CT scanning was performed in 3 postoperation cases.Results There were 1 case (2 ears) with Mondini malformation type Ⅰ, 2 case (4 ears)with Mondini malformation type Ⅱ in 32 patients with prespeech deafness. There were 2 case (4 ears) with chronic suppurative otitis meadia, 1 case (2 ears) with inner ear ossification,3 cases (6 ears)with large vestibular aqueduct syndrome,1 case (2 ear)with cochlear sclerosis in 12 patients with postspeech deafness. 1 case with intracochlear electrode knot and otitis meadia was found by CT.Conclusion CT plays an important role in selecting patients, observing implanted electrode and finding postoperative complication.