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With the continuous promotion of the comprehensive reform of public hospitals, public hospitals urgently need to change the management mode, achieve connotative development, and seek benefits from their own management, which has become an urgent task than ever. The authors expounded the construction and application practice of the hospital intelligent operation management platform, took the information construction as a tool, built the operation data warehouse, established the department accounting model, and explored the construction path of the hospital intelligent operation management, so as to provide a reference for promoting the scientific, refined and informatization of the hospital operation management, and improving the operation management level.
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Objective@#To investigate the high-risk factors for parotid lymph node (PLN) metastasis from nasopharyngeal carcinoma (NPC) and evaluate the feasibility of local intensity-modulated radiotherapy (IMRT) in patients with high-risk NPC.@*Methods@#Clinical data of 440 NPC patients admitted to Department of Radiotherapy of Jiangsu Cancer Hospital from May, 2011 to March, 2017 were collected. The imaging features, treatment strategies and clinical prognosis of PLN metastasis were retrospectively analyzed. The whole group adopts the technique of intensity modulated radiotherapy. Total parotid or partial parotid irradiation, selective PLN irradiation, X-Ray and/or electronic line supplementation, dose 45-60 Gy. The χ2 test or Fisher′s accurate probability method test and single factor analysis, Logistic regression model multi-factor analysis. Kaplan-Meier survival analysis, log-rank test differences.@*Results@#PLN was observed in the parotid of 230 cases. At the end of follow-up, 11 patients (2.5%, 11/440) were diagnosed with PLN metastases. Among 11 cases, 9 patients (81.8%) had PLN size ≥5 mm. Multivariate analysis demonstrated that extracapsular spread of level Ⅱ was an independent risk factor for PLN metastasis. The patients with PLN size ≥5 mm or extracapsular spread of level Ⅱ were assigned into the high-risk PLN metastasis group. The patients in the high-risk group were further divided into the radiotherapy and non-radiotherapy subgroups. Survival analysis demonstrated that for 230 patients with PLN metastasis, the local recurrence-free survival (LRFS) significantly differed, whereas the overall survival (OS), disease metastasis-free survival (DMFS) and progression-free survival (PFS) did not considerably differ between the radiotherapy and non-radiotherapy subgroups in the high-risk PLN metastasis patients.@*Conclusions@#The PLN metastasis rate of NPC is low. Extracapsular spread of level Ⅱ is an independent risk factor. Radiotherapy of the parotid region is considered for patients with PLN size≥5 mm or those with PLN size<5 mm complicated with extracapsular spread of level Ⅱ.
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The authors compared and analyzed the guidelines and the index system of public hospitals as stated in such papers as " State Council′s Opinions on Performance Evaluation of Tertiary Hospitals" (No.4 Document of State Council, 2019)and " Guidance on Strengthening the Performance Evaluation of Public Hospitals" (No.94 Document of Guo Wei Ren, 2015). Based on their studies, this paper summarized the commonness and law of development of the two editions of the indexes. They proceeded on such basis to collect data from over 3 600 medical institutions of tertiary hospitals in Beijing and the rest of China before and after the drug-clinic-separation reform in Beijing, National tertiary public hospitals and analyzed key indexes to learn the guidelines and impacts of the 2019 edition on hospital management. The performance indexes of the 2019 edition highlight the public welfare of public hospitals, strengthen the functional orientation of tertiary public hospitals, and point out the direction for further healthcare reform. These papers have a far-reaching impact on hospital strategy and management mode, guiding public hospitals to change their concepts and take on dual responsibilities of public welfare and self-development.
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The authors compared and analyzed the guidelines and the index system of public hospitals as stated in such papers as " State Council′s Opinions on Performance Evaluation of Tertiary Hospitals" ( No.4 Document of State Council, 2019 ) and " Guidance on Strengthening the Performance Evaluation of Public Hospitals" (No.94 Document of Guo Wei Ren, 2015). Based on their studies, this paper summarized the commonness and law of development of the two editions of the indexes. They proceeded on such basis to collect data from over 3 600 medical institutions of tertiary hospitals in Beijing and the rest of China before and after the drug-clinic-separation reform in Beijing, National tertiary public hospitals and analyzed key indexes to learn the guidelines and impacts of the 2019 edition on hospital management. The performance indexes of the 2019 edition highlight the public welfare of public hospitals, strengthen the functional orientation of tertiary public hospitals, and point out the direction for further healthcare reform. These papers have a far-reaching impact on hospital strategy and management mode, guiding public hospitals to change their concepts and take on dual responsibilities of public welfare and self-development.
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Objective To investigate the high-risk factors for parotid lymph node (PLN) metastasis from nasopharyngeal carcinoma (NPC) and evaluate the feasibility of local intensity-modulated radiotherapy (IMRT) in patients with high-risk NPC.Methods Clinical data of 440 NPC patients admitted to Department of Radiotherapy of Jiangsu Cancer Hospital from May,2011 to March,2017 were collected.The imaging features,treatment strategies and clinical prognosis of PLN metastasis were retrospectively analyzed.The whole group adopts the technique of intensity modulated radiotherapy.Total parotid or partial parotid irradiation,selective PLN irradiation,X-Ray and/or electronic line supplementation,dose 45-60 Gy.The x2 test or Fisher's accurate probability method test and single factor analysis,Logistic regression model multifactor analysis.Kaplan-Meier survival analysis,log-rank test differences.Results PLN was observed in the parotid of 230 cases.At the end of follow-up,11 patients (2.5％,11/440) were diagnosed with PLN metastases.Among 11 cases,9 patients (81.8％) had PLN size ≥5 mm.Multivariate analysis demonstrated that extracapsular spread of level Ⅱ was an independent risk factor for PLN metastasis.The patients with PLN size ≥ 5 mm or extracapsular spread of level Ⅱ were assigned into the high-risk PLN metastasis group.The patients in the high-risk group were further divided into the radiotherapy and non-radiotherapy subgroups.Survival analysis demonstrated that for 230 patients with PLN metastasis,the local recurrence-free survival (LRFS) significantly differed,whereas the overall survival (OS),disease metastasis-free survival (DMFS) and progression-free survival (PFS) did not considerably differ between the radiotherapy and nonradiotherapy subgroups in the high-risk PLN metastasis patients.Conclusions The PLN metastasis rate of NPC is low.Extracapsular spread of level Ⅱ is an independent risk factor.Radiotherapy of the parotid region is considered for patients with PLN size≥5 mm or those with PLN size＜5 mm complicated with extracapsular spread of level Ⅱ.
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Objective To study the impacts and the difference made by the pilot reform and comprehensive reform of clinic-pharmacy-separation on the medical visit behaviors of outpatients in Beijing.Methods Invoice information of outpatients′ fee payment during the December 2012 reform and April 2017 reform at the hospital was collected.Information of these patients at the same time as controls was collected to analyze patients′ fee categories, so as to study the effect on the behavior of these patients.Results The outpatient visits decreased by 5.29% as a result of the pilot reform.The ratio of medical insurance patients rose by 6.86%, and that of such patients seeking only prescriptions rose by 4.30%;number of outpatient visits decreased by 2.03% after the comprehensive reform, while the ratio of medical insurance outpatients dropped by 2.61%, and those seeking prescription only dropped by 2.54%.Conclusions The comprehensive reform of clinic-pharmacy-separation has influenced the outpatient′s medical visit behavior, evidencing a positive outcome of the healthcare reform.
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Objective To analyze the problems frequently found in medical equipment bidding at public hospitals and come up with countermeasures for building a scientific and standardized bidding procedure.Methods 168 cases of medical equipment bidding of the hospital in the recent five years served as objects of study,for a full-process longitudinal study.It covered the preparation of technical parameters,compilation of bidding documentation,bid opening/evaluation process,all the way to final acceptance and after-sales service,and complaints responses.Results In the 168 cases,imported equipments accounted for 86.90%;only 16.07% of the purchases involved consumables,yet their importance deserved high attention;59.52% of the equipments involved after-sales maintenance costs,calling for regular maintenance to ensure smooth operation of the equipments.Conclusions Quality of domestic equipments should be enhanced,for optimization of the ratio between domestic and imported equipments;equipment purchase,after-sales service and consumables purchase should be taken into account in general;scientific evaluation levels and standards should be established to enhance supervision,for the purpose of scientific and rational purchase of medical equipments.
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Objective To explore the relationship between the rs18004197 polymorphism in the 3'-untranslated region of adenomatous polyposis coli (APC) gene and colorectal cancer susceptibility.Methods Firstly,we collected the peripheral venous blood of 573 colorectal cancer cases and 588 controls,and then extracted DNA from blood samples,genotyped rs1804197 polymorphism using real-time PCR and assessed its association with the susceptibility of colorectal cancer.Results There were 387 CC (67.5％),153 AC (26.7％) and 33 AA (5.8％) genotypes in the colorectal cancer cases.In the control group,there were 427 CC (72.6％),144 AC (24.5％) and 17 AA (2.9％) genotypes.The AA genotype odds ratio (OR =2.14,95％ CI:1.17-3.91,P =0.011) and the A allele frequency (P =0.011) were significant difference in case and control groups.Further subgroup analysis showed that the differences of the frequency distribution in the male (P =0.048) and non-drinking (P =0.020) groups were statistically significant.In the male group,the risk of colorectal cancer was increased by 0.41 (OR =1.41,95％ CI:1.01-1.98) for individuals bearing the A allele.In the non-drinking group,the risk of colorectal cancer was increased by 0.22 (OR =1.22,95％ CI:0.91-1.64) for individuals bearing the A allele,but the result was not statistically significant.Conclusion The rs18004197 polymorphism in the 3'-untranslated region of APC gene is related to the susceptibility of colorectal cancer.The AA genotype may increase the susceptibility of colorectal cancer.
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Objective To investigate the incidence and risk factors of surgical site infection(SSI)in neurosurgical patients in a tertiary first-class hospital,and provide reference for the prevention and control of SSI.Methods 47 neurological patients with SSI (49 patients developed SSI,2 were excluded from study due to the lack of appropriate control subject)from December 31 ,2011 to December 31 ,2012 were as infected group,and 94 patients without SSI (1 ∶2 matching)were as non-infected group,risk factors for SSI were analyzed retrospectively.Results There was no significant difference in general condition of two groups of patients (all P >0.05 );among 3 708 patients,49 (1 .32%)developed SSI;intracranial infection was the main type of SSI (89.80%);27 patients were performed ce-rebrospinal fluid (CSF)bacteriological detection,6 (22.22%)of whom were positive for CSF bacteriological detec-tion.Univariate conditional logistic regression analysis showed that risk factors for SSI in neurosurgical patients were operational risk assessment score (OR =2.04),frequency of preoperative antimicrobial use(OR =3.15 ),fre-quency of intraoperative antimicrobial use(OR=2.58),duration of operation(OR=2.70),surgical blood loss(OR=1 .72),indwelling drainage tube(OR=4.30),duration of indwelling drainage tube after operation(OR=2.06),and time for initial dressing change(OR=1 .66);Multivariate conditional logistic regression analysis showed that the in-dependent risk factors for SSI were frequency of preoperative antimicrobial use(P =0.03,OR =4.86),duration of operation(P =0.05,OR = 2.89 ),and time for initial dressing change after operation (P = 0.01 ,OR = 1 .92 ). Conclusion Risk factors for SSI in department of neurosurgery are multiple,duration of operation,duration of in-dwelling drainage tube after operation,and time for initial dressing change after operation are major risk factors.
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Objective To observe the anti-cancer effect in vitro of Aitongxiao Granules containing serum on SMMC-7721 and Bel-7404 liver cancer cells, thus revealing the anti-cancer mechanism of the treatment in adjusting proliferation and apoptosis. Methods Male Sprague-Dawley rats were administered by gastrogavage Aitongxiao decoction of 86.4, 43.2, 21.6 g/kg twice a day for 1 week. Using serum pharmacologic method, the proliferation of SMMC-7721 and Bel-7404 liver cancer cells were determined by MTT chromatometry after co-cultured with medicated serum containing different concentration of Aitongxiao decoction. The apoptosis of SMMC-7721 and Bel-7404 liver cancer cells were detected by flow cytometry. Results The research in vitro showed that Aitongxiao Granules containing serum low, medium and high dose groups had varying degrees of inhibition on hepatoma cells, and this inhibition showed a concentration dependence within a certain range. Aitongxiao Granules containing serum could induce apoptosis of human hepatoma SMMC-7721 cells and Bel-7404 cells. Conclusion Aitongxiao Granules showed effect of inhibiting proliferation and inducing apoptosis on SMMC-7721 and Bel-7404 cells in vitro.
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<p><b>OBJECTIVE</b>To summarize anesthetic management of low birth weight infants undergoing surgical intervention of congenital heart disease without cardiopulmonary bypass.</p><p><b>METHODS</b>Fifty-three low birth weight infants (including 49 premature infants) with congenital heart disease underwent surgical treatment without cardiopulmonary bypass during the period from June, 2003 to July, 2013. The mean gestational age of the infants was 30.96∓3.09 weeks (26-40 weeks) with a mean age on the operation day of 32.81∓20.76 days (4-87 days), birth weight of 1429.90∓455.08 g (640-2460 g), and weight on the operation day of 1750.20∓481.59 g (650-2460 g). All the infants underwent cardiac operations without cardiopulmonary bypass under general anesthesia. The respiratory parameters and acid-base and electrolyte balance were adjusted according to blood gas analysis. The inotropic drug was used to maintain the hemodynamic stability.</p><p><b>RESULTS</b>Forty-seven of the infants received patent ductus arteriosus (PDA) ligation. Of these infants, 1 had cardiac arrest before the operation with failed cardiopulmonary resuscitation, and in another case, PDA ligation was aborted due to severe hypoplasia of the aortic valve and ascending aorta found intraoperatively by transesophageal echocardiography. Two infants underwent coarctation of the aorta (CoA), and 1 of them died during the operation due to cardiac arrest. The total mortality of these infants was 3.77% and the early postoperative mortality (<72 h) was 5.66%.</p><p><b>CONCLUSIONS</b>Non-cardiopulmonary bypass surgery can be performed in low birth weight infants in early stage, and effective anesthetic management can reduce the perioperative mortality and improve the postoperative survival rate.</p>