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Objective:To analyze general information, diagnosis and treatment of digestive endoscopy departments in county-level hospitals of Yunnan Province, thus to provide evidence for improving the endoscopic diagnosis and therapy in these hospitals.Methods:An online survey was performed to collect quality-related information of digestive endoscopy centers (departments) at county-level hospitals of Yunnan from January 2019 to January 2020, including endoscopic equipment, endoscopic techniques, staffing, number of operations, and quality control.Results:A total of 143 county-level hospitals were involved in this study. Each hospital owned only 1.74 endoscopy operation rooms on average, 1.42 regular endoscopy workstation, 4 endoscopes. There were only 10 endoscopic ultrasonography workstations and 2 enteroscopy workstations respectively installed in these hospitals. Endoscopic retrograde cholangiopancreatography was independently performed in only 4 hospitals. There were 392 professional endoscopists in all 143 hospitals, 18.62% (73/392) of whom were able to perform endoscopic therapy of grade 4, while only 6.12% (24/392) of whom could perform endoscopic submucosal dissection (ESD) independently. In 2019, the early diagnostic rate of gastrointestinal tract cancer in these hospitals was 19.48% (1 133/5 817). The early diagnostic rate was 21.04% (276/1 312) for esophageal cancer, 19.53% (397/2 033) for gastric cancer, and 18.61% (460/2 472) for colorectal cancer. The colorectal adenoma detection rate was 12.83% (12 207/95 148). The rate of reaching cecum during colonoscopy was 70.49% (67 067/95 148). The complete resection rate of ESD was 12.54% (221/1 763).Conclusion:The general situation of digestive endoscopy in county-level hospitals of Yunnan is far from being well-developed, which may be attributed to slow upgrading of equipments, inadequate training of endoscopic professionals and undemanding quality control. It is highly significant to improve medical service and quality of diagnosis and treatment of digestive endoscopy in these hospitals, on the basis of a complete endoscopy quality control system with a high standard.
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Objective:To investigate the application value of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals.Methods:The clinical data of 51 patients with acute coronary syndrome who received treatment in Feng Tai People's Hospital from January 2020 to January 2022 were retrospectively analyzed. They were divided into a control group ( n = 25) and an observation group ( n = 26). The control group was given standard dual antiplatelet and statin drugs. The observation group underwent percutaneous coronary intervention and stent implantation based on conventional drug treatment. All patients were followed up for 1 year. Cardiac function indexes left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared between the two groups. The number of readmissions, length of hospital stay, quality of life score, medication, the incidence of complications, and the incidence of adverse cardiovascular events were compared between the two groups. Results:Before treatment, there were no significant differences in LVEF and LVEDD between the two groups (both P > 0.05). After treatment, LVEF was increased, and LVEDD was decreased in each group compared with before treatment. After treatment, LVEF and LVEDD in the observation group were (50.34 ± 5.97)% and (49.01 ± 5.02) mm, respectively, which were significantly superior to (45.61 ± 5.42)% and (52.12 ± 5.24) mm in the control group ( t = -2.96, 2.17, both P < 0.05). After treatment, the number of readmissions in the observation group was significantly less than that in the control group [(0.8 ± 0.1) times vs. (2.1 ± 0.3) times, t = 20.14, P < 0.001]. The length of hospital stay in the observation group was significantly shorter than that in the control group [(12.4 ± 3.1) days vs. (25.3 ± 3.9) days, t = 13.10, P < 0.001]. Quality of life score in the observation group was significantly higher than that in the control group [(85.3 ± 5.9) points vs. (72.5 ± 5.2) points, t = -8.19, P < 0.001]. After treatment, the incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group [3.9% (1/26) vs. 28.0% (7/25), χ2 = 3.94, P = 0.041). Conclusion:Use of percutaneous coronary intervention in patients with acute coronary syndrome in county-level hospitals is feasible. It can improve patients' cardiac function and has a remarkable clinical effect with a low incidence of adverse cardiovascular events.
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Objective:To investigate the current status of endoscopy department of county hospitals in China, and to improve the construction quality of the endoscopy department of county hospitals.Methods:County hospitals from 20 provinces, autonomous regions and municipalities in 2019 were investigated in this study through an online survey. Questions were about the department scale, basic information of the endoscopy center, clinical diagnosis and treatment ability, teaching and academic ability.Results:A total of 114 county hospitals were included. The department of gastroenterology in county hospitals owned 38.9 beds, 8.6 doctors and 6.4 nurses on average in 2019. The mean host and endoscope were 3.1 and 11.0 respectively in each center. The mean outpatient, discharge and endoscopy procedure were 22 thousand , 2.3 thousand and 7.8 thousand respectively. The referral rate of 53 (46.5%) hospitals to higher-level hospitals was less than 3%. In terms of teaching and academy, 5 (4.4%) in 114 hospitals had endoscopist training bases of Chinese Medical Association. Fifty-two (45.6%) county hospitals hosted academic conferences at the city level and above, 21 (18.4%) published SCI papers and 67 (58.8%) published papers in key Chinese journals.Conclusion:Endoscopy centers of most county hospitals are well constructed with comprehensive facilities, qualified medical ability, management, and a research team, which meets the recommendation level of service.
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Objective:To investigate the clinical application value of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area.Methods:Twenty-six patients who underwent laparoscopic cholecystectomy based on the concept of enhancing recovery after surgery using the LEER model in People's Hospital of Jinkouhe District of Leshan from January to October 2021 were included in the observation group. An additional 20 patients who concurrently underwent laparoscopic cholecystectomy and conventional intervention were included in the control group. Clinical efficacy, postoperative complications and postoperative pain were compared between the two groups.Results:Postoperative fasting time, length of hospital stay, and total hospital days in the observation group were 6 (6, 6) hours, 2 (2, 3) days and 4 (4, 6) days respectively, which were significantly shorter than 24 (24, 36) hours, 5 (5, 6) days, 7 (7, 9) days in the control group ( H = 351.00, 407.50, 458.00, all P < 0.05). Hospitalization cost in the observation group was 5 454.58 (5 014.11, 6 016.58) yuan, which was significantly lower than 6 611.91 (6 192.68, 7 841.73) yuan in the control group ( H = 420.00, P < 0.05). There were no significant differences in operative time and postoperative complications between the two groups (both P > 0.05). At postoperative 6 hours, Visual Analogue Scale score in the observation group was 3 (3, 4) points, and patients with mild pain accounted for 73.07% (19/26). At postoperative 24 hours, Visual Analogue Scale score in the observation group was 2 (2, 3) points, and patients with mild pain accounted for 92.31% (24/26). Overall pain was well controlled after surgery. Patient satisfaction rate in the observation was 96.15% (25/26). All patients recovered and were discharged. Conclusion:Application of enhanced recovery after surgery using the LEER model in patients subjected to laparoscopic cholecystectomy in basic hospitals of Yi nationality area can promote postoperative recovery, contribute to changing the theory of diagnosis and treatment, and improve overall medical quality. The enhanced recovery after surgery protocol using the LEER model has a good application value.
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Objective:To explore the impact of different referral timing on postponing early-onset pre-eclampsia (PE), postponing severe pre-eclampsia (SPE), reducing SPE severe complications and improving maternal and neonatal outcomes by analyzing the pregnancy outcomes of SPE patients who were referred from primary hospitals to tertiary referral center in the referral system.Methods:The clinical data of 159 SPE patients who were referred from primary hospitals, treated and then terminated their pregnancy in Peking University Third Hospital from January 2020 to October 2021, were observed and analyzed in this clinical observational study. According to the clinical stage of PE at the time of referral, they were divided into four groups: 38 cases were referred after onset of SPE severe complications (SPE-C group), 72 cases were referred after onset of SPE (a-SPE group), 15 cases were referred after onset of PE (a-PE group) and 34 cases were referred after detection of PE early warning-signs (Warn-s group). And then these 159 cases were divided into different color groups according to the project management system for high-risk pregnant women. Patients of Red color (highest risk) and Orange color (higher risk) were required to be referred to tertiary hospitals (Red-Orange group, 113 cases), and patients of Yellow color (high risk) could be treated under tertiary hospitals (Yellow group, 46 cases). The maternal and neonatal outcomes of different referral timings were analyzed and compared.Results:(1) Pregnancy outcomes of different referral timings grouped by PE clinical stage at the time of referral: the later the referral timing, the higher the rate of SPE severe complications, the shorter the interval from referral to termination of pregnancy. The rate of SPE severe complications in the SPE-C group was significantly higher than those of the other three groups, and the interval from referral to termination of pregnancy in the SPE-C group was significantly shorter than those of the other three groups (all P<0.05). The referral gestational age of Warn-s group was earlier than those of the other three groups (all P<0.05). The average gestational ages for onset of SPE, termination of pregnancy, and onset of SPE severe complications were all after 34 gestational weeks, and were later than those of a-SPE group and SPE-C group; the rates of SPE onset before 34 gestational weeks, SPE severe complications onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, neonatal intensive care unit (NICU) hospitalization, and pregnancy giving up before 28 gestational weeks were lower than those of a-SPE group and SPE-C group, the length of NICU stay was shorter than those of a-SPE group and SPE-C group, and its rate of take-home-babies was 100%, significantly higher than those in a-SPE group and SPE-C group (all P<0.05). The gestational ages for onset of SPE and termination of pregnancy in a-PE group were later than those in a-SPE group and SPE-C group, the rates of SPE onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, and NICU hospitalization were lower than those of a-SPE group and SPE-C group, the length of NICU stay was shorter than those of a-SPE group and SPE-C group (all P<0.05). (2) Pregnancy outcomes of different referral timings grouped by the color classification of PE clinical characteristics: among the 159 cases of SPE, 113 cases (71.1%, 113/159) were in the Red-Orange group which were required to be referred to tertiary hospitals, and 46 cases (28.9%, 46/159) were in the Yellow group,which were not in the range of referral requirements, but actually referred to the tertiary hospital and eventually developed SPE. Gestational ages for onset of SPE, termination of pregnancy, and onset of SPE severe complications in the Yellow group were later than those of the Red-Orange group, while the rates of SPE onset before 34 gestational weeks, SPE severe complications onset before 34 gestational weeks, terminating pregnancy before 34 gestational weeks, NICU hospitalization, and pregnancy giving up before 28 gestational weeks were lower than those of the Red-Orange group, the length of NICU stay was shorter than that of the Red-Orange group, and its rate of take-home-babies was higher than that in the Red-Orange group (all P<0.05). (3) Analysis of different clinical referral timings in the Yellow group: among these 159 SPE patients, 46 cases (28.9%, 46/159) would be excluded from the range of referral requirements which belonged to the Yellow color grade, but 6 cases still developed SPE severe complications (4 cases in Warn-s group and 2 cases in a-PE group), 17 cases were terminated pregnancy before 34 weeks of gestation (12 cases in Warn-s group and 5 cases in a-PE group), and 23 cases developed SPE before 34 weeks of gestation (17 cases in Warn-s group and 6 cases in a-PE group). (4) Multivariate analysis: referral after detection of PE early warning signs was the independent protective factor for postponing the onset of SPE severe complications ( P<0.05). Referral after detection of PE early warning signs and referral after onset of PE were both protective factors for postponing the onset of SPE and early-onset PE (all P<0.05). Conclusions:Different referral timing in the referral system is one of the key points that affect the maternal and neonatal outcomes of SPE. Referral after detection of PE early warning signs and timely referral after onset of PE would reduce early-onset PE, postpone the onset of SPE and reduce the severe complications of SPE. The clinical development and evolution of PE is really complicated, and referral based on specific clinical situations is better than referral based on fixed mode.
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Objective To evaluate the necessity of construction of hospital information system integration platform for county Hospital as the urban and rural medical hub in the context of the development of modern medical information.Methods By referring to the development of the domestic and international integration platform,and comprehensively considered the development status of the county hospital,and analyzed based on the perspective of sustainable development.Results The hospital information integration platform was formed to meet the needs of the county hospital,and it platform was used to open up the internal and external medical information resources,realize the integration of business resources and process optimization..Conclusion The county hospital building information system integration platform is the inevitable trend of the current construction of information technology,and its comple-ted construction can enhance province -city-county tertiary care facility data communication,reduce the coupling within the hospital business systems,and make the county hospital more flexible in the future construction and devel-opment.
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Based on the current county hospital information construction in the problem of integration,pro-posed a scheme based on a unified architecture application integration platform.The original business system interface standardization of the construction of hospital information systems analysis and integration platform architecture and integration framework,the framework can be achieved through integrated hospital between heterogeneous systems.A unified standardized interfaces can achieve a good cross -system data integration.The construction of county hospitals information system integration platform,data sharing and interaction is conducive to solve the problem of data islands facing the county hospital,hospital to enhance business development capabilities and scale.