A wound diagnosis and treatment mode with integrated medical care for repair of chronic infectious wounds plus bone exposure at lower extremities / 中华创伤骨科杂志

Objective:To evaluate a wound diagnosis and treatment mode with integrated medical care in the repair of chronic infectious wounds plus bone exposure at lower extremities.Methods:A retrospective analysis was conducted of the 64 patients with chronic infectious wound plus bone exposure at the lower 1/3 of the leg who had been admitted to Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University from January 2019 to December 2021. The patients were divided into 2 groups according to the wound diagnosis and treatment mode. In the observation group of 31 patients subjected to the wound diagnosis and treatment mode with integrated medical care led by specialist nurses, there were 24 males and 7 females with an age of (53.6±12.4) years, the wound was located at the tibial side in 15 cases and at the fibular side in 16 cases, the wound areas averaged [28.27 (23.56, 37.70) cm 2], and the time from injury to treatment was (27.3±4.1) d. Evaluation of the patient's condition, wound diagnosis and formulation of treatment protocols were performed jointly by a doctor-nurse team after the patients were admitted, and continuous diagnosis and treatment of the wounds were carried out mainly by specialist nurses during the doctors' follow-up. In the control group of 33 patients subjected to the conventional wound diagnosis and treatment mode led by doctors, there were 25 males and 8 females with an age of (51.3±14.3) years, the wound was located at the tibial side in 17 cases and at the fibular side in 16 cases, the wound areas averaged [27.49 (17.84, 40.45) cm 2], and the time from injury to treatment was (27.6±4.0) d. The 2 groups were compared in the wound healing rate, wound recurrence rate, hospitalization time and patients' satisfaction. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The observation group achieved a significantly higher wound healing rate within 1 month after treatment [83.87% (26/31)] than the control group [60.61% (20/33)], a significantly lower wound recurrence rate within 6 months after treatment [0% (0/31)] than the control group [18.18% (6/33)], significantly shorter hospitalization time [18.0 (15.1, 20.9) d] than the control group [26.8 (18.4, 40.1) d], and significantly higher patients' satisfaction [50 (50, 50) points] than the control group [50 (42, 50) points] (all P<0.05). Conclusion:In the repair of chronic infectious wounds plus bone exposure at lower extremities, the wound diagnosis and treatment mode with integrated medical care led by specialist nurses may result in a higher wound healing rate, a lower wound recurrence rate, a shorter hospital stay and higher patients' satisfaction than the conventional wound diagnosis and treatment mode led by doctors.

Influencing factors of hospitalization costs for lung cancer patients in Wuhan in 2018-2020 / 公共卫生与预防医学

Objective To summary the hospitalization costs of lung cancer patients, and analyze the influence factors in these patients, and provide basis for controlling hospitalization costs of lung cancer patients. Methods The hospitalization costs data of hospitalized lung cancer cases in Wuhan from 2018 to 2020 were collected from medical records. Nonparametric test was used to analysis the data for single factor analysis. The patients were divided into two groups according on the upper quartile value of hospitalization cost, that is high-cost group (the cost ≥ the upper quartile value) and normal cost group (the cost “four major hospitals in Hubei” respectively. The hospital type is an independent influencing factors, compared with specialized hospital, the OR is 4.726 for general hospital. The hospitalization days is the independent influencing factors, more hospitalization days has high cost. The treatment mode is the independent influencing factors, compared with non-operative treatment, the OR is 556.129, 18.156 and 5.212 for surgical model, radio therapy model and interventional model respectively. Conclusion The age, hospital level, hospital type, hospitalization days and treatment mode are the independent influencing factors of hospitalization costs. To reduce the hospitalization cost of lung cancer patients, we should standardize the diagnosis of lung cancer patients, and focus on standardizing the treatment mode, also considering other influencing factors, such as hospital level, hospital type.

Construction and practice of medical alliance referral system based on blockchain / 中华医院管理杂志

Hierarchical diagnosis and treatment system is an important measure to rationally allocate medical resources and promote the homogenization of basic medical services. The medical alliance is an important service mode and service system of hierarchical diagnosis and treatment, whose role is to perfect the up-down linkage and meet the patient′s medical needs. Informatization construction is an important starting point to promote the services of the medical alliance. In order to solve the problem of connectivity, the medical alliance needs to establish a regional referral platform and realize the integrated service of all medical institutions. Renji Hospital, Shanghai Jiaotong University School of Medicine, has built a blockchain based referral system for hierarchical diagnosis and treatment, incorporating the S2B2C mode concept, and using the traceability, tamper proof and distributed accounting features of blockchain technology, realized independent storage of data in hospitals, realized real-time information sharing and interconnection, and provided a feasible solution for medical alliance management.

Analysis on the promotion effect of the national multi-disciplinary team diagnosis and treatment pilot project of digestive system tumors / 中华医院管理杂志

Objective:To analyze the progress and promotion effect of the national multidisciplinary team(MDT) pilot project of digestive system tumor diagnosis and treatment, for the reference in promoting the popularition of tumor MDT model.Methods:The data of MDT project evaluation forms of 231 digestive system tumor MDT pilot hospitals in 2018(July 2017 to June 2018), 2019(July 2018 to June 2019)and 2020(July 2018 to June 2019)were obtained. The MDT of digestive system tumors, the development of outpatient and inpatient MDT, the distribution of cases, and the management, charging and regional radiation of MDT in the pilot hospital were analyzed. Descriptive analysis and frequency analysis were used for all the data.Results:With pilot hospitals of missing data excluded, the number of pilot hospitals included in the analysis from 2018 to 2020 was 227, 224 and 224, respectively.The number of pilot hospitals carrying out digestive system tumor MDT increased from 174 in 2018 to 222 in 2020, the number of outpatient and inpatient MDT cases increased from 48 332 and 61 823 to 72 493 and 106 899 respectively, and the proportion of pilot hospitals implementing the MDT management system increased from 159 to 214. In 2020, the average expenses of outpatient and inpatient MDT were mainly 200-500 yuan, and 135(60.3%) pilot hospitals became the leading MDT hospitals in the region.Conclusions:The MDT pilot project of digestive system tumors in China has achieved remarkable results.For example, the number of pilot hospitals carrying out MDT keeps increasing year by year, and the pilot hospitals have played a leading role in the region. In order to accelerate the coverage of the tumor MDT model, the authors suggested that the hospitals should optimize MDT in terms of patient accessibility, optimize management mode, promote the medical insurance reimbursement, and strengthen regional influence.

Establishment and application of the one-stop multi-mode stroke rescue platform / 中华医院管理杂志

Stroke rescue features strong time sensitivity and high complexity. Minimizing the time of consumption in pre-hospital and in-hospital stroke rescue is key to improve stroke rescue efficiency and reduce the disability rate. In December 2017, a tertiary hospital launched the construction of a one-stop stroke rescue platform. This platform was centered on " multi-mode image fusion operating room" , operating as a one-stop rescue mode integrating emergency admission, imaging examination, intravenous thrombolytic therapy, mechanical thrombolytic therapy, postoperative evaluation, and so on. The seamless convergence workflow of pre-hospital, in-hospital and post-hospital could effectively optimize the physical rescue pathway. In order to ensure the efficient and orderly operation of the platform, the hospital adopted such measures as multidisciplinary integration, pre-hospital and in-hospital integration construction, and regional stroke care network. Since its operation in September 2019, the platform has treated more than 1 000 patients by December 2021. The application of the platform had effectively improved the efficiency of stroke rescue, led the development of regional stroke rescue system, and provided the reference for raising the stroke rescue capacity and management level in China.

Discussion of novel mode of acupuncture and moxibustion based on identifying the acupoint sensitization / 中国针灸

On the base of the paradigms of clinical studies on modern moxibustion by identifying the acupoint sensitization, the records of ancient literature in successive dynasties were collected on "identifying the sensitization" of acupoints in acupuncture. In association with acupoint detection of acupuncture recorded in current textbooks, a novel concept, "exerting acupuncture by identifying the acupoint sensitization" is proposed. Acupoint sensitization is the common initial link of effect achieved by both acupuncture and moxibustion. Hence, on the basis of the routine acupoint selection by differentiating syndrome, the state of acupoint must be considerably emphasized in either acupuncture or moxibustion. The clinical curative effect may be improved by selecting the sensitized points and identifying sensitization. This novel mode of diagnosis and treatment focuses on identifying acupoint sensitization by unifying acupuncture with moxibustion and in coincidence with the modern clinical characteristics of either acupuncture or moxibustion.

Exploration and thoughts on perioperative treatment of advanced gastric cancer / 中华胃肠外科杂志

Perioperative treatment is critical to improve the outcomes of patients with advanced gastric cancer. There are three therapeutic modes of perioperative treatment for resectable gastric cancer: neoadjuvant chemotherapy+ D1/D2 surgery+ adjuvant chemotherapy, D0/D1 surgery+ adjuvant radiochemotherapy, and D2 surgery+ adjuvant chemotherapy. Over the decades, a large number of clinical studies had been conducted to optimize the perioperative treatment mode of gastric cancer, including the postoperative radiotherapy and chemotherapy, and perioperative chemotherapy, and to explore the feasibility of preoperative radiochemotherapy, targeted therapy, and immunotherapy in advanced gastric cancer. After nearly 20 years of development and exploration, although the perioperative treatment mode for advanced gastric cancer has become standardized, there are still some core issues that need to be solved urgently, including the selection of population for perioperative treatment, the limitation of efficaly evaluation criteria, insufficient emphasis on laparoscopic exploration before neoadjuvant treatment, and lack of exploration in esophagogastric junction cancer. We should fully integrate the current clinical research data into clinical practice, adopt a multidisciplinary diagnosis and treatment mode, and follow the principles of standardized diagnosis and treatment based on a multi-dimensional analysis of patient characteristics, and formulate the most reasonable treatment strategy to ultimately benefit patients.

The Dilemma and Countermeasure of the Hierarchical Diagnosis and Treatment in China / 中国医学伦理学

Hierarchical diagnosis and treatment is an effective way to "optimize and reconstruct medical and health service system" and solve the problems of "difficulty and expensiveness of getting medical treatment". At present, the hierarchical diagnosis and treatment still exists many problems in the process of practice, and the solu-tion of these problems not only requires government departments to do the top-level supporting policies, but also needs the medical institutions at all levels to change their thinking mode and innovate the appropriate hierarchical diagnosis and treatment system. This paper analyzed the dilemma of hierarchical diagnosis and treatment in China from the aspects of medical alliance operation mechanism, medical insurance system, physician multi-point occu-pation, medical resource allocation and medical information sharing and so on, and put forward corresponding countermeasures.

The effects of different pre-hospital intervention of treatment modes on the prognosis of patients with severe multiple trauma / 中华急诊医学杂志

Objective To investigate the effects of different treatment modes on the prognosis of patients with severe trauma.Methods The general data of 396 patients with severe trauma [injurey severity scores (ISS) ≥25] in our hospital emergency for treatment from January 1,2008 to January 1,2012 was collected.The trauma patients were divided into study group and control group.In the study group,the trauma patients were cared by emergency physician of our hospital for pre-hospital treatment during transportation by ambulance since January 1,2010.In the control group,the trauma patients were served with traditional pre-hospital emergency care by the 120 and 999 before January 1,2010.The injury severity score,medical care and outcomes were recorded in trauma database and the efficiency and quality of medical care were compared between two groups.Results The emergency treatment time,length of hospital stays,ICU admission rate,prehospital mortality rate,long-term (6 months) disability rate,and complication rate in the study group were lower than those in the control group,presenting (78.23 ± 21.57) min vs.(96.45 ± 35.14) min,(23.55±12.46) dvs.(28.67±20.72) d,8.1％ (18/222)vs.65.5％ (114/174),13.3％ (34/256) vs.21.6％ (48/222),4.1％ (9/222)vs.9.2％ (16/174),8.1％ (18/222)vs.18.4％ (32/174),in which the differences were statistically significant (P ＜ 0.05).Hospital mortality in the study group was also lower than that in the control group,showing 8.1％ (18/222) vs.12.6％ (22/174),but there was no statistically significant difference (P ＜ 0.05).There was no significant difference in time from occurrence of injury to receiving treatment between the two groups.Conclusion Emergency physicians-cared mode had advantages to improve treatment success rates and reduce mortality in patients with multiple trauma compared with the current conventional emergency mode.It is a good alternative emergency mode.

Analysis on transformation situation of tuberculosis diagnosis and treatment mode in Guangxi during 2011-2012 and countermeasure discussion / 重庆医学

Objective To analyze the transformation situation of the tuberculosis (TB) diagnosis and treatment mode in 18 coun-ties(cities) of Guangxi and to explore the countermeasure for perfecting the TB control service system in Guangxi .Methods The self-designed questionnaire was adopted to retrospectively investigate the transformation situation of the TB diagnosis and treatment mode in 18 counties(cities) .Results In the 18 counties(cities) ,there were 8 counties(cities) ,accounted for 44 .4% ,with the trans-formation reason of the qualification was not completed in the original agency;there were 16 counties (cities ) ,accounted for 88 .9% ,with issuing the formal documents and arranging relevant work by the local health bureau before the transformation ;the number of full-time TB staff was reduced in 14 counties(cities) ,accounted for 77 .8% ,after the transformation ;there were 8 coun-ties(cities) ,accounted for 44 .4% ,set up the independent TB outpatient in the designated hospital ;there were 4 counties(cities) ,ac-counted for 22 .2% ,received the evaluation of very goodandgoodfor the TB control work after the transformation .Conclusion The health administrative department should actively promote the counties (cities) without the completed medical qualification to transform the TB diagnosis and treatment mode and coordinate the related works to carry out smoothly .

Randomized Controlled Trial on Effectiveness of Traditional Chinese Medicine Five Elements Music Therapy in Improving Quality of Life for Senior and Non-senior Advanced Cancer Patients / 世界科学技术-中医药现代化

This study was aimed to evaluate effects of traditional Chinese medicine ( TCM ) five elements music therapy on the quality of life for both senior and non-senior advanced cancer patients , and improve TCM com-prehensive treatment mode . A total of 170 patients were stratified according to 70-year-old in a randomized controlled trial ( RCT ) with a parallel single-blind design . The ratio of patients among three groups was 2:2:1 . In the experimental group , TCM five elements music was given in the treatment . In the positive control group , western music was used in the treatment . And in the negative control group , no music was given in the treat-ment . The treatment was given for 30 min , 5 times per week . And the observation duration was 3 weeks . The Hospice Quality of Life Index-Revised ( HQOLI-R ) , Karnofsky Performance Scale ( KPS ) and Symptom Diary Score recorded by patients were used in the evaluation . The results showed that when comparing HQOLI-R , KPS and Symptom Diary Score before and after treatment among all advanced cancer patients in each group , there was a significant difference before and after treatment in the TCM five elements music therapy group ( P 0 . 05 ) . It was concluded that TCM five elements music therapy is effective in improving quality of life and subjective symptoms for both senior and non-senior advanced cancer patients . However , the sensitivity of using the Symptom Diary Score as an evaluation index among senior patients still needs to be further proved .

A comparative study of survival benefits in patients with stage III/IV gastric cancer receiving sequential or consolidated treatment mode with Traditional Chinese medicine / 肿瘤

Objective: To observe the effects of sequential or consolidated treatment mode with TCM (Traditional Chinese medicine) in the comprehensive treatment on the OS (overall survival) and MST (median survival time) in patients with stage III/IV gastric cancer. Methods: The clinical records of eighty-eight patients with stage III/IV gastric cancer receiving integrative medicine (Western medicine integrated with TCM) between January 1, 2007 and January 1, 2010 were retrospectively reviewed. Of the 88 patients, 38 received sequential treatment mode with TCM, and 50 received consolidated treatment mode with TCM. The survival was followed up with a phone call and calculated by Kaplan-Meier method. The factors related with the survival were analyzed by stratified analysis. Results: The median OS of the 88 patients was 16.0 months. The median OS in the sequential treatment group was significantly prolonged as compared with that in the consolidated treatment group (33.0 vs 20.0 months, P = 0.047). The patients receiving TCM decoction had a longer median OS than the patients without receiving TCM decoction (23.8 vs 15.6 months, P = 0.012).There was a significant difference in the median OS between the patients with Borrmann III and Borrmann IV (16.8 vs 11.3 months, P = 0.029). The results of the stratified analysis revealed that the MST of the patients with clinical stage IV was obviously prolonged in the sequential treatment group than in the consolidated treatment group (P <0.05); and the MST of patients with single syndrome, composite syndromes or receiving TCM decoction between the two groups had no significant differences. Conclusion: The integrative medicine can provide survival benefits for patients with stage III/IV gastric cancer. As compared with the consolidated treatment mode, the sequential treatment mode with TCM has more advantages in prolonging the OS. Copyright© 2012 by TUMOR.

The multidisciplinary integrated treatment mode of stroke unit for stroke / 中国综合临床

0.05).There are significant statistical differences in NIHSS(91.3% vs 71.3%)and BI(93.8% vs 75.0%)between two groups af- ter treatment(P0.05). Conclusion Multidisciplinary integrated treatment mode is an effective treat ment for stoke.