Practice and exploration of the " 1+ 6+ N" medical alliance cooperation system of a hospital in Xinjiang / 中华医院管理杂志

Medical alliances constitute a vertical integration of regional medical resources, and an effective means to promote the tiered medical services. As one of the largest tertiary hospitals in Xinjiang, a hospital has gradually built a " 1+ 6+ N" medical alliance cooperative system fitting the geographical characteristics of Xinjiang since 2018. The system was based on the hospital, made county-level medical institutions as the hub, primary medical and health units as the focus, and telemedicine as the bridge. It turned a telemedicine service platform as the medium, integrating such service segments, as offline practices of experts like clinical teaching, ward rounds, surgical guidance and discipline construction, and as online practices like remote consultation, remote diagnosis, remote education, and remote new technology training among others. Then these segments were integrated into such cooperative models as the remote cooperative medical alliances, specialist-cooperative medical alliances, inter-department co-construction medical alliances, precision-based assistance medical alliances, urban medical group type of medical alliances, and " alliance-consortium" integrated development medical alliances. These practices enabled the expansion and primary support of high-quality medical resources. By June 2022, the hospital had established cooperation via medical alliances with 285 medical institutions at all levels. The implementation of this cooperation mechanism has effectively improved the medical service capacity, diagnosis and treatment capacity of difficult and critical diseases, diagnosis and treatment homogeneity and remote diagnosis capacity in the region, as well as the smooth and orderly progress of the tiered medical services and two-way referrals within a medical alliance.

The value of high-risk human papillomavirus detection in women with atypical squamous cell of undetermined significance / 中国医师进修杂志

Objective To evaluate the triage value of high-risk human papillomavirus (HR-HPV)detection in women with atypical squamous cells of undetermined significance (ASCUS).Methods Two huandred women with atypical squamous cells of undetermined significance (ASCUS) were selected by thinprep cell test(TCT) simultaneously using HPV DNA testing by hybrid capture Ⅱ (HC) and biopsy under the colposcopy,compared the HR-HPV DNA testing with final pathological diagnosis.CIN (cervical intraepithelial neoplasia) means cervical biopsy positive.Results The positive rate of cervical biopsy in HPV positive patients was 60.38％(96/159),and in HPV negative patients was 21.95％(9/41),the difference was obviously (P ＜ 0.05).Conclusion HR-HPV detection is a good triage approach for the patients with ASCUS.

Cochlear implantation in the ossified cochlear / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore the problems and describe clinical experiences associated with multichannel cochlear implantation in patients with cochlear ossification.</p><p><b>METHODS</b>Seven cochlear implant cases with bilateral cochlear ossification from 1996 to 2006 in Beijing Tongren Hospital were retrospectively reviewed, 4 of which were the consequence of meningitis. Three patients' cochlear were completely ossified, 1 patient's tympanic scala was completely ossified, 1 patient's cochlear was partially ossified, and 2 patients' cochlear were partially fibrotic. This article addressed the components of the preoperative evaluation, surgical decision-making, and specific techniques for cochlear implant array insertion in all kinds of ossified cochlea.</p><p><b>RESULTS</b>Gusher was found in 1 case but less serious than that with inner ear malformations. The electrodes were inserted in the cochleostomy in full length in 4 cases, 1 case gave up, and the cochlear implant array were partially inserted in the remains. No serious complications occurred after implantation. All patients had auditory sensations. The impedance of the electrodes, the T level, C level and the hearing threshold were slightly higher than that of the normal cochlear implantation.</p><p><b>CONCLUSIONS</b>The key influencing factor of ossified cochlear patients were the degree of the disease and whether the electrode implanted completely or not. So, the profound sensorineural hearing loss patients after meningitis should be paid more attention. Patients with ossified cochlear could be benefit from cochlear implantation.</p>