The correlation between cardiac troponinⅠ level and short-term mortality after liver transplantation / 中华普通外科杂志

Objective:To evaluate the correlation between elevated cTnI level and 28-day mortality after liver transplantation.Methods:A retrospective study was conducted in adult patients admitted to ICU after liver transplantation from Jun 2015 to March 2019 at Beijing Chao-Yang Hospital. The cardiac troponin Ⅰ levels within 48 h after surgery were examined. Patients outcome was followed up,the primary end point was mortality within 28-day. Univariate and multivariate logistic regression models were used to look for predictors of 28-day mortality.Results:Three hundred and eighteen patients were included in our analyses. Twenty-six patients died and 292 survived within 28 days after LT. Two hundred and forty-three of 318 (76.4%) cases presented elevated cTnI in the early stage after LT. Thirty-seven of 318 (11.6%) patients presented a moderate elevation of cTnI level (5-10 times over normal upper limit), 75 (23.6%) of them presented severe cTnI elevation (10 times over normal upper limit). Univariate and multivariate logistic regression model shows severe cTnI elevation was the independent prognostic factors associated with 28-day mortality [Odds Ratio (95% confidence interval)=3.151(1.218-8.150), P=0.018]. Conclusion:Early cTnI elevation is common after liver transplantation, and severe cTnI elevation is significantly associated with 28-day mortality.

Research on the innovative mode of corporate governance in public hospitals led by " party building" / 中华医院管理杂志

Establishing and perfecting the modern hospital management system is an important guarantee to promote the high-quality development of public hospitals. It is a significant and challenging task that how to integrate particular " CPC′s building" with " corporate governance structure" for improving the modern governance system of public hospitals in China. On the basis of bibliometrics and content analysis and with the practical experience of public hospitals in China, the authors summarized the logical relationship between modern management system and the framework of corporate governance system, initially constructed the innovative mode of " corporate governance" with the core of " party building" , and then reshaped the corporate governance structure of public hospitals in China. The results could provide reference for strengthening the party construction, establishing modern management system, and improving the corporate governance of public hospitals in China.

A study on the public hospital ranking based on super efficiency DEA model / 中华医院管理杂志

Objective:To develop a new kind of efficiency-based hospital ranking based on existing major hospital rankings with reference to hospital input data.Methods:DEA method was called into play and built five models for hospital ranking according to the efficiency value so calculated. The hospital beds available and the number of employees of 59 general hospitals in 2018 were used as the input indicators, and China′s Best Hospitals ranking by Fudan University′s Hospital Management Institute(Fudan ranking)and the total scoring and individual items evaluation from China Hospital STEM ranking by the Medical Information Institute of the Chinese Academy of Medical Sciences were used as the output indicators.Results:The correlation coefficients between hospital beds and the scores from Fudan-rankings and STEM-ranking were 0.08 and 0.09 respectively( P>0.05), and the correlation coefficients between personnel and scores from the two rankings were 0.34 and 0.39 respectively( P<0.01). The correlation coefficients of the efficiency values of the five super-efficiency DEA models and the beds were 0.37, -0.61, -0.71, -0.61 and-0.61 respectively( P<0.01), and the correlation coefficients of personnel were-0.17, -0.37, -0.60, -0.39 and -0.39( P<0.01)respectively. Compared with the original ranking, the ranking of the efficiency value of the super-efficiency DEA model found the average ranking of hospitals in Beijing and Shanghai rose by 6.38 places, and the ranking of hospitals in non-Beijing and Shanghai areas dropped by 4.37 places on average. The difference was statistically significant( P=0.02), and other differences in the ranking of different types hospitals were not statistically significant. Conclusions:Thanks to the super-efficiency DEA efficiency value which is added with such input indicators as hospital beds and personnel, the ranking becomes more scientific and comprehensive. The research results can provide references for more rational patient flow and encourage hospitals onto a more healthy development pathway.

Study on hospital management of human resources based on Development Chinese Hospital Management Survey(D-CHMS) / 中华医院管理杂志

Objective:To quantitatively measure the level of hospital human resources management of public hospitals in China with D-CHMS.Methods:From January through December of 2019, the Development Chinese Hospital Management Survey(D-CHMS)was used in field survey of relevant personnel of 36 tertiary general hospitals and 27 secondary general hospitals, with 10 persons chosen from each hospital. Survey data were subject to descriptive analysis and t test, for quantitative measurement of the human resources management level of these sample hospitals. Results:The level of human resources management in Chinese public hospitals was on the low side, as seven secondary dimensions scored 2.94 in average. To name a few, talents retention and talents recruitment scored the lowest, being (2.13±0.29) and (2.90±0.63) respectively. Tertiary hospitals presented an obviously better performance than secondary hospitals in incentives for best performers, talents retention and recruitment. Human resources management level of hospitals in China′s west regions scored the highest, followed by those in the east regions.Conclusions:Public hospitals in China, especially secondary hospitals were expected to enhance their human resources management. Approaches recommended include building a talent pool, developing a series of preferential policies, building development platforms, optimizing performance appraisal, motivating remuneration schemes, and offering unique employee value propositions, which serve to recruit and retain talents.

DRG indicators based Bootstrap-DEA hospital efficiency analysis for tertiary hospitals in Hubei province / 中华医院管理杂志

Objective:With Diagnosis related groups(DRG)indicator introduced into the hospital efficiency evaluation, to analyze the adjustment effect of DRG on the efficiency value, and to compare the similarities and differences between the DEA efficiency value and the DRG efficiency indicator.Methods:The DRG pilot data in 2017 and 2018 of tertiary hospitals in Hubei province and related data from other reports were collected. Indicators including the actual number of beds, the number of employees, the actual total bed days occupied, and medical income were used as input indicators, and total admissions, number of discharges, weight of DRG and number of DRG groups were used as output indicators. 7 models were constructed using different indicator combinations. The efficiency of the hospital was calculated by the Bootstrap-DEA efficiency evaluation method. The relationship between hospital attributes and efficiency was analyzed by a generalized linear model.Results:There was an abnormal phenomenon that the higher the hospital level, the lower the efficiency in the efficiency value calculated by the traditional method. The efficiency values of county hospitals, city hospitals and provincial hospitals were 0.83, 0.74 and 0.71, respectively( P<0.01). DRG weight and group number were used as output for DEA analysis, and the efficiency values of county hospitals, city hospitals, and provincial hospitals were 0.95, 0.95 and 0.96( P=0.20)respectively. The DRG efficiency indications of county hospitals, city hospitals and provincial hospitals were 1.42, 1.11, 1.00 respectively( P<0.01). The higher the level, the lower the efficiency, while the efficiency values calculated by DEA were 0.84, 0.82, 0.86, respectively( P=0.58). Conclusions:The efficiency value calculated by the traditional method presents a systematic bias, which could be corrected effectively when DEA analysis using DRG weights is used as output indicator. The results developed new ideas of efficiency analysis for hospitals practicing DRG management.

Cost efficiency analysis of 141 public tertiary hospitals based on COST-DEA model / 中华医院管理杂志

Objective:To measure the cost efficiency and its components of 141 public tertiary hospitals of China and measure the influencing factors.Methods:COST, CCR and BCC model of DEA were used to measure the cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency and scale efficiency.Results:In 2018, the values of cost efficiency, allocative efficiency, technical efficiency, pure technical efficiency, scale efficiency of the sample hospitals were 0.632, 0.929, 0.675, 0.732 and 0.917 respectively. 10(7.09%)sample hospitals were in the state of constant returns to scale, 41(29.08%)sample hospitals were in a state of decreasing returns to scale, while 90(63.83%)sample hospitals were in a state of increasing returns to scale. The regional GDP per capita and the bed utilization rate, average hospitalization days, average charge per output of hospital had significant impacts on the cost efficiency.Conclusions:Technical efficiency is the main factor affecting cost efficiency, and pure technical efficiency is the key factor for technical efficiency. Continuously improving the internal management level of the hospital is the main and necessary approach to enhance the technical efficiency of public tertiary hospitals. Internal factors have greater impacts on the efficiency of the sample hospitals. Reducing the average length of stay, increasing the utilization rate of beds and reducing the average charge level per outpatient can improve the cost efficiency of the hospitals.

Optical imaging quality change of multifocal intraocular lens following Nd∶YAG laser damage / 中华实验眼科杂志

Objective To study the optical imaging quality of multifocal intraocular lens (IOL) following Nd∶YAG laser damage.Methods Three hydrophobic acrylate discs used to make multifocal IOL were placed in line,and the Nd∶YAG laser was used to emit the posterior surface,mid-plane and anterior surface of the discs by gradually increasing the emitting energy to determine the damaged threshold energy of various planes.Eight multifocal IOLs were divided into 2 groups.IOL damage models were established by emitting 12 points along 12 clocks on circle of 3.0 mm in diameter in the group 1 (IOLs NO.1,2,3,4) and 6 points with 1-clock interval on circle of 1.0 mm in diameter in the group 2 (IOLs NO.5,6,7,8) with Nd∶YAG laser.The modulation transfer function (MTF),line spread function (LSF) and United States air force (USAF) test target images of the IOLs were tested under the optical aperture at 2.0,3.0 and 4.5 mm.Results The damage thresholds of laser power were not significantly different among three hydrophobic acrylate discs (Fgroup =1.100,P =0.337),and the thresholds were significantly different among different planes in the discs (Fposition =195.279,P=0.000),with the highest damage threshold in the anterior surface and the lowest damage threshold in the mid-plane of the discs(all at P＜0.01).The shifts of far focus and near focus MTF curves,LSF curves and USAF target images of the IOLs under the 2.0,3.0 and 4.5 mm optical aperture after laser damage were in coincidence with those before laser damage both in group 1 and group 2.The glare phenomenon of the USAF target image was observed at near focus under the 4.5 mm optical aperture both before and after laser damage.Conclusions Multifocal IOL is vulnerable to injury when the laser beam focuses on the midplane,and the anterior surface of IOL can tolerate certain degree of damage.In standard model eye,the MTF curves,LSF curves and USAF target images of multifocal IOL was not impacted by laser induced spots injuries under different pupil diameters.

The SWOT analysis on private hospitals in the background of new healthcare reform / 中国卫生政策研究

Objective:This study aims to ensure the private hospitals development strategy in the background of new healthcare reform and put forward some scientific suggestions to help promote their sustainable development. Methods:The SWOT analysis method was adopted to analyze the private hospitals’ internal strength, weakness, exter-nal opportunity and threats. Results: The results showed a clear property right, advanced management system and other outstanding advantages in the private hospitals. Opportunities like the improved policy environment and people’s medical demand expansion are also very prominent. Meanwhile, the private hospitals development also faces some disadvantages and challenges such as illegal operation, disorder in the market competition, vague orientation, etc. Conclusions:It suggests the strengthening of the personnel and hospital culture construction, adoption of the differen-tiation strategy, improvement of the diagnosis and treatment ability, etc.

Study on DEA-based Chinese hospital efficiency and applied indicators / 中国卫生政策研究

Objective:This study aims to explore recent developments in DEA-based hospital efficiency studies in China, so as to provide reference for further research in DEA-based hospital efficiency. Methods:In this study, a 30-year retrospective systematic review is conducted for the classification of 85 hospital efficiency studies that have been published in China with DEA. The characteristics are summarized and compared with those of international liter-ature according to the selection of input and output indicators to evaluate the normalization of studies in China. Re-sults:The classification reveals several problems existing in DEA-based hospital efficiency studies in China, such as too few studies on hospital allocation efficiency, the application of simple classical models, imprecise selection of in-put-output indicators, inappropriate application of monetary variables as output indicators, etc. Conclusions and sug-gestions:The normalization and rationality of DEA methods applied in China’s hospital efficiency research need to be improved, so as to shorten the gap between China and the international world. Chinese researchers should pay more attention to studying the latest international research findings, so as to scientifically select input and output indicators. In depth analysis of methods and application conditions should be conducted so as to improve the normalization and science of China’s hospital efficiency research.

Literature review of multiple-site physician practice:Based on content analysis / 中国卫生政策研究

Objectives:This study aims to summarize the research progress of multiple-site physician practice to determine further research directions. Methods:Literature on Chinese multiple-site physician practice between 1949 and 2013 was obtained from CNKI, Wan fang database and CQVIP database, the annual volume distribution of se-lected documents was been described and the topics and content of literature cited at least once were summarized through literature content analysis. Results:The volume of literature increased rapidly from 2009, guided by related government policies. Content analysis is insufficient in the research areas of supporting policies, international experi-ences, relevant laws and empirical studies. Suggestions: Further research should focus on multiple-site physician practice policies themselves and supporting policy analysis, international comparisons of multiple-site physician prac-tice systems, studies into relevant laws and regulations and empirical studies based on quantitative methods.

Effects of pulse electrical stimulation on mutual adhesion of vascular endothelial cell and endothelial progenitor cell / 生物医学工程学杂志

The present paper is aimed to investigate the effects of pulse electrical stimulation on mutual adhesion of vascular endothelial cell and endothelial progenitor cell (EPC). EPC was induced from periphery blood, labeled with fluorescence dye and then co-cultured with vascular endothelial cell. With a fixed electric voltage and frequency of 5V and 5Hz, respectively, the co-culture system was continually stimulated for 24h under different pulse width, 1, 3, 6 and 9ms. After pulse stimulation, fluorescence intensity of adherent labeled EPC was measured and converted to fluorescence ratio. Compared to that in the control group, fluorescence ratio of 3 ms and 6 ms group were significantly larger, while that in the 9 ms group was lower. The peak fluorescence ratio value was appeared at 6 ms group. It is indicated that suitable pulse electrical stimulation could benefit the adhesion of endothelial cell and EPC. All these results provide a new theoretical basis about why electrical stimulation could contribute to neovascularization.

Impacts ofmedical insurance payment modes on the implementation of clinical pathways / 中华医院管理杂志

Implementation of clinical pathways has a natural tie with payment modes of medical insurance,as various payment modes apply different impacts on clinical pathway.This article compared the strengths and weaknesses of various payment modes,and analyzed their impacts on clinical pathway.This way the authors provide references for decision makers of medical insurance policy.

Comparative analysis of implementation LIANG of clinical pathways of Chinese hospitals in different areas / 中华医院管理杂志

Objective To find out present condition and differences in implementation of clinical pathways in hospitals of in China.Methods "Clinical pathway" was entered as a keyword to search in PubMed NCBI Chinese Science and Technology Periodical Database for related literatures in China from 1999 to 2009,analyzing the general implementations of clinical pathways in hospitals in different areas using the SPSS12.0 software.Results A total of 1051 relevant literatures were found.Through data analysis of these literature,differences of implementation of clinical pathways were found for 162 hospitals of different areas.It was found that the differences of total diseases among China's East,West and Central areas are significant statically.Diseases of implementation per hospital in the Central average 16.8,those in the East 8 types,while those for the West 4.4.Tertiary hospitals account for 70% as the main force of clinical pathway implementation,with diseases of implementation up to 13.7,while that under tertiary level down to 2.8.Conclusions Implementation of clinical pathways varies significantly among hospitals in different areas in China.In the process of implementing clinical pathway,appropriate management strategies should be developed according to actual situation in different hospitals in light of policies,hospital management and patient considerations.

Design of Electric Stimulator of Cell Culture / 医疗卫生装备

Objective To design an instrument that can provide a series of pulse to stimulate cell by means of external electric field, the structure and function of organism can retrieve. Methods AVR MCU, produced by America ATMEL Co., is used as the core of the system. The program has been developed to adjust three pulse's parameters, including amplitude, frequency and pulse duration. The cooperation between DAC and OP completes the transformation from monopole pulse to bipolar pulse. The booster PB50 amplifies the current and voltage of the output. Results The Stimulator can provide bipolar pulse, amplitude: up to ?40V, frequency: 0.01Hz -10Hz, pulse duration: 0.4ms -24ms. Conclusion Cooperating with special electrode board, the instrument can provide effective electric field for cell simulating. At present the instrument has been used in the research of the endothelial progenitor cell.