Analysis on the influencing factors and strategies of high-quality development of public hospitals / 中华医院管理杂志

Objective:To analyze the internal conditions and external environment of high-quality development of high-level public hospitals and establish a high-quality development strategy model, for reference of public hospitals to formulate and implement high-quality development strategies.Methods:The case hospital was a pilot in high-quality development of high-level public hospitals. SWOT method was used to analyze the influencing factors, AHP analytic hierarchy process was used to compare the importance of each influencing factor, and then the four-quadrant coordinate system method was used to establish a high-quality development strategy model.Results:The total strength(S), the total weaknesses(W), the total opportunity(O), and the total threat(T)were 0.095, 0.063, 0.065 and 0.024 respectively, reflecting that the strength of internal conditions was greater than the weaknesses, and the opportunities of external environment were greater than the threats. In the four-quadrants, the growth strategy model had the largest triangle area(0.003), and the strategic quadrilateral center of gravity was located in the opportunity area of the growth strategy.Conclusions:High-level public hospitals as represented by the case hospital had entered a period of important strategic opportunities, which the external opportunities were greater than its own strength. These hospitals were recommended to fully leverage the external opportunities, adopt a positive growth oriented(SO)strategy, formulate a development strategy with their own characteristics, promote the interaction of internal conditions and external environment to form new momentum, hence achieving high-quality development.

Virologic and clinical characteristics for prognosis of severe COVID-19: a retrospective observational study in Wuhan, China

BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has progressed to a pandemic associated with substantial morbidity and mortality. The WHO and the United States Center for Disease Control and Prevention (CDC) have issued interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19), but there is limited data on the virologic and clinical characteristics for prognosis of severe COVID-19. MethodsA total of 50 patients with severe COVID-19 were divided into good and poor recovery groups. The dynamic viral shedding and serological characteristics of SARS-CoV-2 were explored. The risk factors associated with poor recovery and lung lesion resolutions were identified. In addition, the potential relationships among the viral shedding, the pro-inflammatory response, and lung lesion evolutions were characterized. ResultsA total of 58% of the patients had poor recovery and were more likely to have a prolonged interval of viral shedding. The longest viral shedding was 57 days after symptom onset. Older age, hyperlipemia, hypoproteinemia, corticosteroid therapy, consolidation on chest computed-tomography (CT), and prolonged SARS-CoV-2 IgM positive were all associated with poor recovery. Additionally, the odds of impaired lung lesion resolutions were higher in patients with hypoproteinemia, hyperlipemia, and elevated levels of IL-4 and ferritin. Finally, viral shedding and proinflammatory responses were closely correlated with lung lesion evolutions on chest CT. ConclusionsPatients with severe COVID-19 have prolonged SARS-CoV-2 infection and delayed intermittent viral shedding. Older age, hyperlipemia, hypoproteinemia, corticosteroid usage, and prolonged SARS-CoV-2 IgM positive might be utilized as predicative factors for the patients with poor recovery.

Interrupted time series analysis for impacts of day surgery on average days of stay / 中华医院管理杂志

Objective To evaluate the effects of day surgery on average days of stay, and to provide scientific basis for shorter average days of stay. Methods Data of average days of stay from November 2011 to December 2016 were extracted from 6 departments, Xiangya Hospital, Central South University. Segmented regression analysis of interrupted time series was used to analyze the trend of average days of stay of pre-and post-day surgery. Results Thanks to the application of day surgery, average days of stay decreased by 0. 071 days per month, and the monthly decline increased by 0. 049 days (P<0. 001) than before. Average days of stay in the department of stomatology, ear-nose-throat, general surgery and hepatobiliary & enteric surgery research center were the most obvious, and the monthly decline increased by 0. 110 days (P<0. 001), 0. 049 days (P=0. 008) , 0. 075 days (P<0. 001), and 0. 057 days (P=0. 003), respectively than before. Conclusions Day surgery could decrease average days of stay, enhancing the utilization of hospital resources.

Reconstruction and practice of key nodes in the clinical pathway information system / 中华医院管理杂志

Xiangya Hospital of Central South University has reconstructed its key nodes of the clinical pathway information system in order to promote efficient and extensive implementation of the clinical pathway. Its methods include introduction of new classification of clinical pathways, enriched contents of clinical pathway forms, and design of such concepts as "Standard stage date", "Big category of drugs","Grouping prescriptions" and "Concreted mutation".

Effects of aconitine poisoning and Shuang-huang-lian treatment on the expression of myocardial ryanodine receptor / 中南大学学报(医学版)

OBJECTIVE@#To study the impact of aconitine and Shuang-huang-lian injection on the expression of myocardial ryanodine receptor (RyR2) and to discuss the anti-arrhythmic mechanisms of Shuanghuanglian against aconitine poisoning.
@*METHODS@#A total of 52 SD rats were randomly divided into 3 groups: aconitine group (group A, n=20), Shuang-huang-lian group (group B, n=20) and control group (group C, n=12). Aconitine at a dose of 0.3 mg/kg was firstly administrated to the rats of group A and group B through gavage. 30 minutes later, normal saline was delivered to rats in group A through intraperitoneal injection, while rats in group B received Shuang-huang-lian at a dose of 100 mg/kg through intraperitoneal injection. Group C accepted twice administration of normal saline by gavage and intraperitoneal injection. The disposals for each group were implemented for 10 consecutive days. The rats' electrocardiograms (ECG) were recorded on day 1, 3, 6 and 10. Immunofluorescent staining technique and real-time quantitative PCR technique was used to detect the protein and mRNA expression of myocardial RyR2.
@*RESULTS@#The arrhythmia scores of group B at different time were lower than group A and the difference was statistically significant (P0.05). On day 3, 6 and 10, the expression of RyR2 protein and mRNA in group A was dramatically increased compared to group B and group C (P<0.01). 
@*CONCLUSION@#Shuang-huang-lian injection can effectively prevent the arrhythmia caused by aconitine, which is related to suppressing the aconitine-induced RyR2 expression.

Study of the Efficacy of Losartan on Unstable Angina / 中国医师杂志

Objective To investigate the effects of losartan on unstable angina (UA).Methods In a period of 14 days, 83 subjects with UA were randomly divided into 2 groups (group T and C). In group C, nitroglycerin 10-20mg plus 5%glucose 250ml was given by vein drips twice daily. Aspirin 150mg/day and metoprolol 12.5～25mg twice daily were given too. In group T, losartan, in a single dose of 50mg/day was given in addition to treatments of group A. Frequency of angina pectoris, rate pressure product, ST segments changes in 12 lead ECG and several heart function indexes in echocardiography were investigated at the beginning and the end of the study.Results The differences of efficacy between the two groups were significant ( P

The Effect of Atorvastatin on Seumr Hypersensitive C-reactive Protein Level in Patients with Cardiac Syndrome X / 中国医师杂志

Objective To explore the level changes of serum hypersensitive C-reactive protein (hs-CRP) in patients with cardiac syndrome X (CSX) and the effect of atorvastatin on hs-CRP level. Methods 25 patients with CSX and 10 matched healthy subjects were enrolled in this study, and the serum hs-CRP levels were compared between the patients and healthy subjects. The patients were randomly devidid into routine therapy group (n=12), which received diltiazem 30mg t.i.d and isorbide dinitrate 10mg t.i.d, and atovastatin thrapy group (n=13), which received the same dosage of diltiazem and isobide dinitrate, and atovastatin 20mg/d additionally. The course of treatment was 12 weeks. At the beginning and the end of study, standardized angina questionnaires and exercise stress test were performed in all patients, and their serum hs-CRP levels were measured. Results ⑴The serum hs-CRP levels of patients with CSX were significantly hagher than those of healthy subjects(3 7?3 2mg/L vs 0 9?0 5mg/L, P