Construction and effectiveness evaluation of surgical complication monitoring mode based on medical record homepage data / 中华医院管理杂志

Objective:To explore the establishment of a surgical complication monitoring mode based on data on the medical record homepage, and analyze its impact on the trend of changes in surgical complication incidence.Methods:A monitoring mode of surgical complication was developed based on the " structure-process-results" framework by using surgical complication rates derived from performance appraisal for a tertiary general hospital in Guangzhou. The number of surgical complications and the number of discharged surgical patients was collected from the hospital from January 2019 to June 2022 through the home page collection system for performance appraisal of national tertiary public hospitals. Descriptive analysis was used to analyze the incidence of surgical complications, and Joinpoint regression was used to analyze the trend of changes in the incidence of surgical complications. Monthly percentage change ( MPC) and average monthly percentage change ( AMPC) were calculated. Results:Since the hospital began implementing the surgical complication monitoring mode in May 2021, the incidence of surgical complications had decreased from 2.55% in June 2021 to 0.82% in June 2022, with an MPC of -5.58% ( P=0.024), which was better than the changes from January 2019 to May 2021 ( MPC=0.18%, P=0.755). Conclusions:The surgical complication monitoring mode constructed by the hospital can effectively reduce the incidence of surgical complications, providing reference for optimizing hospital′s medical quality management process and decision-making mode.

Effects of an educational intervention for rational cardiac enzyme requisitions in critically ill patients: a pre-post intervention study.

BACKGROUND: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where troponin is available. OBJECTIVE: The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit. METHOD: We conducted a quasi-experimental, pre-post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two 12-month periods: pre-intervention (September 2017-August 2018) and post-intervention (October 2018-September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in CK-MB and troponin testing. RESULTS: We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of CK-MB and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of CK-MB with troponin after the intervention (-0.13 tests per patient, P = 0.0016) but not in the secular trend for the concomitance. The proportion of patients with the acute coronary syndrome as a discharge diagnosis was not different between the pre- and post-intervention period. CONCLUSION: Our pre-post interventional study demonstrated a significant decrease in the concomitance of CK-MB and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions.

Influencia del acompañante en las consultas de Atención Primaria sobre las habilidades en comunicación y el tiempo de entrevista / Influence of the companion in Primary Care consultations on communication skills and interview time

Objetivos: Valorar la influencia del acompañante en consulta sobre la calidad de la comunicación médico-paciente y la duración de la consulta. Diseño: Descriptivo transversal. Emplazamiento: Diez centros de salud. Participantes: Médicos residentes de Medicina Familiar y Comunitaria. Intervenciones: Auditoría por pares de videograbaciones de consultas a demanda. Mediciones principales: Habilidades en comunicación utilizando el cuestionario CICAA-2 (mejorable, aceptable o adecuada); edad (MIR), sexo (MIR, paciente y acompañante), motivos de consulta y duración de la entrevista. Análisis bivariante y multivariante. Autorización del CEI, consentimiento informado oral y custodia de las videograbaciones. Resultados: Participaron 73 MIR (53,8% mujeres, 32,9±7,7 años) valorando 260 entrevistas (60,3% mujeres, 2,1±1,0 motivos de consulta). Un 27,7% de consultas con acompañante (sexo femenino 65,3%). La duración media de las entrevistas fue de 8,5±4,0 minutos, superior 2,7±0,5 minutos en consultas con acompañante (p<0,001 t de Student) y con mayor número de motivos de consulta (40% con ≥ 3 motivos, p=0,048 X2). El valor medio de la puntuación total de la escala CICAA-2 (46,9±16,5) fue superior en las consultas con acompañante (diferencia 4,6±2,3), al igual que la tarea 2 (39,3±15,8 con diferencia 4,4±2,2) (p<0,05 t de Student). El modelo obtenido con regresión logística binaria muestra una mayor duración de la consulta con acompañante (OR 1,2; IC [1,1-1,3]) y posiblemente mejor puntuación en la tarea 2 (OR 1,02; IC [0,99-1,1]). Conclusiones: Las comunicaciones triádicas suponen un desafío para las habilidades de comunicación del médico, que mejora sus capacidades para identificar y comprender los problemas del paciente, aunque a costa de una mayor inversión de tiempo.(AU)

Objetives: To know the influence of the companion in triadic clinical encounter on the quality of doctor–patient communication and the duration of the interview. Design: Cross-sectional descriptive study. Location: 10 Primary Care Centers. Participants: Resident doctors of Family and Community Medicine. Interventions: Peer review of video recordings of clinical demand consultations. Main measurements: CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. Results: 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1–1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99–1.1]). Conclusions: Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.(AU)

[Influence of the companion in Primary Care consultations on communication skills and interview time]. / Influencia del acompañante en las consultas de Atención Primaria sobre las habilidades en comunicación y el tiempo de entrevista.

OBJETIVES: To know the influence of the companion in triadic clinical encounter on the quality of doctor-patient communication and the duration of the interview. DESIGN: Cross-sectional descriptive study. LOCATION: 10 Primary Care Centers. PARTICIPANTS: Resident doctors of Family and Community Medicine. INTERVENTIONS: Peer review of video recordings of clinical demand consultations. MAIN MEASUREMENTS: CICAA-2 questionnaire to assess communication skills (improvable, acceptable or adequate); age and sex, reasons for consultation and duration of the interview. Bivariate and multivariate analyses. Ethical authorization, oral informed consent and custody of the video recordings. RESULTS: 73 RD (53.8% women, 32.9±7.7 years) participated with 260 interviews (60.3% women and 2.1±1.0 clinical demands). 27.7% of consultations with a companion (female sex 65.3%). The mean duration of the interviews was 8.5±4.0min. Clinical encounters lasted longer when a companion attended (2.7±0.5min more; p<.001 Student t) and with a greater number of clinical demands (40% with ≥3 reasons, p=0.048 X2). The mean value of the total score of the CICAA-2 scale (46.9±16.5; difference 4.6±2.3) and Task 2 (39.3±15.8 with difference 4.4±2.2) were higher when companion was present (p<.05 Student t). The model obtained with logistic regression shows a longer duration of the consultation with a companion (OR 1.2; CI [1.1-1.3]) and possibly a better score in Task 2 communication skills (OR 1.02; CI [0.99-1.1]). CONCLUSIONS: Triadic communications challenge the clinician's communication skills, improving their abilities to identify and understand patient problems, albeit at the cost of a greater investment of time.

Emergency department physicians' distribution of time in the fast paced-workflow-a novel time-motion study of drug-related activities.

Background In the emergency department physicians are forced to distribute their time to ensure that all admitted patients receive appropriate emergency care. Previous studies have raised concerns about medication discrepancies in patient's drug lists at admission to the emergency department. Thus, it is important to study how emergency department physicians distribute their time, to highlight where workflow redesign can be needed.Aim to quantify how emergency department physicians distribute their time between various task categories, with particular focus on drug-related tasks.Method Direct observation, time-motion study of emergency department physicians at Diakonhjemmet Hospital, Oslo, Norway. Physicians' activities were categorized in discrete categories and data were collected with the validated method of Work Observation Method By Activity Timing between October 2018 to January 2019. Bootstrap analysis determined 95% confidence intervals for proportions and interruption rates.Results During the observation time of 91.4 h, 31 emergency department physicians were observed. In total, physicians spent majority of their time gathering information (36.5%), communicating (26.3%), and documenting (24.2%). Further, physicians spent 17.8% (95% CI 16.8%, 19.3%) of their time on drug-related tasks. On average, physicians spent 7.8 min (95% CI 7.2, 8.6) per hour to obtain and document patients' drug lists.Conclusion Emergency department physicians are required to conduct numerous essential tasks and distributes a minor proportion of their time on drug-related tasks. More efficient information flow regarding drugs should be facilitated at transitions of care. The presence of healthcare personnel dedicated to obtaining drug lists in the emergency department should be considered.

Increasing the rate of timely completion of a rapid frozen-section pathological report using the PDCA cycle / 中国基层医药

Objective:To investigate the application value of the PDCA cycle in increasing the rate of timely completion of a rapid frozen-section pathological report.Methods:The basic data of 1 926 rapid frozen section pathological reports not managed by the PDCA cycle in the Department of Pathology, Zhoushan Hospital, during January to August 2019 were collected. The number of pathological reports completed within 30 minutes and the rate of timely completion of pathological reports were calculated and compared with those calculated based on 1 051 pathological reports managed by the PDCA cycle during September to December 2019.Results:After management by the PDCA cycle, the rate of timely completion of frozen-section pathological reports was significantly increased from (84.51 ± 3.61)% to (91.87 ± 1.37)% ( t = 3.86, P < 0.05). Conclusion:Application of the PDCA cycle to pathology management can help monitor the completion of pathological reports on frozen sections. This facilitates determination of reasonable intervention measures and thereby increases the rate of timely completion of pathological reports on frozen sections.

Las perplejidades éticas del Rey Ludwig II de Baviera: locura, extravagancia y profesión médica / The ethical perplexities of king Ludwig II of Bavaria: madness, extravagance and medical profession / As perplexidades éticas do Rei Ludwig II da Baviera: loucura, extravagancia e profissão médica

1. Bernhard von Gudden diagnosticó el trastorno del Rey Ludwig II de Baviera como "paranoia" (locura), aunque Ludwig nunca fue personalmente evaluado por este experto psiquiatra, diagnóstico que usó el gobierno bávaro para justificar la remoción de Ludwig del poder. 2. Su conducta progresivamente anormal; sus proyectos múltiples de construcción, por los cuales incurrió en fuertes deudas; su convicción de descender directamente de los Borbones gracias al "bautismo"; su desenfrenada vida homosexual, todo constituyó la base para el diagnóstico psiquiátrico. 3. De acuerdo con los criterios actuales de la psiquiatría, Ludwig mostró rasgos de un trastorno de personalidad esquizotípico, unido a un sindrome orbitofrontal, y un modo de existencia extravagante. 4. Bernhard von Gudden fundamentó su diagnóstico y peritaje psiquiátricos siguiendo los principios éticos de beneficencia y primum non nocere, "ayudar, al menos no dañar".

Abstract: Bernhard von Guden diagnosed the Bavarian King Ludwig II with "paranoia" (madness), although Ludwig was not personally evaluated by this expert psychiatrist, a diagnosis that the Bavarian government used to justify removing Ludwig from power. 2. His increasingly abnormal behavior, his multiply building projects, for which he incurred much debt, his conviction that he descended from the Bourbons through "baptism", his unbridled homosexual life, together formed the basis for the psychiatrist´s diagnosis. 3. According to modern criteria of psychiatry Ludwig displayed traits for schizotypal personality disorder together with an orbitofrontal syndrome, and an extravagance way of existence. 4.Bernhard von Gudden based his psychiatric diagnosis and expertise following the ethical principles of beneficence and primum non nocere, "to help, at least not to harm"

Resumo: 1. Bernhard von Gudden diagnosticou o transtorno do Rei Ludwig II da Baviera como "paranoia" (loucura), ainda que Ludwig nunca tenha sido pessoalmente avaliado por este especialista psiquiatra, diagnóstico que o governo bávaro usou para justificar a remoção de Ludwig do poder. 2. Sua conduta progressivamente anormal; seus projetos múltiplos de construção, pelos quais incorreu em fortes dívidas; sua convicção de descender diretamente dos Bourbons graças ao "batismo"; sua desenfreada vida homossexual, tudo constituiu a base para o diagnóstico psiquiátrico. 3. De acordo com os critérios atuais da psiquiatria, Ludwig mostrou traços de um transtorno de personalidade esquizotípico, unido a uma síndrome órbito-frontal e um modo de existência extravagante. 4. Bernhard von Gudden fundamentou seu diagnóstico e perícia psiquiátrica seguindo os princípios éticos de beneficência e primum non nocere, "ajudar, ao menos não prejudicar".

The impact of COVID-19 in medical practice. A review focused on Urology

ABSTRACT COVID-19 pandemic is a rapidly spreading virus that is changing the World and the way doctors are practicing medicine. The huge number of patients searching for medical care and needing intensive care beds led the health care system to a burnout status especially in places where the care system was already overloaded. In this setting, and also due to the absence of a specific treatment for the disease, health authorities had to opt for recommending or imposing social distancing to relieve the health system and reduce deaths. All other medical specialties nondirectly related to the treatment of COVID-19 had to interrupt or strongly reduce their activities in order to give room to seriously ill patients, since no one knows so far the real extent of the virus damage on human body and the consequences of doing non deferrable procedures in this pandemic era. Despite not been a urological disease, the urologist needs to be updated on how to deal with these patients and how to take care of himself and of the medical team he works with. The aim of this article is to review briefly some practical aspects of COVID-19 and its implications in the urological practice in our country.

Establishment and application of networked full-coverage multi-disciplinary team management mode under hospital administrative guidance / 中华医院管理杂志

Multi-disciplinary team(MDT)mode is regarded as the key to standardized diagnosis and treatment of malignant tumors. The model, however, encounters such roadblocks in the current form of MDT organization, as costly clinical resources and time consumption, low efficiency, poor management of participating experts in MDT, and lack of enforceability of the therapeutic decisions made. This paper summarized the practical MDT experiences of the Affiliated Cancer Hospital of Shandong First Medical University. It introduced the construction of an intranet-based MDT system covering a large proportion of newly diagnosed malignant tumor patients, and the practices and achievements of such MDT management system under hospital administrative guidance. The authors proposed to use reporting ratio as the main assessment indicator in promoting MDT, and that to define the performance, responsibilities and rights in MDT practice. These measures aim at to upgrading individual behaviors of doctors to organizational behaviors of hospitals, and providing cancer patients with more standardized, comprehensive and personalized diagnosis and treatment decisions.

Current setup and insights of the practicing scope of physicians in China / 中华医院管理杂志

Objective:To analyze the setup basis and registration rules of the practice scope of physicians in China, and take into account the current situation of individual provinces, for suggestions on further revision of the practice scope of these physicians.Methods:Relevant documents on practice scope setup were retrieved from such databases as CNKI, Wanfang and Weipu databases, while relevant national policies, laws and regulations were reviewed. On-site visits were conducted to health committees and medical institutions in 7 provinces from June 2020 through December 2020. Seminars and special interviews were held with relevant management personnel and doctors of different positions, for the purpose of learning the current physician practice scope setup and their suggestions for reform. Data gained from the above methods were summarized to arrive at reform suggestions for optimizing China′s practice scope setup, with further improvement made based on expert consultation method.Results:Several setbacks were found in the setup of their practice scope in China, namely as unclear setup principles, generalized setup of the national standards, inconsistent setup standards among the provinces, prohibition of cross-category registration, and roadblocks against in changing scope of practice. As the setup of the practice scope should set free manpower, unleash vitality, and delegate power, the practice scope should be changed to three categories of " discipline" , " discipline+ technology" and " comprehensive" . Physicians should be entitled to register separately as " discipline" and " discipline+ technology" as their practice scope, with " comprehensive" practice scope approved by a simple procedure of a notice.Conclusions:The setup and modification of the practice scope should be in a general rather than detailed manner, and conducive to the development of related disciplines. Such measures should also fully unleash the vitality of Chinese physicians, and take into account of both peacetime and emergencies, and both medical service and prevention.

Current setup and insights of the diagnosis and treatment subjects in medical institutions in China / 中华医院管理杂志

Objective:To study the current setup of diagnosis and treatment subjects in China and make reform suggestions in light of existing problems.Methods:Relevant documents on medical institutions′ diagnosis and treatment subjects setup were retrieved from such databases as CNKI, Wanfang and Weipu database, while relevant national policies, laws and regulations were reviewed. On-site visits were conducted to health committees and medical institutions in 7 provinces from June 2020 through December 2020. Seminars and special interviews were held with relevant management personnel and doctors of different positions, for the purpose of learning the current medical institutions′ diagnosis and treatment subjects and their suggestions for reform. Data gained from the above methods were summarized to arrive at reform suggestions for optimizing China′s medical institutions′ diagnosis and treatment subjects, with further improvement made based on expert consultation method.Results:Problems found focus on such areas as inconsistent setup standards for medical treatment subjects, multiple overlapping services, and unclear numbering rules. Based on the disease list and skill list of the DRG system, a novel diagnosis and treatment subject setup method guided by service items could be established. Otherwise, the numbering and categories could changed on the current basis to correct existing problems. The subjects could be divided into such five categories as clinical, oral, traditional Chinese medicine, medical technology, and comprehensive, with level-1 and level-2 subjects set up respectively.Conclusions:In terms of subject functions, the setup of diagnosis and treatment subjects should be regularly adjusted or filed, instead of complete equivalence with administratively licensed subjects. As the current setup of diagnosis and treatment subjects had been in place for years, and had become key references for the department setup and performance appraisal of medical institutions, it was proposed to make adjustment on the current basis for the purpose of correcting existing problems.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as "adrenal incidentalomas" and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.

Is Follow-up of Adrenal Incidentalomas Always Mandatory?

Adrenal masses are mainly detected unexpectedly by an imaging study performed for reasons unrelated to any suspect of adrenal diseases. Such masses are commonly defined as “adrenal incidentalomas” and represent a public health challenge because they are increasingly recognized in current medical practice. Management of adrenal incidentalomas is currently matter of debate. Although there is consensus on the need of a multidisciplinary expert team evaluation and surgical approach in patients with significant hormonal excess and/or radiological findings suspicious of malignancy demonstrated at the diagnosis or during follow-up, the inconsistency between official guidelines and the consequent diffuse uncertainty on management of small adrenal incidentalomas still represents a considerable problem in terms of clinical choices in real practice. The aim of the present work is to review the proposed strategies on how to manage patients with adrenal incidentalomas that are not candidates to immediate surgery. The recent European Society of Endocrinology/European Network for the Study of Adrenal Tumors guidelines have supported the view to avoid surveillance in patients with clear benign adrenal lesions <4 cm and/or without any hormonal secretion; however, newer prospective studies are needed to confirm safety of this strategy, in particular in younger patients.

[New opportunity of management strategy of diagnosis and treatment of chronic wound: emerging technology].

Along with the development of society and the change of disease spectrum, chronic wound is gradually becoming the core of burn and plastic surgery field. Although there have been some progresses in the diagnosis and treatment technology, the management strategy of chronic wound is still in the traditional mode stage. The development of internet of things, cloud computing, big data, artificial intelligence, and other emerging technologies is changing with each passing day, and they have rapidly penetrated into the health care field. To explore the application prospect of emerging technology in the diagnosis and treatment management of chronic wound and to plan its strategy and mode in the diagnosis and treatment of chronic wound can further promote development of discipline of burns.

New opportunity of management strategy of diagnosis and treatment of chronic wound: emerging technology / 中华烧伤杂志

Along with the development of society and the change of disease spectrum, chronic wound is gradually becoming the core of burn and plastic surgery field. Although there have been some progresses in the diagnosis and treatment technology, the management strategy of chronic wound is still in the traditional mode stage. The development of internet of things, cloud computing, big data, artificial intelligence, and other emerging technologies is changing with each passing day, and they have rapidly penetrated into the health care field. To explore the application prospect of emerging technology in the diagnosis and treatment management of chronic wound and to plan its strategy and mode in the diagnosis and treatment of chronic wound can further promote development of discipline of burns.

Effect of health management mode of chronic disease on management of hypertension patients / 中国基层医药

Objective@#To analyze the effect and clinical value of the health management model of hypertension and chronic diseases developed by the health management center.@*Methods@#From June 2015 to June 2018, 550 patients with hypertension were selected in Taizhou Central Hospital and Taizhou Hospital.According to the management of chronic health point, the patients were divided into two groups, with 275 cases in each group.The patients before the chronic disease health management (from June 2015 to January 2017) were selected as control group, and the patients after implementing the health management of chronic disease (from February 2017 to June 2018) were selected as observation group.The standard blood pressure and blood fat were compared between the two groups.@*Results@#The compliance rate of blood pressure in the observation group was 61.09%, which was significantly higher than 34.91% in the control group, and the difference between the two groups was statistically significant(χ2=6.012, P<0.05). After intervention, the triglycerides [(1.47±0.21)mmol/L], total cholesterol[(4.61±0.51)mmol/L], and low-density lipoprotein [(2.76±0.22)mmol/L] in the observation group were significantly different with those in the control group (t=5.991, 6.398, 8.128, all P<0.05). After intervention, the body mass index [(24.32±1.88)kg/m3] and waist circumference [(83.26±6.03)cm] in the observation group were significantly different with those in the control group (t=5.928, 7.489, all P<0.05).@*Conclusion@#The model of health management for chronic diseases developed by the health management center can improve blood pressure and blood lipids of people who have physical examination, and provide effective health guidance services for patients with hypertension, which is worthy of further promotion in clinical practice.

Effect of health management mode of chronic disease on management of hypertension patients / 中国基层医药

Objective To analyze the effect and clinical value of the health management model of hypertension and chronic diseases developed by the health management center.Methods From June 2015 to June 2018,550 patients with hypertension were selected in Taizhou Central Hospital and Taizhou Hospital .According to the management of chronic health point,the patients were divided into two groups ,with 275 cases in each group.The patients before the chronic disease health management (from June 2015 to January 2017) were selected as control group ,and the patients after implementing the health management of chronic disease (from February 2017 to June 2018) were selected as observation group.The standard blood pressure and blood fat were compared between the two groups .Results The compliance rate of blood pressure in the observation group was 61.09%,which was significantly higher than 34.91%in the control group,and the difference between the two groups was statistically significant (χ2 ＝6.012,P＜0.05). After intervention,the triglycerides [( 1.47 ±0.21) mmol／L], total cholesterol [( 4.61 ±0.51 ) mmol／L], and low－density lipoprotein [(2.76 ±0.22)mmol／L] in the observation group were significantly different with those in the control group ( t ＝5.991,6.398,8.128,all P＜0.05).After intervention,the body mass index [( 24.32 ± 1.88)kg／m3] and waist circumference [(83.26 ±6.03) cm] in the observation group were significantly different with those in the control group (t＝5.928,7.489,all P＜0.05).Conclusion The model of health management for chronic diseases developed by the health management center can improve blood pressure and blood lipids of people who have physical examination ,and provide effective health guidance services for patients with hypertension ,which is worthy of further promotion in clinical practice.

El sentido social del profesionalismo médico / The social meaning of medical professionalism

Se examina el significado actual del profesionalismo y la aparente inconsistencia entre el crecimiento de su demanda, el contexto de profundos cambios y la insatisfacción con la práctica médica. Se revisa el clima cultural de nuestro tiempo como entorno indispensable para comprender los cambios acontecidos en la organización social de la medicina. Uno de los rasgos críticos de las profesiones ha sido el poder de manejar el conocimiento especializado según parámetros propios y sin control externo. Los límites de esta autorregulación pericial se han diluido y representan una amenaza importante para el profesionalismo. Junto con cambios fundamentales y tensiones en las condiciones de laborales, la demanda de profesionalismo ha crecido. El profesionalismo puede contribuir a estabilizar los sistemas sociales como una tercera lógica instalada entre el mercado y las organizaciones públicas pues goza de la capacidad de someter a los intereses colectivos el individualismo devastador. El profesionalismo como un sistema basado en valores e ideología surge como respuesta a los desafíos planteados a la práctica de la medicina. Representa reflexiones y preservación de valores tradicionales que inspiran una práctica de excelencia y que sin duda restaurará y mejorará la confianza pública en la medicina.

This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine.

Examina-se o significado atual do profissionalismo e a aparente inconsistência entre o crescimento de sua exigência, o contexto de profundas mudanças e a insatisfação com a prática médica. Confere-se o clima cultural de nosso tempo como contexto indispensável para compreender as mudanças acontecidas na organização social da medicina. A possibilidade de operar com conhecimento especializado, segundo parâmetros próprios e sem controle externo tem sido um dos problemas das profissões. Os limites desta autorregulação pericial se têm dissolvido e representam una ameaça importante para o profissionalismo. Junto com mudanças fundamentais e tensões nas condições de trabalho, tem crescido a procura de profissionalismo. Este pode contribuir a estabilizar os sistemas sociais como una terceira lógica instalada entre o mercado e as organizações públicas uma vez que goza é capaz de submeter o individualismo devastador aos interesses coletivos. Profissionalismo como um sistema baseado em valores e ideologia responde aos desafios colocados à prática da medicina. Representa pensamento e preservação de valores tradicionais que inspiram uma prática de excelência e que sem sombra de dúvidas vai recuperar e melhorar a confiança pública na medicina.

Clinical effect of enhanced recovery after surgery management in patients with vaginal hysterectomy / 中国基层医药

Objective@#To analyze the effect of enhanced recovery after surgery program(ERAS) in perioperative management of vaginal hysterectomy.@*Methods@#The clinical data of 73 patients who underwent transvaginal hysterectomy for uterine fibroids, adenomyosis, middle pelvic defects, cervical lesions and endometrial lesions were retrospectively analyzed.All patients were divided into two groups according to the perioperative management method.The observation group (35 cases) received the enhanced recovery program, while the control group (38 cases) received the routine perioperative management.The general data and perioperative management indicators of the two groups were recorded and compared.@*Results@#There were no statistically significant differences between the two groups in mean age, body mass index, abdominal surgery history and diagnosis constitution(all P>0.05). The first feeding time[(7.6±1.3)h vs.(12.6±3.2)h], postoperative exhaust time[(15.5±4.6)h vs.(20.2±6.5)h], indwelling catheter time[(20.1±4.9)h vs.(28.4±6.8)h], mobilization time[(19.2±3.5)h vs.(24.2±7.9)h], the length of hospital stay[(4.5±0.7)d vs.(5.8±1.2)d]and hospitalization expense[(6 545.2±430.7)CNY vs.(7 953.8±653.3)CNY]of the observation group were less than those of the control group, the differences were statistically significant(t=8.069, 3.538, 5.938, 3.582, 5.590, 10.777, all P<0.05). There were no statistically significant differences between the two groups in the operation time[(45.3±20.8)min vs.(39.9±17.4)min]and the amount of bleeding[(69.4±32.2)mL vs.(57.0±24.5)mL](t=0.231, 0.067, all P>0.05).@*Conclusion@#The ERAS program perioperative management can speed up the postoperative recovery process, reduce the length of hospital stay and the financial burden of patients who underwent transvaginal hysterectomy.