【摘要】 目的 探討高血壓危象評估和處理原則及對高血壓危象急診處理的指導意義。 方法 依據高血壓危象評估和處理原則對2008年1月-2009年12月期間收治的160例高血壓危象患者進行診斷和治療。結果 160例高血壓危象患者中,高血壓急癥134例,高血壓亞急癥26例。高血壓急癥中,以心腦血管病變為主,包括腦卒中、急性冠脈綜合征和急性左側心力衰竭。依據高血壓危象評估和處理原則進行急診處理,能夠對高血壓危象進行準確評估和有效處理,減少診治失誤,降低死亡率并改善預后。結論 有關高血壓危象的評估和處理原則能夠指導高血壓危象的急診處理,取得良好的預后。【Abstract】 Objective To investigate the principles of evaluation and management of hypertensive crises in order to guide emergency clinical practice for better managements and prognosis. Methods One hundred and sixty patients with hypertensive crises admitted to our department from January 2008 to December 2009 had been diagnosed and treated. Results There were 134 patients with hypertensive emergencies (HE) and 26 patients with hypertensive urgencies(HU)in accordance with those principle. Cardiocerebralvascular diseases were the main symptom of HE including stroke, acute coronary syndrome and acute left ventricular failure. According to those principles,the emergency management was carried out, accuracy evaluation and effective management of hypertensive crises could reduce wrong diagnosis and treatment,decrease mortality and improve prognosis. Conclusion The principle of evaluation and management of hypertensive crises could guide the emergency management of hypertensive crises and obtain better prognosis．
Objective To evaluate the right usage of statistical methods in medical articles. Methods 544 theses from eight medical journalspublished during1998 and 2005 were analyzed. Results 136 theses had obvious statistical errors,accounting for 25.00%. The main types of the errors were: the wrong methods of data analyzing for 61.76%, diagram error for 14.71%, nonstatistical dealing for8.82%, the mixture of rate and ratio for 8.82%, and the other error for 5.88%. Conclusion The statistical methods should be highly valued. Despite handing themanuscript to the specialist in the same field, the statistician checking system should be built through the process of manuscript dealing.
ObjectiveAs few studies have evaluated the policy effects of the Chinese simplified DRGs-PPS systematically, this research aims to assess its policy effects and to provide insight for other developing regions that are undergoing the same reform.
MethodsThe history and major problems of the Chinese DRGs-PPS were analyzed qualitatively. Moreover, the efficiency (average hospitalization cost; length of stay, LOS) and equity of the simplified DRGs-PPS were examined at both macro and micro levels.
ResultsAs of today, only 20 of the 32 provinces in mainland China had implemented the simplified DRGs. There were also huge differences in terms of the number and categories of diseases among the various provinces involved. Literature review showed that " lack of rationale in setting payment standards" , "limited diseases are included into the DRGs categories" and "lack of regulation to avoid ethical risks of health service providers" were the frequently cited problems. On the macro level, the national average medical cost had increased while the average LOS had been relatively stable from the year 2004 onwards, and simplified DRGs had been implemented widely since 2004 while discrepancies existed in various provinces. On the micro level, among the studies that focused on assessing hospitals with statistical test, 78% (11/14) of these studies revealed that hospitalization cost could be reduced and 60% (6/10) of them indicated that LOS could be reduced.
ConclusionBy comparing the policy effects at both macro and micro levels, we conclude that the simplified DRGs are useful in controlling hospitalization cost but they fail to reduce LOS. Also much more still needs to be done in China to facilitate the transition from simplified DRGs to genuine DRGs.
Protein-energy wasting is one of the common complications of maintenance hemodialysis patients. It often causes decreased immune function, increased anemia, and decreased heart, brain, lung and other organ functions, resulting in decreased quality of life, decreased long-term survival rate, and increased mortality. This article discusses the causes, diagnosis, evaluation methods, intervention and prevention of protein-energy wasting in maintenance hemodialysis patients, and aims to provide a theoretical basis for evaluating the nutritional status, early intervention for protein-energy wasting, and improving prognosis and quality of life of maintenance hemodialysis patients.
ObjectiveTo explore effective evaluation tools as well as systems of medical service capability related to total payment control of medical insurance.
MethodsCombining references and using the Delphi method, the evaluation indicators of total payment control of medical insurance were screened and identified. Then, based on analytic hierarchy process, a weight questionnaire was designed and weighted coefficients of all-level indicators were also calculated.
ResultsWe proposed a mathematical model to evaluate medical service capability related to total payment control of medical insurance using three types of primary evaluation indicators and seventeen types of secondary evaluation indicators with their weighted coefficients.
ConclusionThe establishment of the evaluation systems of medical service capability in medical institutions could objectively reflect medical service capability to some extent, and provide references on total payment control of medical insurance for medical insurance agencies.
Rational drug use is a global concern. As one of the highest risk groups for drug use, children's rational drug use has always been concerned. Based on the previous research results of the research group, we developed evaluation indicator systems for assessing rational drug use to treat community-acquired pneumonia and primary nephrotic syndrome in children and proton pump inhibitors in pediatric intensive care units and finished empirical research. This study further summarizes and expounds the construction ideas of rational drug use evaluation indicators for children based on diseases or drugs, and provides a reference for constructing children's rational drug use evaluation indicators.
Objective To evaluate quality and current status of traditional Chinese medicine (TCM) guidelines and consensus, and to promote the improvements in the quality of guidelines and consensus. Methods A systematic collection of TCM guidelines and consensus published in medical journals in 2022 was conducted. We used scientific, transparent, and applicable ranking tools (STAR) for evaluation, analyzed the scoring rates (%), and assessed the quality level and influencing factors of guidelines and consensus through methods such as comparison and stratification. Results A total of 130 TCM guidelines and consensus were included. Guideline areas with higher scores included recommendations (65.3%), evidence (55.9%), and guideline development groups (54.2%). In the case of consensus, higher scores were observed in recommendations (38.7%), guideline development groups (37.0%), and funding (30.0%). The total score rate of TCM guidelines exceeded that of national guidelines, while the consensus rate was lower. Stratified analysis revealed statistical differences in guideline score rates among journals and issuing institutions, as well as significant differences in consensus score rates among journals, formulation institutions, subjects, and funding categories. Conclusion The quantity and quality of TCM guidelines and consensus are on a positive trajectory, with higher quality levels in guidelines than in consensus. The overall quality of TCM guidelines surpasses that of national guidelines, particularly emphasizing the scientificity of guideline formulation. However, the overall quality of consensus remains lower than that of the national consensus. Factors such as journals, formulation institutions, subjects, and funding categories are identified as potential influences on the quality of TCM guidelines and consensus.
ObjectiveNew Rural Cooperative Medical Systems (NCMS) has been constructed as a financial protection for rural population commencing 2003. With the development of NCMS, there were quite a few management models existing across the nation. In order to assess the management alternatives, we try to explore how to set up a set of indicators to analysis management effect of different management models.
MethodsBy literature review, we sorted all qualitative indicators into 8 types. Delphi and Multi-Attribute utility theories were applied to construct the appraisal indicators, including shaping first and second level indicators and assigning the weights for each type of indicators.
ResultsWe managed to identify the indicator system which was comprised of 4 types of first level indicators, aiming at claim, manament process, transparency and supervision on accredited hospitals. Besides, there were 9 sub-indicators.
ConclusionThe evaluation indicators are constructed for future assessment on management effect of rural health insurance.
Objective To explore the evaluation index and appointment mechanism of healthy professional titles. Methods We collected the data of people evaluated and appointed as advanced professional titles, and the evaluation and appointment documents in West China Hospital. We analyzed the evaluation index and appointment mechanism. Results A total of 400 people gained senior title promotion. The evaluation indexes focused on academic degrees, papers, research projects, patents, as well as awards and honors. The research achievements reduced of 80% people who had gained senior titles. Conclusion Current evaluation indexes prefer to inflexible index and ignore flexible index. The appointment mechanism lacks outcome evaluation, and the professional title will not be eliminated once appointed. In the future, we should improve the evaluation index and appointment mechanism focusing on the specific characteristics of healthy professional titles.
ObjectiveTo evaluate the effect of basic life support (BLS) intensive training for medical students who have received BLS training within one year.
MethodsWe enrolled 865 medical students between January to December 2015 who had received BLS training within one year. These students were divided into three groups [undergraduate upcoming doctor (group A, n=436), postgraduate upcoming doctor (group B, n=197), and undergraduate upcoming medical technician (group C, n=232)] based on their major and educational background. In the study, they received on-the-spot BLS intensive training, and took BLS basic knowledge examination, skill examination and comprehensive capacity test before and after training. During the study, comprehensive capacity was evaluated by training scale including such items as emergency awareness, psychological diathesis, disposal ability, cooperation ability, and operation accuracy.
ResultsBLS basic knowledge scores for the above three groups before and after training were respectively 58.9±9.5 vs 93.5±7.6, 52.5±4.5 vs 90.3±3.5, 54.8±5.3 vs 88.5±4.5, and the skill scores were 58.8±3.2 vs 95.3±1.7, 57.6±4.2 vs 90.5±2.3, 50.9±3.8 vs 93.5±1.8, respectively. The scores after training were significantly better than those before training (P＜0.05). Comprehensive capacity was also improved significantly after intensive training (P＜0.05).
ConclusionsEstablishing a BLS intensive training program has important clinical significances for updating and consolidating the emergency knowledge, improving teaching quality and emergency training effect. So it is worth popularizing.
