Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
ObjectivesTo analyze the theoretical and practical research and effect evaluation of integrated care at home and abroad, so as to provide evidence for the development of integrated care in China.MethodsPubMed, CNKI and WanFang Data databases and government documents, research reports were searched to collect studies on integrated care, and then literature review was then performed.ResultsForeign integrated care was dominated at government level. The integration involved numerous departments such as hospital and insurance institutions. The degree of integration was high and funds were sufficient. The theoretical framework was studied from the macro, meso and micro perspectives, and people-centered, value-based integration was proposed. However, in China the integrated care was primarily guided by the government nationally. Local government was responsible for specific integration practices. The degree of integration was low and funds were insufficient. The theoretical research mostly focused on cooperation, interest mechanisms and so on. At home and abroad, researchers focused on the evaluation of health service and quality. Foreign countries paid more attention to medical costs, while in China, due to the imbalance of interest mechanisms, researchers paid more attention to medical expenses and performance evaluation.ConclusionThere is no unified theoretical framework and method for integrated medical care. Researchers and policy makers should combine the successful experience and characteristics at home and abroad, consider the complex health policy context of the country to implement integrated care.
ObjectiveTo research prognostic prediction value of serum γ-glutamyltransferase-to-prealbumin ratio (GPR) for patients with hepatocellular carcinoma (HCC) after radical resection. MethodsThe clinical data of HCC patients undergoing radical resection from January 2013 to November 2021 were analyzed retrospectively. The optimal critical value of GPR was determined by receiver operating characteristic (ROC) curve. The patients were allocated into the low GPR group (GPR was the optimal critical value or less) and the high GPR group (GPR was greater than the optimal critical value). The differences of clinicopathologic characteristics were compared between the two groups. The overall survival (OS) and relapse-free survival (RFS) were analyzed by the Kaplan-Meier survival curve and compared by the log-rank test between the two groups. The risk factors affecting the OS and RFS of patients with HCC were analyzed by univariate and multivariate Cox regression, and the predictive value of GPR on the OS was evaluated by ROC curve. ResultsA total of 216 eligible HCC patients were gathered. The optimal critical value of GPR was 0.29, 93 cases were in the low GPR group and 123 cases were in the high GPR group. Compared with the low GPR group, the proportions of the patients with preoperative alanine aminotransferase >50 U/L, albumin <40 g/L, total bilirubin ≥34.2 μmol/L, tumor size >5 cm, multiple tumor lesions, stage Ⅲ of China liver cancer staging (CNLC), and major hepatectomy (liver segment resection was 3 or more) were higher in the high GPR group (P<0.05). The Kaplan-Meier survival curve showed that the OS and RFS of the low GPR group were better than those of the high GPR group (χ2=14.356, P＜0.001; χ2=7.963, P=0.005). Cox regression multivariate analysis showed that the preoperative alpha-fetoprotein (AFP) ≥400 μg/L, GPR >0.29, stage Ⅲ of CNLC, and operation time (more than 3 h) were the risk factors for OS and RFS of HCC patients (P<0.05). The area under the ROC curve of GPR alone and it in combination with risk factors (preoperative AFP and CNLC stage, respectively) and in combination with the above three indicators to predict the OS of patients with HCC were 0.636, 0.712, 0.696, and 0.737, respectively. ConclusionFrom the results of this study, GPR is associated with the postoperative survival of patients with HCC after radical resection, and GPR in combination with preoperative AFP and CNLC stage has a certain predictive value for the OS.
Objective To analyze the prognosis and indications of transjugular intrahepatic portosystemic shunt (TIPS) in patients with Budd-Chiari syndrome (BCS). MethodsPatients with primary BCS who received TIPS in the Department of Gastroenterology, West China Hospital of Sichuan University between February 2009 and February 2020 were retrospectively reviewed. The medical history, preoperative imaging, surgical records, and postoperative outpatient follow-up medical records were recorded. The laboratory indexes before and after operation were compared, and the cumulative free from hepatic encephalopathy rate, stent patency rate, and cumulative survive rate were calculated. Cox proportional hazards model was used to analyze the independent risk factors of hepatic encephalopathy, shunt dysfunction and death. Results A total of 48 patients were included. The main indications for TIPS included variceal bleeding (16 cases), refractory ascites (24 cases), and diffuse obstruction of hepatic vein with acute liver function impairment (8 cases). The cumulative 1 year, 2 years and 3 years of free from hepatic encephalopathy rates were 92.3%, 89.2% and 85.3%, respectively. The stent patency rates were 89.7%, 72.2% and 54.8% at postoperative 1 year, 3 years and 5 years, respectively. The cumulative survival rates were 86.0%, 79.5% and 71.4% at postoperative 1 year, 3 years and 5 years, respectively. Conclusion TIPS can achieve good efficacy in patients with BCS, and most patients receive TIPS for portal hypertension complications rather than acute liver function impairment.
Objective To investigate the relation between CD44v6 and lymph node metastasis and prognosis of gastric carcinoma. Methods The expression of CD44v6 in 100 cases of advanced human gastric carcinoma was detected by immunohistochemical twostep method. Its relation with clinical pathology and prognosis was analyzed. Results CD44v6 expression occurred in 64%(64/100) of all gastric carcinomas; with the increase of depth of cancer invasion and local lymph node metastasis, the expression of CD44v6 elevated. Conclusion CD44v6 plays an important role in lymph node metastasis of human gastric carcinoma. It may be used as a new indicator to predict metastatic potential and prognosis of gastric carcinoma.
Interventional radiology is an emerging discipline based on image-guided minimally invasive diagnosis and treatment. The number of interventional procedures performed is increasing year by year, resulting in a dramatic increase in the demand for interventional radiologists. Procedure training systems based on virtual reality (VR) technology simulate real interventional procedure through real-time interaction between hand manipulators and virtual environments, allowing physicians to experience real interventional procedures during training and reducing training time and costs. A growing number of medical schools are now adopting VR simulated training systems for interventional procedure training. This article reviews the relevant research progress of VR simulation interventional procedure training system in recent years and discusses the development prospects of VR technology in interventional procedure training.
Objective To analyze the dynamic efficiency of township hospitals. Methods Based on the DEA-Malmquist index, this research analyzed the change of the total factor productivity indices and the decomposition items of 281 township hospitals in Hunan province with panel data from 2000 to 2008. Results Among 281 township hospitals, less than half increased their scale efficiency, while more than half increased their total factor productivity, technology, whole efficiency and technical efficiency. Increasing technology and whole efficiency was the best way to improve total factor productivity. Besides, increasing technical efficiency and scale efficiency was the best way to improve whole efficiency. Conclusions The improvement of scale efficiency is key to developing the central township hospitals, while the improvement of technology is the key to developing general township hospitals.
ObjectiveTo systematically review clinical value of des-γ-carboxy prothrombin (DCP) in the diagnostic of primary hepatocellular carcinoma (PHC).MethodsDatabases including PubMed, The Cochrane Library, EMbase, Medline (Ovid), CNKI, VIP, WanFang Data and CBM were electronically searched to collect relevant studies on DCP in the diagnosis of PHC from inception to December 31st, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using Meta-Disc 1.4 software and RevMan 5.3 software.ResultsA total of 50 studies involving 15 099 cases were included. The results of meta-analysis showed that the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, pooled diagnostic odds ratio and area under the curve of SROC were 0.69 (95%CI 0.67 to 0.70), 0.89 (95%CI 0.89 to 0.90), 7.35 (95%CI 6.08 to 8.90), 0.31 (95%CI 0.27 to 0.35), 26.63 (95%CI 20.42 to 34.73) and 0.909 9, respectively.ConclusionsSerum DCP has higher diagnostic efficacy for PHC, especially with higher specificity of diagnosis. Due to the limited quality and quantity of included studies, the above results should be validated by more studies.
