ObjectivesTo analyze the balance of medical human resource allocation in Chengdu and to discuss the impact of human resource allocation structure on the hospital’s medical service capabilities, so as to provide a theoretical basis for the hospital to optimize the talent team structure.MethodsThe Moran’s index and Gini coefficient were used to evaluate the spatial aggregation and grade distribution difference of human resources allocation, respectively. The case mix index (CMI), the length of hospital stay, and the difficulty of surgery were used as outcome variables, and a multiple regression analysis model was established to explore the impact of human resource indicators on the hospital’s medical service capabilities.ResultsThe distribution of doctors showed an obvious spatial aggregation in Chengdu, and there was a positive spatial correlation (Moran’s Idoctor=0.290); the distribution of nurses had no obvious spatial aggregation (Moran’s Inurse=0.102). Under different medical service capacity segments, the Gini coefficient of doctors was 0.518, and the Gini coefficient of nurses was 0.576, both exceeding 0.5, indicating that the distribution of medical human resources in different levels of hospitals was considerably different. The regression results showed that the expansion of the quantity of senior title doctors and the proportion of medical care both could improve the hospital’s CMI. The increase in the quantity of doctors with senior titles also had a certain impact on improving the hospital’s surgical capabilities. The expansion of the proportion of medical care could lead to a slight increase in the length of patients' hospital stay.ConclusionsOptimizing the allocation structure of medical human resources in different regions and hospitals with different levels is an important task in the construction of a hierarchical diagnosis and treatment system. It is necessary to further integrate medical human resources throughout the whole city and strengthen personnel training and team building in primary health institutions. Hospitals at different levels should implement their own development positioning and further optimize their human resource allocation structure according to development needs. Tertiary hospitals should pay more attention to the cultivation of senior professional doctors, optimize the proportion of medical care, and improve the hospital’s medical service capabilities. The primary health institutions should pay attention to the comprehensive construction of medical personnel, and strengthen the development of the team of general practitioners, so as to achieve a comprehensive improvement of the city’s medical service capabilities.
In order to understand the evolution of the diagnosis and treatment plans of corona virus disease 2019 (COVID-19), and provide convenience for medical staff in actual diagnosis and treatment, this paper uses the 9 diagnosis and treatment plans of COVID-19 issued by the National Health Commission during the period from January 26, 2020 to August 19, 2020 as research data to perform comparative analysis and visual analysis. Based on text mining, this paper obtained the text similarity and summarized its evolution law by expressing and measuring the similarity of the overall diagnosis and treatment plans of COVID-19 and the same modules, which provides reference for clinical diagnosis and treatment practice and other diagnosis and treatment plan formulation.
Despite of the progress in the treatment of severe acute pancreatitis (SAP), there are still factors that hinder the improvement of the efficacy of treatment: there is a lack of an accurate and easy-to-use system for early severity prediction; the multidisciplinary collaboration mechanism needs to be further optimized; there is no clinical efficacy evaluation system for traditional Chinese medicine (TCM); the therapeutic targets of TCM are unclear; the effector substances are unknown; and the research and development of new medicines is still difficult. In order to further reduce the mortality of SAP and realize the goal of improving the efficacy, we should strengthen the integration of Chinese and Western medicine, multidisciplinary collaboration, and improve the treatment levels; as well as carry out basic and clinical research oriented to clinical value. We will also promote the innovative development of combined Chinese and Western medicine in the treatment of SAP by elucidating the mechanism, validating the efficacy and commercializing the achievements. In view of SAP, a major and difficult disease, we should insist on the principle of integrity and innovation, the synergy of Chinese and Western medicines and the complementarity of advantages, and promote the innovation and development of combined Chinese and Western medicines in the treatment of SAP, so as to further reduce the morbidity and mortality and to alleviate the burden of the disease.
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. The metabolic changes of atrial myocytes, especially lipid metabolism, have a significant impact on the electrical signals and structural remodeling of atrial tissue, and play an important role in the occurrence and development of AF. The reduction of fatty acid oxidation ratio and increased aerobic glycolysis ratio are characteristic changes of tissue metabolic remodeling in AF. In this review, we will introduce the latest research status of lipid metabolism in AF from aspects of AF metabolism, clinical treatment and diagnosis and prognosis.
Under the vigorous promotion of national policies, by the end of 2018, the construction of the national medical consortium has been fully launched, and all public tertiary hospitals have actively participated in the construction of medical consortium. The practice of lead-type close medical consortium in West China Hospital of Sichuan University is an innovative exploration in the context of the new national medical reform. Combining the social responsibilities, location characteristics, functional orientation of West China Hospital of Sichuan University, and the remarkable results of the lead-type close medical consortium, this article elaborats three distinctive features of the lead-type close medical consortium, namely the cooperation between the government and the hospitals as the cornerstone, the hierarchical collaboration as the core, and the medical care and great health as the guiding principle, to provide a reference for the construction of a high-quality and efficient medical and health service system in China.
In recent years, three-dimensional (3D) technology has been more and more widely used in the auxiliary diagnosis and treatment of structural heart disease (SHD), and is also an important basis for the application of other technologies such as artificial intelligence. However, there are still some problems to be solved in the clinical application of 3D technology. In this paper, the application of 3D technology in SHD field is reviewed, and the future development of 3D technology is prospected.
With the aging of the Chinese population, the incidence of vascular diseases is increasing year by year. Currently, venous diseases account for a large proportion of vascular surgical diseases. With the rapid development of venous imaging, the rapid progress of endovascular technology and the innovation of vene-related instruments, the diagnosis and treatment of venous diseases are constantly updated. As the development source and foundation of vascular surgeons, venous diseases should be paid attention to by every vascular surgeon. This paper will discuss the current research hotspots of venous surgery.
Day surgery is an important diagnosis and treatment modality to promote hierarchical diagnosis and treatment and form a “surgery in hospital, recovery in community” diagnosis and treatment mode. At the same time, the promotion and implementation of hierarchical diagnosis and treatment provides institutional support and promotion for the perfection of day surgery management. Based on the experience from the Day Surgery Centre of General Hospital of Eastern Theater Command, this paper investigates the role of “gate-keepers” and recovery guidance in community and secondary hospitals in the perfection of day surgery in tertiary hospitals. Taking orthopedic day surgery as an example, which accounts for the largest proportion in day surgery in General Hospital of Eastern Theater Command, this paper aims to explore a feasible model of hierarchical diagnosis and treatment of day surgery, which specifies the responsibilities and works of hospitals at all levels.
Objective To review and evaluate the advantages and disadvantages of minimally invasive treatment techniques for tibial plateau fractures (TPFs), as well as the research progress and limitations. Methods The relevant domestic and international research literature on the minimally invasive treatment of TPFs in recent years was reviewed. The advantages, disadvantages, and clinical efficacy of various technologies were summarized and analyzed, and an outlook on future development trends was provided. Results Surgery remains the primary method for treating displaced TPFs. Although traditional open reduction and internal fixation has advantages such as direct reduction and simplicity of procedure, it has gradually fallen out of favor with clinical orthopedic doctors due to extensive soft tissue removal, excessive bleeding, tissue adhesion, and postoperative complications such as skin infection, fracture nonunion, and joint dysfunction. As medical technology continues to develop, minimally invasive surgery and precise diagnosis and treatment are gradually being introduced to orthopedic trauma. Guided by concepts such as “minimally invasive treatment”, “homeopathic repositioning of fractures”, and “internal compression fixation”, many traction reduction devices, internal fixation devices, minimally invasive reduction techniques, and computer-aided navigation technologies have been widely used in the clinical treatment of TPFs. This has greatly helped to overcome the challenges of intraoperative reduction, secondary reduction loss, and postoperative functional impairment and effectively promoting the adoption of minimally invasive treatment techniques in the clinical treatment of TPFs. Conclusion Minimally invasive treatment techniques have made significant progress in the clinical treatment of TPFs, particularly with regard to the reduction, and have demonstrated unique advantages. While relevant research results have received international recognition, there is still a need for orthopedic scholars to conduct real-world research to further explore the underlying principles and mechanisms of action.
Objective To investigate the cause, treatment, and prognosis of the postpancreaticoduodenectomy hemorrhage (PPH) . Method A total of 779 patients who underwent pancreaticoduodenectomy at Fudan University Shanghai Cancer Center between January 2015 and December 2016 were enrolled, and the data of them were retrospectively analyzed. Results Sixteen patients (PPH group) suffered from PPH and 763 patients didn’t suffered from PPH (non-PPH group) of 779 patients. There was no significant difference in the age, gender, type of disease, operative time, blood loss, and ratio of blood transfusion between the 2 groups (P>0.05), but the incidences of pancreatic fistula and delayed gastric emptying, postoperative drainage time, hospital stay, and mortality were all higher or longer in PPH group compared with non-PPH group (P<0.001). Of the 16 PPH patients, early haemorrhage occurred in 3 patients (including 2 patients with gastrointestinal haemorrhage and 1 patient with intra-abdominal haemorrhage) and delayed haemorrhage occurred in 13 patients (including 6 patients with gastrointestinal haemorrhage and 7 patients with intra-abdominal haemorrhage). All the 3 patients with early haemorrhage were cured by surgery. Of the 13 patients with delayed haemorrhage, 5 patients were cured by radiological intervention, 2 patients were cured by endoscopic hemostasis, and 3 patients were cured by conservative treatment, but 3 patients with sentinel bleeding died after interventional embolization+surgery. Conclusions The mortality of PPH is high. Surgery is optimal to early haemorrhage and radiological intervention is optimal to delayed haemorrhage, including embolization or covered stent implantation. The sentinel bleeding should be given great attention.