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The positive interaction between medical treatment system and medical insurance system is of great significance to promote the reform of medical and health care system. Due to the complexity of the relationship between them, it is difficult to explain it comprehensively with a single theoretical method. The authors analyzed the relationship between medical treatment system and medical insurance system by applying system theory, game theory and synergy theory, and then put forward policy suggestions to optimize the linkage reform of medical treatment system and medical insurance system, so as to better promote the reform of " three medical linkage" and promote the construction of healthy China. The suggestions included optimizing the allocation of health resources, accelerating the construction of medical insurance legislation and health technical evaluation system, strengthening the construction of multi-level medical insurance system, promoting the inter regional information interconnection between medical care and medical insurance, improving the coordination mechanism, negotiation mechanism, incentive and constraint mechanism between medical care and medical insurance.
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The construction of Health Hospital will become an important opportunity to promote the strategy of Healthy China. The authors analyzed the connotation of Health Hospital, and the feasibility of building Health Hospital from four aspects, including integrating health policy, building healthy environment, implementing health actions and optimizing health services. Then, six essential factors of building Health Hospital were put forward, namely, establishing a green environment, improving the operation mechanism, disseminating health culture, developing information technology, creating intelligent health care and strengthening top-level design.
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Objective To investigate the effect of active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) in patients with pre-hospital respiratory and cardiac arrest.Methods Forty-five patients with respiratory and cardiac arrest,and with contraindication of chest compression admitted to Baiyin Central Hospital of Gansu Province from March 2012 to September 2018 were enrolled,and they were divided into two groups according to random number table.AACD-CPR (abdominal compression-decompression group,n =24) and cardiopulmonary resuscitation (CPR) with unarmed abdominal compression (unarmed abdominal pressure group,n =21) were performed respectively.The success rate of rescue was observed in the two groups,and the changes in heart rate (HR),pulse oxygen saturation (SpO2) and blood pressure 30 minutes after CPR in patients with restoration of spontaneous circulation (ROSC) were observed.Results Among the 24 patients in the abdominal compression-decompression group,5 patients (20.83％) had ROSC,and 2 patients (9.52％) had ROSC in 21 patients of the unarmed abdominal pressure group.The success rate of resuscitation in the abdominal compression-decompression group was significantly higher than that in the unarmed abdominal pressure group (P ＜ 0.05).HR of ROSC patients at 30 minutes of CPR in abdominal compression-decompression group was significantly lower than that in unarmed abdominal compression group (bpm:139.45±5.08 vs.147.62±5.24,P ＜ 0.05),and SpO2 and blood pressure were significantly higher than those in unarmed abdominal compression group with significant differences [SpO2:0.92 ± 0.03 vs.0.85 ± 0.03,systolic blood pressure (SBP,mmHg,1 mmHg =0.133 kPa):118.23 ± 3.26 vs.98.51 ± 3.10,diastolic blood pressure (DBP,mmHg):60.10 ± 2.50 vs.56.36 ± 2.45,all P ＜ 0.05].Conclusion The effect of AACD-CPR was superior to that of unarmed abdominal pressure CPR,which had higher application value to rescue patients with respiratory and cardiac arrest with chest pressure contraindication.
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13th Five-Year period is China's comprehensive completion of the decisive stage of a well-off society,when the development of public hospitals is facing great opportunities and challenges.Five development concepts introduced by the fifth Plenary Session of the 18th CPC Central Committee,offer guidance on public hospital reform and development.Among such concepts,innovation is leading the first power of hospital development;Coordination is the inherent requirements of the hospital' s sustainable and healthy development;Green is a necessary condition for the sustainable development of the hospital,and also an important reflection of the hospital development achievement;Opening is the only way for the rapid development of hospital;Sharing is the essential requirement of hospital development.Five development concepts shall guide the reform and development of Chinese public hospitals during the period of 13th Five-Year.
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BACKGROUND:Studiesin vitro have suggested that icarin can attenuate lipopolysaccharide (LPS)-induced acute pneumonia. Is the anti-inflammatory effect of icarin stil valid in the presence of wear particles? OBJECTIVE:With studiesin vivo andin vitro, to investigate the regulatory effect of icarrin on titanium particle-induced inflammatory reaction. METHODS:(1) Studiesin vivo: Eighty male C57BL/6 mice aged 6-8 weeks were randomly divided into four groups: control group, icarin group, titanium particle group, and titanium particle+icarin group. Mice in the titanium particle group and titanium particle+icarin group received surgical procedure, and sterile and endotoxin-free titanium particles were implanted on the calvaria surfaces to induce inflammatory reaction. Mice in the control group and icarin group received the same surgery, but no wear particles were implanted. Then icarin was given oraly to mice in the titanium particle group and titanium particle+ icarin group with a dose of 200 mg/kg per day for 2 weeks from the day of modeling. Mice in the control group and icarin group were given oraly the same dose of placebo. Two weeks later, tumor necrosis factor-α and interleukin-1β at protein and mRNA levels were respectively detected with enzyme-linked immunohistochemical (ELISA) and quantitative real time reverse transcription PCR (qRT-PCR) analysis. (2) Studiesin vitro: Mouse monocyte/macrophage RAW264.7 cels were cultured with different conditioned media: control group, nuclear factor receptor ligand кB (RANKL); icarin group, RANKL+icarin; titanium particle group, RANKL+titanium particles; titanium particle+icarrin group, RANKL+icarin+titanium particles. Titanium particles stimulated RAW264.7 cels were co-cultured with RANKL and icarin for 72 hours. Tumor necrosis factor-α and interleukin-1β at protein and mRNA levels in the supernatant were detected with ELISA analysis and qRT-PCR, respectively. RESULTS AND CONCLUSION: (1) Resultsin vivo: icarin treatment obviously decreased titanium particle-induced inflammatory cellinfiltration and made the thickness of periosteum thinner, down-regulated tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels. (2) Results in vitro: when RAW264.7 cels were stimulated with titanium particles for 72 hours, tumor necrosis factor-α and interleukin-1β expressions at protein and mRNA levels in culture media increased obviously; when icarin was administrated, tumor necrosis factor-α and interleukin-1βexpressions at protein and mRNA levels down-regulated significantly. These results suggest icarin can obviously suppress titanium particle-induced inflammatory reactionin vivo andin vitro.
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Objective To identify shortcomings in the current evaluation index system of medical quality. Methods The documentary analysis focused on the existing index system comprises the Hospital Management and Quality Evaluation Standards (2007) by China Hospital Association, Hospital Management Evaluation Guidelines (2005) by the Ministry of Health, and Implementation Rules of Hospital Management Evaluation Standards for Beijing (2007). JCI Accreditation Standards for Hospitals (edition 2) (2003), and New Hospital Accreditation Standards for Taiwan (2005, 2006) were referred to in the study. Results The shortcomings found include the weak operability of indexes, and the deficiency of evaluation indexes from the point of hospital visiting process by patients. Conclusion In view of the hospital visiting process of patients, add more indexes for patients' hospital visiting process,and quantize and highlight the operability of indexes, with summary and optimization of experiences in time by steps.
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A description of the positioning of public hospitals in China, and an exploration of such issues as their compensation mechanism, management system, and operation mechanism. The authors hold that it is imperative to maintain a reasonable balance of the government, society and individuals in their share of healthcare expenditure, prioritize funding recipients, and encourage medical cost payment based on disease diagnosis groupings; to precisely distinguish the ownership, operation right, decision right, and supervision right of public hospitals, for building an effective incentive and supervision mechanism; to further consolidate the president responsibility system and target responsibility system, build a flexible talent use system and distribution mechanism, build a better quality control mechanism, a strict expenditure and cost control mechanism, and a scientific talent development mechanism as well.
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The paper systematically elaborated the concept of corporate governance structure of public hospitals and theories in relation. In addition, it analyzed the status quo and problems existing in corporate governance structure of public hospitals in China, proposing the basic principles and the council model of corporate governance structure. The authors emphasized the following responsibilities and rights of the council, the president, and the board of supervisors in such a framework: 1) As the hospital's highest decision-maker, the council exercises the rights of ownership, playing a decisive role in hospital management; 2) the president is appointed and dismissed by the council, and authorized to run the hospital; 3) the supervisors are responsible for overseeing the council and senior management. In the end, this paper summarized the external environment required for building corporate governance structure of public hospitals.
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Widely accepted in other countries,DRG payment is also referred to in China now and then.The authors reviewed the status quo of medical payment in China,as well as the practices and studies of DRG payment overseas.Based on such studies,the paper probed into the feasibility of DRG application in China,in terms of policy environment,application demand,research basis and technical conditions.Proposed in the paper are ranges of application,possible roadblocks and countermeasures for the application in China,aiming to promote the research,application and use of the method in China.
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Thanks to the three decades of reform and opening up,hospitals in China have made tremendous achievements in their development,yet facing new ehallenges as well.to address these challenges,there is an urgent need for these hospitals to further their reform under the guideline of the scientific concept of development.This will help them strengthen their hospital culture,quality control,technology,human resources development,and their leadership,in order to achieve a better and faster growth,better serving the role to build a harmonious socialist society.
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OBJECTIVE To evaluate the hand hygiene compliance(HHC) in China.METHODS The field observation for hand hygiene compliance,the hand hygiene material and equipment were performed in parallel in 8 hospitals from Beijing,Shanghai and Guangzhou.RESULTS It was shown that the average hand hygiene compliance before contacting patient was 35.3%,much lower than the compliance after contacting patient(56.5%).The nurse′s HHC(39.3%) was the best among groups before contacting patient,but the physicians took the first place of HHC after contacting patient.The best discipline in HHC was gynecology and obstetrics departments,especially before contacting patient and after contacting other surface,comparatively the worst was the surgeons.Most of hospitals(83.3%) provided the unmedicated detergent for handwashing.The alcohol-based hand rub(ABHR) for hand disinfection was available(56%) in many hospitals,in contrast the HHC with ABHR was quite low(14.2%).CONCLUSIONS These results indicated that the HHC is relatively low and improving adherence to hand hygiene practice is a multidisciplinary and systematic approach in China.It might be essential for promoting the HHC of health care workers,especially the physicians and surgeons,to strengthen the education and enlarge the continuous investment for some hard-ware improvement.
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AIM: To examine the effect of compound salvae-dropping-pill (CSDP) on intracellular free calcium in cultured rat myocardial cells subjected to hypoxia and reoxygenation.METHODS: The Fluo- 3/AM was applied to probe intracellular calcium concentration and the fluorescent intensity was detected using laser confocal microscopy technique.RESULTS: Fluorescent intensity in hypoxia plus CSDP group was significantly lower (1 217 78?312 07) than that of hypoxia group (1 509?508 48), and the Fluorescent intensity of hypoxia/reoxygenation plus CSDP group was also markedly lower (1 567.91?577 61) than that of hypoxia/reoxygenation group (1 617.60?477.53).CONCLUSION: The cultured rat myocardial cells could be effectively protected by administration of CSDP in case of hypoxia and reoxygenation through decreasing the intracellular calcium concentration. [
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AIM: The experiment was designed to study the effect of compound Danshen dripping pills (DSDP) on myocardium with anoxin/reoxygenation. METHODS: The myocardial anoxin/reoxygenation model was made in perfused isolated rat heart. DSDP and isosorbide dinitrate (ID) were given at the time of pre-perfusion and reperfusion, then HPLC and H-600 electron microscope were used to detect the change of high energy phosphate and the ultrastructure of myocardial cell. RESULTS: ① The contents of AMP, ADP, ATP and AN in myocardium in only anoxin/reoxygenation group were obviously lower than those in the control group (P0.05). ③ In the groups with ID, the contents of AMP, ADP, ATP and AN were distinctively lower than those in the control group (P
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Objective To explore advanced and effective methods of medical quality control. Methods A perspective method, together with literature summary, process analysis, statistics and computer network techniques, was employed. Results A model of real time control of medical quality via element management, process management, and monitored control management was set up; methods of real time control of quality and expenses for disease entities in hospitals were defined; the effect of clinical paths on real time control of the quality of hospitalization was ascertained; and ways of real time control of the quality of medical records were determined. Conclusion Real time control of medical quality is a new, effective way of monitoring medical quality.
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It is imperative to do a good job of the following four tasks so as to promote the building of the hospital via ethics and the progress of its culture level. The first task is to strengthen ideals and convictions and tamp the ideological basis. It is important to implant ideals and convictions, enhance the awareness of the "military spirit" and pay special attention to the "official ethics" of leading cadres. The second task is to enhance the advancement of medical ethics and raise the level of professional morality. It is important to strengthen medical ethics education, amplify rules and regulations and intensify supervision and control. The third task is to take patient care as the core of medical work and deepen quality service. It is important to strive for continuous quality improvement, bring in innovations in medical services and increase input in hardware. The fourth task is to consolidate the cultural building of the hospital and give full play to the edifying role of culture. It is important to optimize the environment of cultural building through upholding the "spirit of the General Hospital" and conducting a variety of cultural activities.
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In recent years, the issue of liabilities in state-owned medical institutions in China has come to the attention of departments at different levels and has become one of the top concerns of various government departments and hospital administrators. Defining the appropriate scope of liabilities ratio for hospitals has become an urgent task in ensuring their unconventional and sustainable development from a high starting point and at a fast pace. On the basis of relevant financial theories and in light of the current situation of the domestic medical market and characteristics of state-owned hospitals, the paper makes a case study of the liabilities ratio of hospitals in a certain region so as to explore the appropriate scope of liabilities ratio and the scale of liabilities for hospitals.
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Objective To explore an advanced and effective method of hospital cost management so as to improve the effectiveness of hospital economic management. Methods A variety of methods were used, including field research, expert consultation, activity-based costing management, business process reengineering, and satisfaction survey combined with statistics and computer network technology. Results A system for implementing activity-based costing was established and remarkable results were achieved in lowering the cost of patient care, optimizing business process, raising the staff's awareness of cost, and assisting in development decision-making. Conclusion Activity-based costing, an advanced method of cost management, is of great significance to Chinese hospitals in reducing operational cost, optimizing work process, and improving the effectiveness of management.
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As part of the activities of the year of hospital management, the Ministry of Health recently issued A Guide to the Assessment of Hospital Management (provisional) so as to help the health administrative departments at various levels reinforce hospital management, assess hospitals in a scientific, objective and accurate manner, promote the inteusional construction of the hospitals, and constantly improve the level of hospital management. The author reviews the implementation process of hospital assessment in China and the historical background of the issuing of the Guide, discusses its guiding ideology, main goals, formulation principles, key content, and chief features, and explains and analyzes the key issues and major assessment content. The author gives a brief account of his understanding of the Guide for discussion and references to others.
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Objective To find out the classification of diseases contracted by patients of the emergency department.Methods A retrospective investigation and analysis was made of the medical records of 82 598 emergency cases in our hospital. Results Injury and poisoning, respiratory disease, and disease of digestive system were the first three kinds of disease treated by the emergency department; male emergency cases outnumbered female ones; the volume and visiting hours of emergency cases in a typical day take the shape of humps, with 19 to 21 hours being the climax; the ages of emergency cases averaged 41.5, with patients of the age group running from 19 to 35 being the largest in number in 16 kinds of disease. Conclusion ①It is imperative to determine the priorities of technology construction and the orientation of talent cultivation in the emergency department according to the disease spectrum of emergency cases. ②It is necessary to attach importance to the education of males in health, safely and precautions. ③It is essential to fully recognize the great significance that enhancement of the expertise of the emergency department carries with regard to the health of the population. ④It is important to rationally plan work in accordance with the rush hours of emergency cases's visits.
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With Chinas accession to the WTO, implementation of the intellectual property agreement, exemptions and reductions of tariff and cancellation of non tariff barriers, and execution of the general agreement on services and trades will exert a widespread impact on the domestic medical market. Reform of the medical and health system will become extremely urgent; competition in the market of medical services will grow increasingly fierce; management of human resources will find itself in a dilemma; and supervision and control of the medical market will turn more difficult. A thorough study of the opportunities and challenges confronting the medical industry after Chinas WTO entry will, therefore, contribute to a better understanding of the reality and adequate preparation for the challenges. It is imperative to establish the idea of lifelong learning, to always remember that "development is a golden principle"; to set up the commanding elevation of talents in the 21 st century; to speed up innovations in medical technology; and to construct a modern hospital management system.