Evaluation of the provision and needs of the medical service of the Russian Federation for hospital beds

Taking into account the average statistical data of the last years the need of treated contingents for hospital beds constitutes 9.7%. Increase in accessibility of hospital treatment for the military pensioners and members of families as well as improvement of management of military hospital affairs will increase the index up to 9.9%. With transfer of military medical service to national standards and development of hospital-substitutive technologies the need for hospital beds will constitute 8.4%. The results obtained show that if all contingents attended to RF AF medical service would have the opportunity to treat only in the military medical institutions the reforming of military health should be aimed at maintenance and more effective use of hospital bed fund.     

某医院免费患者住院诊疗费用与效率分析

目的通过收集某医院2001～2007年该院为免费患者服务的工作效率及患者诊疗的费用报表数据，分析效率、费用变化趋势、费用消费的人群分布、费用结构，从中了解医疗费用增长的原因。方法用治愈、好转率、床位周转率、床位使用率、术前住院日、人均费用、日均费用、人均住院日、药费比等指标，使用秩和比排序分析7年的综合效率变化趋势。结果免费住院患者工作效率没有明显提高，但耗费却快速增长。按人群使用的金额分析，A组人群的花费占据首位。按费用结构显示，在各项费用中药品增长为最快。结论加强免费医疗费用管理，制定合理用药规范，逐步实施病种管理，改革服务评价内容，对于节约费用、提高效率具有重要意义。     

In-hospital morbidity and mortality after endovascular treatment of unruptured intracranial aneurysms in the United States, 1996-2000: effect of hospital and physician volume

BACKGROUND AND PURPOSE: Endovascular therapy is increasingly being used for the treatment of unruptured intracranial aneurysms. Our purpose was to determine the risk of adverse outcomes after contemporary endovascular treatment of unruptured intracranial aneurysms in the United States. Patient, treating physician, and hospital characteristics were tested as potential outcome predictors, with particular attention paid to volume of care. METHODS: We conducted a retrospective cohort study by using the Nationwide Inpatient Sample, 1996-2000. Multivariate logistic and ordinal regressions were used with end points of mortality, discharge other than to home, length of stay, and total hospital charges. RESULTS: Four hundred twenty-one patients underwent endovascular treatment at 81 hospitals. The in-hospital mortality rate was 1.7%, and 7.6% were discharged to institutions other than home. Analysis was adjusted for age, sex, race, primary payer, year of treatment, and four variables measuring acuity of treatment and medical comorbidity. Median annual number of unruptured aneurysms treated was nine per hospital and three per treating physician. Higher volume hospitals had fewer adverse outcomes; discharge other than to home occurred after 5.2% of operations at high volume hospitals (>23 admissions per year) compared with 17.6% at low volume hospitals (fewer than four admissions per year) (P<.001). Higher physician volume had a similar effect (0% versus 16.4%, P=.03). The mortality rate was lower at high volume hospitals (1.0% versus 3.7%) but not significantly so. At high volume hospitals, length of stay was shorter (P<.001) and total hospital charges were lower (P<.001). CONCLUSION: For patients with unruptured aneurysms treated in the United States from 1996 to 2000, endovascular treatment at high volume institutions or by high volume physicians was associated with significantly lower morbidity rates and modestly lower mortality rates. Length of stay was shorter and total hospital charges lower at high volume centers.     

Some aspects of outpatient care in the modem world

The problems of improvement of outpatient care are considered, methodology of more active implementation of hospitalization technologies, the use of day care, hospital at home is proposed. It is emphasized that the introduction of hospitalization technology makes it less than treatment in hospital costs to improve quality of life for huge numbers of patients.     

Efficient use of the hospital bed capacity

The development of rather precise methods for determining the efficiency of health service activity as well as the measures directed to maintain and to strengthen the population health is extremely difficult but very important task. However till now the problems of using the medical resources more effectively, the choice of well-founded criteria and indices, the ways with the help of which they are obtained and the methods of their assessment are studied not enough. The systemic analysis of efficiency of using the RF AF medical service hospital bed fund conducted in the State Institute for physicians' advanced training showed that its evaluation should be based on the analysis of three main parameters: the provision and need of the treated contingents for the hospital beds. It will allow to determine the correspondence of available bed capacity to the total number of contingents treated; the number of patients treated in hospitals taking into account the possibilities of the institution; the quality of the rendered medical care.     

Early sheath removal after coronary artery interventions with use of a suture-mediated closure device: clinical outcome and results of Doppler US evaluation

PURPOSE: To evaluate the safety and efficacy of a suture-mediated closure device by comparing clinical outcomes of its use to those of manual compression and by using Doppler ultrasound (US) examination. MATERIALS AND METHODS: One hundred patients were randomized to treatment with either suture-mediated closure (n = 50) or manual compression (n = 50) after percutaneous transluminal coronary angioplasty (PTCA). The 50 patients randomized to receive suture-based treatment were allowed to get out of bed 4 hours after the procedure, whereas bed rest was required for 1 day in the patients treated with manual compression. All patients underwent clinical and US examination before getting out of bed and before discharge from the hospital. RESULTS: Forty-seven of 50 patients randomized to undergo suture-mediated closure were ambulatory the day of intervention, in 6.2 hours +/- 4.7 (mean +/- SE) after undergoing PTCA. The results of the US examination for these patients demonstrated the absence of bleeding complications after getting out of bed. All patients treated with use of manual compression were ambulatory the following day, 18.3 hours +/- 2.2 after undergoing PTCA. There was no difference in the occurrence of vascular complications between the two groups. CONCLUSION: Suture-based closure is a safe and effective method of achieving immediate hemostasis and shorter bed rest without increasing the risk of bleeding complications in PTCA procedures.     

腹腔镜胆囊切除术的常见并发症胆漏

本文报告我院近8年腹腔镜胆囊切除术并发胆漏25例,发生率0.44％,其中胆囊管残端漏4例,占16％,副肝管或迷走胆管损伤漏3例(术中发现),占12％,LC同时胆道手术后吻合口或针眼漏6例,占24％,胆囊床毛细胆管渗漏或其它12例,占48％。渗漏多发生在胆囊床破坏后的病例中,故术中保护完整的胆囊床预防渗漏至关重要。     

Reverse transport of children from a tertiary pediatric hospital

INTRODUCTION: The purpose of this study was to determine the epidemiology and resources used and to study the potential savings of pediatric reverse transport patients. METHODS: A case control study was performed with patients undergoing a reverse or outbound transport from a large, pediatric hospital. Twenty-five children undergoing reverse transport were compared with matched controls. Lengths of stay and costs were compared between the reverse transport and matched control patients. RESULTS: Fifty-two percent of the reverse transport patients returned home, whereas 32% went home for end-of-life care and 16% went to other facilities. The average reverse transport was more than 400 miles and cost $6,064. The reverse transport of these patients did not save pediatric intensive care unit (PICU) days but did result in a shorter hospital stay compared with the matched controls (10 vs. 19 days, P = .03). Decreased utilization of bed days came from less use of intermediate care unit resources. CONCLUSIONS: Pediatric patients undergo reverse transports for a variety of reasons, often for end-of-life care. The ability to reverse transport pediatric patients may not save PICU bed days but may offer pediatric tertiary care hospitals a means to provide more intermediate care bed availability.     

皮肤原位再生医疗技术治疗残余创面疗效观察

目的:观察皮肤原位再生医疗技术在烧伤残余创面中的疗效,分析其应用价值.方法:对近10年来收住院的大面积深度烧伤后残余创面患者在翻身床上采用湿润烧伤膏油纱半暴露治疗,每日换药4次.结果:本组42例患者,41例均在3周内愈合,1例转家庭治疗,回访得知5周后愈合.结论:在翻身床上运用皮肤原位再生医疗技术治疗大面积深度烧伤残余创面效果显著,具有方法简单,费用低,疗效短,患者痛苦少,依从性高等优点.     

MEBO治疗多发性褥疮并感染一例报告

目的:通过对该例社区老年慢性病合并及并发全身多种疾病的综合治疗,总结MEBO良好的临床疗效.方法:根据病例特点进行综合治疗的同时,局部根据老年压迫性溃疡(褥疮)的特性,充分发挥MEBO的局部营养及活血化瘀、抗炎,增强局部血流作用,有效改善微循环,促进创面组织再生.结果:采取综合治疗和心理疏通,取得了预期疗效.经住院4周,肉芽组织新生至右股骨粗隆,骨外露全部被肉芽覆盖,创面缩小约14cm左右,后转家庭病床门诊换药治疗.结论:MEBO具有祛腐、抗炎、活血、生肌功用,对老年压迫性溃疡(褥疮)的治疗有较好的治疗效果.     

The Clinical Practice of Interventional Radiology: A European Perspective

The purpose of this study was to determine the current clinical environment in which interventional radiology (IR) is practiced throughout Europe. A survey, comprising 12 questions on IR clinical practice, was sent to 1800 CIRSE members. Members were asked to return one survey per department. Two hundred seventy-four departments returned completed questionnaires, 22% from the United Kingdom (n = 60), 11% from Germany (n = 30), 8% from Austria (n = 23), and the remainder spread over Europe. Experts, with more than 10 years of IR experience, comprised 74% of the survey group. Almost one-third of the radiologists dedicated more than 80% of their clinical sessions to IR alone (27%; n = 75), with two-thirds practicing in a university teaching hospital setting (66%; n = 179). Few institutions have dedicated IR inpatient hospital beds (17%; n = 46), however, to compensate, day case beds are available (31%), IR admitting rights are in place (64% overall, 86% for in-patients, and 89% for day cases), and elective IR admissions can be made through other clinicians (87%). IR outpatient clinics are run at 26% of departments, with an average of two sessions per week. Dedicated nurses staff the majority of IR suites (82%), but clinical junior doctors are lacking (46%). Hospital management’s refusing access to beds was the most commonly cited reason for not developing a clinical IR service (41%). In conclusion, there is marked variation across European centers in the current practice of IR. Half do not have dedicated junior doctors and only a small minority have inpatient hospital beds. If IR is to be maintained as a dedicated clinical specialty, these issues need to be addressed urgently.     

Experience of surgical hospitalshort-stay in multidisciplinary outpatient clinics

This article describes the experience of creation and the results of the two-year-old surgical hospital (short stay) capacity of 18 beds on the basis of multioutpatient clinics. Standards of examination and treatment of patients are shortly characterized. The information about 1544 patients treated, the structure made of surgical interventions and their outcomes.     

Photodynamic therapy can be safely performed with Talaporfin sodium as a day treatment for central-type early-stage lung cancer

Backgrounds/aimPhotodynamic therapy (PDT) with Talaporfin sodium (Talaporfin) is an effective and safe treatment for central-type early-stage lung cancer (CELC) that is associated with less skin photosensitivity. However, PDT is mostly performed in hospital for the purpose of light shading management in Japan. It is expected that it will be possible to perform PDT with Talaporfin (Talaporfin-PDT) as a day treatment with ≥14 days of shading management at home. This study aimed to confirm the safety of Talaporfin-PDT as day treatment.MethodsWe retrospectively investigated the occurrence of adverse events among consecutive patients who received PDT for CELC in a day treatment setting in the Respiratory Endoscopy Division of our institution between January 2010 and February 2020.ResultsA total of 12 patients (16 treatments) received day treatment of Talaporfin-PDT. Among the 12 patients, one patient (one treatment) was followed at another hospital. No severe adverse events after treatment were observed among the remaining 11 patients (15 treatments). Mild photosensitivity on a photosensitivity test was observed in 3 (3 treatments) of the 11 patients (15 treatments) but no major photosensitivity was observed. This photosensitivity was a temporary reaction.ConclusionTalaporfin-PDT for CELC was safely performed as a day treatment.     

老年髋关节置换术后对侧再骨折的危险因素分析和预防

目的探讨老年髋关节置换术后对侧再发骨折的危险因素并加以预防。方法对2008年1月~2011年1月行髋关节置换术的180例老年患者进行随访,其中24例3年内对侧髋部发生再次骨折。通过比较骨折组与未骨折组患者的性别、年龄、居住环境(农村/城市)、术后健侧髋部骨密度值、健侧股骨近端骨小梁类型(Singh)指数等一般情况以及髋关节置换术后总住院时间、出院后日均卧床时间、有无合并内科疾病和抗骨质疏松治疗情况,归纳再发骨折的危险因素。结果两组患者在性别、年龄方面差异无统计学意义(P年龄=0.084,P性别=0.068),但骨折组患者中农村户口所占比例明显高于未骨折组,差异有统计学意义(P=0.012)。骨折组平均住院时间与出院后日均卧床时间明显长于未骨折组,差异有统计学意义(P平均住院时间=0.024,P出院后日均卧床时间=0.028)。骨折组患者健侧Singh指数低于Ⅲ级的比例以及出院后未规律进行抗骨质疏松治疗的比例明显高于未骨折组,差异有统计学意义(PSingh指数=0.010,P抗骨质疏松治疗=0.015);经Logistic单因素回归分析,农村患者、住院时间及出院后日均卧床时间长、骨密度低、Singh指数低、未规律行抗骨质疏松治疗以及合并内科疾病的患者对侧髋部再发骨折的风险较高。结论对于髋关节置换术后的老年患者,健侧髋部骨密度值偏低、Singh指数低于Ⅲ级、卧床时间长、合并内科疾病以及抗骨质疏松治疗不佳均为对侧再发骨折的危险因素,因此应于第一次术后积极治疗合并内科疾病,行抗骨质疏松治疗并及早进行功能训练,以避免健侧再发骨折。     

基于中国创伤救治培训(主任版)首期学员的创伤救治现状调查

目的通过对参加"中国创伤救治培训--主任版(China Trauma Care Training-Leader,CTCT~?-L)"课程的学员进行问卷调查与课前、课后测试,对学员所在医院创伤救治现状与条件进行分析。方法 2019年4月18-19日参加CTCT~?-L首期培训学员40人作为研究对象,通过调查问卷了解来自不同地区学员的一般信息(性别、职称、职务、科室),所在医院的创伤救治情况(创伤中心建设及影响因素、创伤救治模式、严重创伤患者收治学科、创伤复苏室的条件及CT室/DSA室空间布局、创伤小组的启动与协调、院前院内联络方式、创伤数据库的设置与质控)。采用电子问卷测试的方式、相同的内容对学员进行课前、课后测试(测试内容主要围绕严重创伤救治的流程设置),通过学员反馈以评价课程的培训效果。结果 (1)14人(35.0%)院前、院内联系的方式主要为120平台发布信息;(2)31人(77.5%)所在医院目前的创伤模式主要为"急诊+会诊+分诊";34人(85.0%)院内有创伤小组;(3)27人(67.5%)推荐严重创伤组织协调学科主要为急诊科;(4)33人(82.5%)具备创伤复苏单元;37人(92.5%)具备24h增强CT条件;34人(85.0%)具备24h DSA检查与止血条件;(5)18人(45.0%)在复苏单元内可开展床旁手术;(6)18人(45.0%)有创伤数据库;(7)34人(85.0%)目前已经启动创伤中心建设;(8)二级甲等医院的课前、课后成绩均较高;床位数为1 000~2 000张的医院课前测试成绩最高,床位数为2 000~3 000张的医院课后测试成绩最高;急诊/急诊外科课前测试成绩最高,急诊/急诊外科和创伤外科的课后测试成绩最高;教学医院学员的课前、课后成绩均较高。结论本次调查范围所涉及医院的创伤救治主要采取"急诊+会诊+分诊"的模式;学员所在医院的教学医院属性、医院等级以及床位数影响创伤救治的基础水平;医院对于创伤救治流程管理影响创伤救治的整体水平。CTCT~?-L作为创伤救治培训的高级课程,致力于统一创伤救治的理念,并有助于因地制宜地推动不同模式的创伤中心建设,最终不断提高创伤救治的整体水平。     

美宝湿润烧伤膏联合艾洛松乳膏治疗婴儿湿疹的疗效观察

目的 观察美宝湿润烧伤膏联合艾洛松乳膏与单独使用艾洛松乳膏治疗婴儿湿疹的疗效比较.方法 联合治疗组:白天外涂美宝湿润烧伤膏治疗3次,晚睡前外涂艾洛松乳膏治疗1次;艾洛松乳膏组:晚睡前外涂艾洛松乳膏1次,西组分别于用药7d后观察疗效.结果 联合组76例患儿,痊愈率80.3％,显效率17.1％,有效率2.6％,无效率0％.艾洛松乳膏组57例患儿,痊愈率43.9％,显效率28.1％,有效率12.3％,无效率15.8％.结论 美宝湿润烧伤膏联合艾洛松乳膏治疗婴儿湿疹的疗效优于单纯艾洛松乳膏.     

悬浮床治疗背臀部烧伤205例临床分析

目的观察流体悬浮床在治疗臀背部烧伤患者的临床效果。方法临床使用6张悬浮床治疗臀背部烧伤患者205例,其中包括中小面积烧伤患者,创面简单清创后仰卧于悬浮床上。结果<50%TBSA患者全部治愈,>50%死亡8例,均因脓毒症、肺部感染等导致多器官功能障碍综合征死亡。背臀部创面结痂时间为伤后1～4 d,创面愈合时间缩短,浅Ⅱ度为(9±2)d,深Ⅱ度为(14±2)d,Ⅲ度创面焦痂完整,无明显溶痂现象。结论 卧悬浮床可以使创面愈合加速,减少感染及各种并发症发生,减轻工作量,降低患者的住院成本,可以进一步推广应用到中小面积臀背部烧伤的患者。     

Intraoperative I-125 seed implantation for extensive recurrent head and neck carcinomas

From 1978 to 1988, 41 patients with extensive recurrent carcinomas of the head and neck were treated with surgical resection plus intraoperative iodine-125 seed implantation. Surgery was performed to resect the tumors and to expose the tumor beds for implantation. I-125 seeds were implanted intraoperatively, with a spacing of 0.75-1 cm between adjacent seeds, either into the soft tissue in the tumor bed or onto small patches of gelatin sponges to cover the bone, nerve, or blood vessel involved with disease. Reconstructive flaps were used in 18 patients. The average I-125 dose delivered by the implanted seeds was 8,263 cGy. The determinate 5-year actuarial survival rate for the entire group was 40%. The 5-year local disease control rate was 44%. Major complications were transient wound infection (32%), flap necrosis (24%), fistula formation (10%), and carotid blowout (5%). These results indicate that surgical resection plus I-125 seed implantation provides a potentially curative treatment for patients with extensive recurrent head and neck carcinomas that would be considered traditionally unresectable and that would be treated only with palliative therapy.     

腹腔镜下与经腹子宫肌瘤核除术的临床对比分析

目的：观察分别用腹腔镜与经腹子宫肌瘤核除术治疗妇科子宫肌瘤的临床疗效,并比较两者差异。方法选择2014年1月～2015年6月收治的80例子宫肌瘤患者作为研究对象,按照随机数字表法将研究对象分为实验组和对照组,每组各40例,实验组患者实施腹腔镜下子宫肌瘤核除术,对照组患者实施经腹子宫肌瘤核除术,对两组患者手术情况及术后情况进行对比分析。结果对照组患者的手术时间、术中出血量及住院时间分别为（76.5±13.5）min、（104.1±2.4）L、（10.5±3.2）d,实验组患者的手术时间、术中出血量和住院时间分别为（70.5±10.5）min、（76.1±2.1）L、（6.2±2）d,与对照组相比,实验组患者的手术时间、术中出血量及住院时间均明显减少。对照组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为18（45％）、19（47.5％）、（31±13）h、（4.3±2.1）d,实验组患者的发热情况、镇痛药物应用、肛门排气时间及下床时间分别为14（35％）、5（12.5％）,（21±6）h、（2.7±0.5）d,实验组的发热情况、镇痛药物应用、肛门排气时间及下床时间等均优于对照组。结论与经腹子宫肌瘤剔除术相比,应用腹腔镜进行子宫肌瘤核除术具有手术时间短、出血量少、发热概率低、恢复快等优势,治疗子宫肌瘤安全有效,值得在临床推广应用。