Through reviewing the regulations on the right of emergency treatment of hospitals, we analyzed reasons of emergency treatment of hospitals, including uninformed patients and informed patients without consent in emergency situations, as well as the risk of emergency rescue of hospitals. We put forward how to consider the judgment of emergency situations, justification of emergency treatment of hospitals, and risk attribution. We suggested improving the related legislation and regulations, developing compulsory medical insurance and a medical rescue system on emergency treatment.
In order to standardize the suppliers’ behavior and ensure the healthy development of medical and health services, West China Hospital of Sichuan University deeply analyzed the suppliers’ thought, behavior, and result risk under the idea of Integrity Risk Prevention and Control, and explored the management mode of " dare not rot” " can’t rot” and " don’t want to rot” from the suppliers’ perspective. Several methods were adopted to guide and control suppliers’ behaviors in a standardized way, such as system formulation and publicity, signing the " incorruptible purchasing and saling contract”, supplier filing, " sunshine promotion”, whole-process evaluation, serious accountability, etc. This model can provide a reference for the construction of a new type of cooperation relationship between hospitals and medical enterprises under the new situation.
ObjectiveTo compare and analyze the expenses of inpatients before and after the implementation of the adjustment plan for " abolition of the addition of drug expenses” (also called zero-addition of drug costs) in Sichuan Province, in order to provide a certain reference for understanding the effect of this reform policy and further optimizing the formulation.MethodsFrom the hospital information management system, the data of inpatients with gastric cancer in a tertiary general hospital in Sichuan Province from January to September 2016 (before implementation) and from January to September 2017 (after implementation) were collected and compared. The change in hospitalization expenses of relevant patients before and after the implementation of the adjustment plan for canceling the addition of drug expenses was analyzed.ResultsA total of 2 878 patients were included in the survey; from January to September 2016,1 453 patients were included, and from January to September 2017, 1 425 patients were included. Before and after the implementation of the policy, the median hospitalization expenses of patients with gastric cancer decreased from 7 331.31 yuan to 7 145.12 yuan, with a decrease of 2.54%; the median expenses of medicines decreased from 4 839.79yuan to 4 246.10 yuan, with an decrease of 12.27%; the median expenses of check and inspections increased from 740.00 yuan to 859.00 yuan, with an increase of 16.08%; the median expenses of treatment increased from 251.00 yuan to 424.00 yuan, with an increase of 68.92%; compared with the total expenses and drug expenses before implementation, the total expenses and drug expenses after implementation decreased significantly, while material expenses, treatment expenses, check and inspection expenses and other expenses increased somewhat (P<0.05); differences in radiotherapy expenses and surgical treatment expenses before and after the implementation of the policy were not statistically significant (P>0.05).ConclusionsAfter the implementation of the policy of " abolition of drug expenses addiction”, the total expenses is slightly reduced for the expenses composition of patients with gastric cancer. Through the strengthening of the internal operation and management of the hospital, the government should continually optimize the public medical institution. At the same time, the government should put the compensation mechanism in place and continuously improve the payment method of medical insurance to ensure that the medical value of medical personnel is respected and the medical needs of ordinary people are guaranteed.
ObjectiveTo discuss the ways and effects of carrying out the publicity and education of Party style and clean governance in public hospitals through enterprise WeChat, aiming at improving the quality and efficiency of the publicity and education and forming an accurate and real-time pattern of discipline warning education.MethodsTaking the articles regarding the publicity and education of Party style and clean governance on the enterprise WeChat of West China Hospital of Sichuan University as the research object, the content analysis method was used to review the content from October 2017 to December 2018 and its publicity effect. The number of readers was shown in median (lower quartile, upper quartile) and the statistical analysis was done through rank sum test.ResultsFrom the content updated, medical staff read more about Internet hot spots and related clean governance news happened around them [M (QL, QU): 1 106 (691, 1 506)] than policy learning [301 (233, 408)] (P<0.05) and knowledge explanation [392 (457, 1 133)] (P<0.05). In terms of the methods of the update, medical staff read more about the update in traditional text and pictures [462 (312, 1 073)] than cartoon, video and other methods [230 (175, 315)] (P<0.05).ConclusionPaying attention to updated content, increasing the discussion function of the audience, choosing the time that the audience likes to update the article, and in the meantime, building the brand for the publicity and education of Party style and clean governance in the hospital may have a better effect on the education of Party style and clean governance toward Party members and medical staff in public hospitals.
Through analyzing the relevant regulations of organ transplantation in China, we identified the problems in the regulations of organ transplantation in China, including more strict limitation of the living organ donors resulting in a serious shortage of organ supply, difficulties in preventing the hidden organ trading, and opaque process of organ allocation resulting in unfair distribution. We also put forward the solutions to address above problems, including the improvement of organ transplantation regulations, establishment of the reimbursement mechanism for organ donation, rational mechanism of organ allocation and the brain death criteria, so as to promote more comprehensive sources of organ donation for the patients with end-stage organ failure.
This article introduces the information release and news reports related to the medical rescue in West China Hospital after Wenchuan earthquake, in terms of organization and management of internal and external propaganda, as well as how to organize and optimize volunteers’ involvement in news report. A total of more than 500 medias and over 2000 journalists have been received, 439 items of information have been released, 6675 photos covering 159 topics and 30-hour video records covering 100 topics have been collected. In addition, 5-hour video records and over 1000 photos have been provided to more than 20 medical teams or individual from other provinces.
ObjectiveTo investigate the effects of a self-powered conduit in different patients’ models who underwent extracardiac Fontan procedure.MethodsFour children who underwent extracardiac Fontan procedure in Shanghai Children's Medical Center from 2011 to 2017 year were selected. Venae cavae and pulmonary arteries were reconstructed using Mimics 19.0®. In silico, a venturi conduit was introduced to the anastomosis of venae cavae and pulmonary artery. Then computational fluid dynamics simulation was performed using patients’ clinical data.ResultsWhen inferior venae cavae were directly to or to the left of superior venae cavae, the venturi conduit could assist the return of venous blood and reduce the pressures of venae cavae about 0.5 mm Hg. And the pressure differences between venae cavae and pulmonary arteries were about –0.7 mm Hg, which suggested that the conduit could generate right ventricle-like effect.ConclusionThe venturi conduit can reduce the pressure of venae cavae, increase pulmonary circulation flow and improve Fontan hemodynamics.
ObjectivePulmonary vein banding was used to establish a piglet model of pulmonary vein stenosis. We investigated the pathomorphological alterations of pulmonary veins in the model and compared it with the vascular tissue of recurrent stenosis after total anomalous pulmonary venous connection (TAPVC).MethodsTen pigs of 6 weeks old were selected and randomly divided into 2 groups: 5 in a sham operation group and 5 in a pulmonary vein banding group. The operation had two stages, in which thoracotomies through intercostal space were done respectively on both sides. Biocompatible materials were applied around the pulmonary veins in the experimental group. The same method was used in the sham group. But the pulmonary veins were not banded. Six weeks after the operation, the pulmonary veins of the animals were harvested for hematoxylin-eosin staining and immunofluorescence staining to observe the pathological alterations of pulmonary veins. The proliferative tissues of patients with recurrent stenosis after TAPVC repair were collected and observed by hematoxylin-eosin staining and immunofluorescence staining.ResultsBoth the sham operation group and the pulmonary vein banding group survived. But the pulmonary vein banding group had obvious clinical manifestations of pulmonary venous stenosis. Compared with the sham group, the pulmonary vein banding group showed intimal hyperplasia, decreased expression of endothelial marker and increased expression of mesenchymal markers, and co-expression of endothelial and mesenchymal markers in intimal cells. Human pathology also showed intimal hyperplasia and co-expression of endothelial and mesenchymal markers in intimal cells.ConclusionThe surgical pulmonary vein stenosis in piglets shows intimal hyperplasia and myofibroblasts, which was consistent with clinical pathology.
ObjectiveTo analyze the outcomes of surgical repair for mixed total anomalous pulmonary venous connection (TAPVC).MethodsBetween 2006 and 2018, a total of 51 patients with mixed TAPVC underwent surgery in our hospital. Patients with such associated anomalies as single ventricle and tetralogy of Fallot were excluded. There were 35 males and 16 females with a median age of 102.0 (59.0, 181.0) days and a median weight of 5.0 (4.1, 6.4) kg. Patients were divided into three categories based on the anatomy: "3+1" pattern (n=38, three pulmonary veins drained at one site, and the other drained at the opposite site); "2+2" pattern (n=9, the pulmonary veins from each lung joined to form a confluence and drained at separate sites); bizarre pattern (n=4, the anatomy could not be classified into the above two patterns).ResultsThere was no in-hospital death. The median follow-up was 41.0 (18.0, 86.5) months. Postoperative pulmonary venous obstruction occurred in 10 patients. Kaplan-Meier survival curves showed no statistically significant difference in postoperative pulmonary venous obstruction among the three groups (P=0.239). Cox risk regression showed that preoperative pulmonary venous obstruction was significantly associated with postoperative pulmonary venous obstruction (P=0.024).ConclusionMixed TAPVC has various anatomic morphologies and requires individualized surgery.
ObjectiveTo compare the outcomes of sutureless technique and conventional technique in the surgical repair for infracardiac total anomalous pulmonary venous connection (TAPVC).MethodsThe clinical data of 46 consecutive patients with infracardiac TAPVC undergoing surgical repair in our hospital between June 2014 and April 2019 were retrospectively analyzed. Patients with combined congenital cardiac anomalies such as single ventricle and tetralogy of Fallot were excluded. Patients were divided into a conventional technique group and a sutureless technique group according to the surgical techniques. There were 35 patients in the conventional technique group, including 28 males (80.0%) and 7 females (20.0%) with a median age of 21 (8, 42) d and a median weight of 3.6 (3.0, 4.0) kg. There were 11 patients in the sutureless technique group, including 8 males (72.7%) and 3 females (27.3%) with a median age of 14 (6, 22) d and a median weight of 3.5 (2.9, 3.6) kg. The curative effect of the two groups was compared.ResultsThere were 5 deaths (10.9%) in the conventional technique group, including 4 in-hospital deaths (8.7%) and 1 late death (2.2%). Overall mortality of the conventional technique group (14.3%, 5/35) was higher than that of the sutureless technique group (0.0%, 0/11), although the difference was not statistically significant (P=0.317). Cox regression analysis showed that sex (P=0.042), age at repair (P=0.028), cardiopulmonary bypass time (P=0.007), aortic cross-clamping time (P=0.018) and duration of ventilation (P=0.042) were risk factors for postoperative mortality. The median follow-up was 18.00 (5.00, 37.75) months. Postoperative pulmonary venous obstruction occurred in 22 patients of the conventional technique group, which was significantly more than that of the sutureless technique group (P=0.000).ConclusionFor infracardiac TAPVC, sutureless technique can reduce the incidence of postoperative pulmonary venous obstruction compared with conventional technique.