目的 了解社区人群对脑卒中危险因素及症状的知晓现状。 方法 随机抽样调查1 208名居民及112名医务人员的人口学特征、对危险因素及预警信号的知晓现状及其影响因素、信息来源及需求情况。 结果 90.1%、100.0%的居民及医务人员可辨识高血压是卒中的危险因素，而社区居民及医务人员对年龄、糖尿病、吸烟等危险因素的认识比例分别为65.0% 和85.0%，且对危险因素的控制策略缺乏了解。87.4%、100.0%社区居民及医务人员将一侧肢体的活动障碍作为卒中的第一大预警信号，其次为头晕、步态不稳、头痛、言语困难、视物模糊。卒中知识得分的单因素及多因素分析示：大学文化、已婚且在职的居民及高学历的医务人员对卒中信息的了解程度高。卒中信息的获取途径依次为电视、社区医生/讲堂、报纸、杂志、网络。 结论 西部城市社区人群卒中知识知晓率低，开展针对低学历医务者的卒中培训及低学历、独居及退休人员的居民讲堂是改善现状的必要途径。同时也为政府建立有效的院前早期识别及快速转诊技术提供了依据。Objective To assess the baseline knowledge of risk factors and warning signs of cerebral apoplexy in communities. Methods A total of 1 208 inhabitants and 112 medical personnel were selected by systematic sampling. The questionnaire included social-demographic data, knowledge of cerebral apoplexy risk and warning signs and influencing factors, the sources and requirement of information about cerebral apoplexy. Results Hypertension was a risk factor in 90.1% of residents and 100.0% of medical personnel. Age, diabetes and smoking were identified as the risk factor in 65.0% of medical personnel and 85.0% of residents. Medical therapy of risk factors was insufficient. The most common warning signs of cerebral apoplexy was hemiplegia, the following were vertigo, ataxia, headache, aphasia and double vision. Stepwise multiple regression analyses showed that residents who had higher educational background, spousal, workers and community worker with higher educational background had higher knowledge scores of cerebral apoplexy. The main sources of information about cerebral apoplexy were television, doctors, newspaper, magazine and network. Conclusions At present, the urban community residents in west China are lacking in knowledge about cerebral apoplexy. Going forward, targeted educational residents and medical workers should be directed at those who was highly educated, living alone, and retired. It is also provide a theoretical basis for establishing a prehospital identification and transfer treatment system based on community in developing countries.
Objective To investigate the relationship between the tibia callus diameter ratio(CDR) and prognosis during tibial distraction and the occurrenceof late deformity or fracture. Methods We measured tibiallengthening callus diameter and added up the cases of angular deformity and fracture in 68 casesfrom January 1996 to December 2001, to calculated callus diameter ratios and compare the relationship between the tibia callus diameter during tibial distraction and the occurrence of late callus angular deformity or fracture. Results In 23 cases of CDRlt;80%, 13 cases had new bone fracture, 21 cases had angular deformity gt;5 degree. In 6 cases of 81%lt;CDRlt;85%, there were 4 cases of angular deformity gt;5 degree. In the other 39 cases of CDRgt;85%, there were no fracture and angular deformity. Conclusion When the CDR was gt;85%, there wereno angular deformity and fracture, but when the CDR was lt;80%, the complications of fracture and angular deformity occur. CDR is a better alarming index for preventing the complications occurring in tibial lengthening.
ObjectiveTo explore the current situation of financial toxicity (FT) of breast cancer patients undergoing daytime chemotherapy under the background of diagnosis intervention packet (DIP) and its influencing factors, and to build a risk early warning model.Methods Convenient sampling method was used to select breast cancer patients undergoing chemotherapy in the daytime ward of Tianjin Medical University Cancer Institute & Hospital between April and May 2022. The general data questionnaire and FT comprehensive score scale were used to investigate them, and the influencing factors of patients’ FT were discussed through single factor analysis and logistic regression analysis, and the risk early warning model was established. Hosmer-Lemeshow fitting effect test was used to evaluate the prediction effect of the model.Results A total of 278 patients were included. The median (lower quartile, upper quartile) of FT score was 14.00 (8.75, 23.00), of which 195 patients (70.14%) had FT score≤22; 83 patients (29.86%) had FT scores>22. Logistic regression analysis showed that age, per capita monthly income of families, commercial health insurance, chemotherapy cycle, tumor stage, neoadjuvant chemotherapy were the influencing factors for high-risk FT of breast cancer patients undergoing daytime chemotherapy. The results of Hosmer-Lemeshow goodness of fit test showed that the model-predicted FT of breast cancer patients undergoing daytime chemotherapy was in good agreement with the actual observation value (χ2=10.685, P=0.220). The area under the curve of the model was 0.931 [95% confidence interval (0.900, 0.962)], the sensitivity was 0.807, and the specificity was 0.913.Conclusions The FT of breast cancer patients undergoing daytime chemotherapy is at a high level. Older age, purchase of commercial health insurance, and high per capita monthly income of families are protective factors for high-risk FT. The wind with chemotherapy cycle≤4 weeks, tumor stage Ⅱ, neoadjuvant chemotherapy are high-risk FT risk factors. The final warning model has been tested to have a good prediction effect, which can provide a reference for clinical medical staff to identify high-risk FT patients early and make preventive strategies as soon as possible.
Objective To provide some theoretical reference and practical guidance for the medical risk management and early warning of private medical institutions, and to improve the service level and social reputation of private medical institutions. Methods China National Knowledge Infrastructure, Wanfang, VIP, and Web of Science database were searched for literature on medical risk management of private medical institutions published from the dates of establishment of databases to July 31, 2023. CiteSpace software was used for analysis. The aspects of literature number, literature source, author-institution cooperation, keyword co-occurrence, keyword clustering and burst were analyzed. Results A total of 2 635 literature were detected. Among them, there were 1446 articles in Chinese and 1189 articles in English. Although domestic research started late, it covered a wide range of disciplines and research fields. The Chinese literature showed a growth trend in the medium term, but the growth trend was slower than that of foreign literature. At the same time, the cooperation network of foreign authors and institutions was closer than that of domestic ones, and the overall development was relatively insufficient. There were differences between domestic and foreign research hotspots in terms of disciplines and research contents. Conclusions It is necessary to strengthen the theoretical and practical research on medical risk management of private medical institutions, and accelerate the construction of risk management and early warning models suitable for the characteristics of private medical institutions in China. In the future, the emerging research fields such as moral hazard, emergency and internal control need to be deepened and expanded.
Breast cancer is a malignant tumor with the highest morbidity and mortality in female in recent years, and it is a complex disease that affects human health. Studies have shown that dynamic network biomarkers (DNB) can effectively identify critical states at which complex diseases such as breast cancer change from a normal state to a disease state. However, the traditional DNB method requires data from multiple samples in the same disease state, which is usually unachievable in clinical diagnosis. This paper quantitatively analyzes the time series data of MCF-7 breast cancer cells and finds the DNB module of a single sample in the time series based on landscape DNB (L-DNB) method. Then, a comprehensive index is constructed to detect its early warning signals to determine the critical state of breast cancer cell differentiation. The results of this study may be of great significance for the prevention and early diagnosis of breast cancer. It is expected that this paper can provide references for the related research of breast cancer.
Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI，all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58±12 years，including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55±13 years，including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed：male gender （2 points），every 5 years older than 60 years （1 point），diabetes mellitus （2 points），preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker （1 point），every 10 ml / （min·1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml / （min·1.73m2） （1 point），preoperative NYHA class Ⅳ （3 points），cardiopulmonary bypass time＞120 minutes （2 points），intraoperative hypotension duration＞60 minutes （2 points），postoperative hypotension duration＞60 minutes （3 points），postoperative peak dosage of intravenous furosemide＞100 mg/day （3 points），postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points），and postoperative mechanical ventilation time＞24 hours （2 points）. The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic（ROC）curve of 0.738 with 95% CI 0.707 to 0.768，while it also presented a good calibration with Hosmer-Lemeshow statistic （P=0.305）. Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established，which may help clinicians implement early preventive interventions.
Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, and to provide evidence and recommendations for healthcare risk management policy in China. Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews, and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results (1) A total of 142 documents were included in this study. The United States had the most relevant documents (68). (2) The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses, and now includes all patient safety incidents. (3) The incidence-reporting systems can be grouped into two models: government-led and legal/regulatory/NGO-collaborative. (4) In two cases, reporting systems were established for specific incident types: One for death or serious injury events (the sentinel events database in Britain, SIRL), and one for healthcare-associated infections (NHSN in America). (5) Compared to the four countries, Taiwan’s system put more emphasis on public welfare, confidentiality, and information sharing. The contents of reporting there covered every aspect of risk management to create a more secure environment. Conclusion (1) Britain’s national reporting and learning system was representative of a government-led model; (2) The United States was the earliest country to have a reporting system, which included a limited range of incident types. Management of incidents became more reliable with increased application of laws, regulations, and guidances; (3) Both the Canadian and the Australian systems drew from the American experience and are still developing; (4) The Taiwanese system was comprehensive and is an instructional case.
目的 探讨改良早期预警评分系统（MEWS）在急诊抢救室的应用价值。 方法 对2012年4月－5月在急诊抢救室就诊的213例患者进行MEWS评分，分析不同分数段患者的分布特点，追踪患者入院后的去向、病情转归及收住专科病房和重症医学科（ICU/CCU）的时间。 结果 与MEWS得分≥5分的患者相比，MEWS得分＜5分者好转出院、转入专科病房的比例较高，转入ICU/CCU比例低，差异有统计学意义（P＜0.05）；不同MEWS评分段患者转入ICU/CCU的时间最短，其次是出院回家，转入专科病房的时间最长，但MEWS得分＜5分者与≥5分者出院、转入专科病房和ICU/CCU时间之间的差异无统计学意义（P＞0.05）。 结论 MEWS可以预测患者病情变化及严重程度，对医护人员及时采取救护措施、合理安排住院有一定的指导作用，值得推广应用。
Objective Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.