1.Root cause analysis as used in China's hospital management: current research and application
Xiaoping XU ; Dongning DENG ; Dongge KE ; Jun XU ; Xiao CAI ; Yonghong GU ; Xinshi ZHANG ; Qianhui YU ; Zhiquan CHEN
Chinese Journal of Hospital Administration 2017;33(8):623-626
Objective To review the current research and application of root cause analysis (RCA) method in China's hospital management.Methods A retrospective analysis in six aspects was made by means of formulating a retrieval strategy and inclusion criteria, retrieval of databases, and literature review.Results The number of Chinese RCA researches was increasing year by year, mostly from researcher of the eastern coastal areas.These studies focused on the effects of RCA application outcomes and nursing safety.Tools in use were mainly fishbone diagram, brainstorming and 3-why method.72.24% of the root causes as found in literature were system factors, and 27.76% were human factors.Most of the researches made positive comments on RCA.Conclusions RCA is being warmly embraced by China's hospital management as it can positively change the accountability culture towards adverse events.Yet RCA has not been satisfactorily applied, and its future research and application in China's hospital management need more in-depth study and critical analysis.
2.Clinicopathological characteristics of aortic aneurysm in elderly patients.
Hua WANG ; Ke CHAI ; Fang FANG ; Yingying LI ; Dongge LIU ; Jiefu YANG
Chinese Journal of Cardiology 2015;43(12):1068-1072
OBJECTIVETo explore the prevalence and clinicopathological features of aortic aneurysm (AA) in elderly inpatients at autopsy.
METHODSAll the AA cases were retrospectively analyzed in 909 autopsy cases aged 60-100 years in our hospital. The pathological changes, comorbidities and death reasons were evaluated.
RESULTSAA was diagnosed pathologically in 59 patients (6.5%), clinical diagnosis was not made in 37(62.7%) cases. The AA prevalence in patients aged ≥ 80 years was significantly higher than patients <80 years (10.2% vs. 2.9%, χ(2)=19.97, P<0.01). Abdominal AA was more common (91.5%) and the prevalence of multiple AA was 20.3%. Coronary artery disease (CAD) was diagnosed in 44 AA patients (74.6%) including 21(35.6%) with severe coronary artery stenosis and 7(11.9%) with three-vessel disease, 31 patients (52.5%) died of cardiac-cerebral diseases, including 7(11.9%) with ruptured AA.
CONCLUSIONSThe prevalence of AA was high in elderly inpatients aged ≥80 years with a relatively high missed diagnosis rate. AA was often complicated with CAD. The main cause of death of AA patients was cardiac-cerebral diseases. The screening, evaluation and treatment of AA should be enhanced in elderly patients, especially in patients aged 80 years and over.
Aged ; Aged, 80 and over ; Aortic Aneurysm ; Aortic Rupture ; Autopsy ; Coronary Artery Disease ; Coronary Stenosis ; Humans ; Inpatients ; Middle Aged ; Prevalence ; Retrospective Studies
3. Pathological features at autopsy in elderly patients with acute myocardial infarction
Hua WANG ; Fang FANG ; Ke CHAI ; Yingying LI ; Yao LUO ; Dongge LIU ; Deping LIU ; Jiefu YANG
Chinese Journal of Cardiology 2017;45(7):591-596
Objective:
To analyze the cardiac pathological features of elderly coronary artery disease (CAD) patients (60 years and over) and evaluate the pathological features at autopsy and risk factors of patients with acute myocardial infarction (AMI).
Methods:
Data from 471 elderly patients (aged from 60 to 100 years old) with CAD confirmed by autopsy hospitalized in our hospital from April 1969 to October 2013 were retrospectively reviewed. Patients were divided into 2 groups: AMI group(
4. Pathological characteristics of the heart and coronary artery from elderly heart failure patients with preserved ejection fraction and coronary artery disease
Ke CHAI ; Hua WANG ; Yingying LI ; Yao LUO ; Fang FANG ; Dongge LIU ; Jiefu YANG
Chinese Journal of Cardiology 2017;45(8):710-715
Objective:
To analyze the pathological feathers of the heart in elderly (60-99 years old) heart failure patients with preserved ejection fraction (HFpEF) and coronary artery disease (CAD) and to explore the misdiagnosis and missed diagnosis rates.
Method:
This retrospective study included 154 HFpEF (left ventricular ejection fraction (LVEF)≥50%) cases and 49 heart failure with reduced ejection fraction (HFrEF) (LVEF≤40%) cases aged 60-99 years old out of 1 485 consecutive autopsy cases. Pathological changes of the heart and coronary artery were compared between patients with HFpEF and HFrEF. The misdiagnosis and missed diagnosis rates of HFpEF were analyzed based on pathological examination.
Results:
Patients with HFpEF were older than those with HFrEF ((85.7±7.4) vs. (82.9±7.8) years old,
5.Pathological characteristics of coronary artery disease in elderly patients aged 80 years and over.
Hua WANG ; Fang FANG ; Ke CHAI ; Yao LUO ; Bing LIU ; Dongge LIU ; Shu rong HE ; Deping LIU ; Jiefu YANG
Chinese Journal of Cardiology 2015;43(11):948-953
OBJECTIVETo define the pathological changes of coronary artery and compare the clinical diagnosis and pathological diagnosis differences in elderly patients aged 80 and over.
METHODSA total of 909 autopsy cases aged 60-100 years in our hospital from April 1st 1969 to October 31th 2013 were analyzed. The prevalence and pathological features of coronary artery disease (CAD) in cases aged 80 years and over were compared with those aged 60-79 years old. The misdiagnosis and missed diagnosis rate were calculated.
RESULTSThe prevalence of CAD by autopsy (63.8% (289/453) vs. 39.9% (182/456), P<0.01), old myocardial infarction (OMI) by autopsy (63.0% (182/289) vs. 51.6% (94/182), P<0.05) and chronic myocardial ischemia by autopsy (22.5% (65/289) vs. 7.1% (13/182), P<0.01) were significantly higher while the prevalence of acute myocardial infarction (AMI) by autopsy was significantly lower (22.1% (64/289) vs. 42.9% (78/182), P<0.01) in aged 80 and over group compared to 60-79 years old group. The misdiagnosis rate of CAD was 65.2% (107/164), the missed diagnosis rate of OMI was 62.1% (113/182) and the missed diagnosis rate of AMI was 37.5% (24/64) in the aged 80 and over group.
CONCLUSIONSThe prevalence of CAD and misdiagnosis and missed diagnosis rate are high in dead inpatients aged 80 years and over. OMI is more common but often missed in this group. Thus, the diagnosis and evaluation of CAD should be enhanced in this patient group.
Aged ; Aged, 80 and over ; Autopsy ; Coronary Artery Disease ; pathology ; Diagnostic Errors ; Humans ; Inpatients ; Middle Aged ; Myocardial Infarction ; Myocardial Ischemia ; Prevalence
6.Pathological changes of left ventricular myocardium in patients with calcified aortic stenosis and coronary artery disease
Yingying LI ; Ke CHAI ; Yao LUO ; Jiefu YANG ; Fang FANG ; Dongge LIU ; Hua WANG
Chinese Journal of Geriatrics 2018;37(3):245-249
Objective To characterize autopsy pathological changes of the coronary artery and left ventricular myocardium in elderly patients with moderate to severe calcified aortic stenosis,and to analyze the causes of death.Methods Seventeen cases of moderate to severe calcified aortic stenosis were identified from an autopsy database of Beijing Hospital containing 909 elderly patients(aged from 60-100 years)collected from April 1,1969 to October 31,2013.All cases were confirmed by autopsy and were analyzed retrospectively.The characteristics of coronary artery lesions,myocardial pathological changes and causes of death were summarized.Results Aortic stenosis was detected in 1.1%(2/190),1.9%(5/266),3.7%(11/297)and 6.4%(10/156)of patients in the 60-69,70-79,80-89 and 90-100 age groups,increasingly prevalent with age(x2=10.08,P=0.018).In addition,seventeencases were confirmed to have moderate to severe calcified aortic stenosis.Of these cases,13 (76.5%) had coronary artery disease and 5 (29.4 %)had severe coronary stenosis.The left anterior descending (LAD) artery was most commonly involved(47.0 %).No thrombus was found in the coronary arteries,and only one had chronic total occlusion(5.9 %).Myocardial infarction was confirmed in all 13 patients with coronary artery disease,including six cases(35.3%)of AMI,11 cases(64.7 %)of OMI and four cases (23.5 %)of AMI and OMI.Among AMI cases,transmural infarction was shown only in one case,with two cases of non-transmural infarction,two cases of subendocardial infarction and one case of focal myocardial infarction.Among OMI cases,transmural infarction was shown in one case,with two cases of non-transmural infarction,four cases of subendocardial infarction and four cases of focal myocardial infarction.The clinical misdiagnosis rate of OMI was as high as 81.8%.Patients died mainly from cardiovascular disease(70.6 %),with six cases (35.3 %) from myocardial infarction,three from heart failure(17.6%) and three from malignant arrhythmia (17.6 %).Six of the cases suffered from sudden cardiac death(35.3%)with biopsy-confirmed myocardial infarction changes.Conclusions The incidence of CAD in elderly patients with calcific aortic stenosis is high.Pathological changes of myocardial infarction,especially of subendocardial and focal infarction,occur in patients with moderate to severe aortic stenosis and coronary heart disease with a high clinical misdiagnosis rate.Aortic stenosis implicates both the valve and myocardium.Assessment of myocardial lesions in patients with calcific aortic stenosis should be carefully conducted in clinical practice.
7.Analysis of disease spectrum and causes of death among elderly patients aged 80 and over
Ni ZHANG ; Hua WANG ; Fang FANG ; Ke CHAI ; Yao LUO ; Bing LIU ; Dongge LIU ; Jiefu YANG
Chinese Journal of Geriatrics 2018;37(5):565-569
Objective To summarize the prevalence of diseases and main causes of death in elderly patients aged 80 and over,and to provide epidemiological evidence for preventive care of geriatric diseases.Methods A total of 922 autopsy cases aged from 60 to 106 at our hospital from April 1,1969 to October 31,2013 were analyzed.The disease spectrum and the main causes of death in cases aged 80 and over were compared with those in cases aged from 60 to 79.Results The top fifteen pathological diagnoscs in elderly patients aged 80 and over were chronic pyelonephritis(62.2 %,290 cases),coronary heart disease(59.2%,276 cases),bronchopneumonia(52.6%,245 cases),prostatic hyperplasia (58.1%,232/399),pleural effusion (47.9%,223 cases),malignant tumor (47.4 %,221 cases),chronic bronchitis(43.1 %,201 cases),pulmonary congestion or edema(42.1 %,196 cases),pericardial effusion (41.8 %,195 cases),old myocardial infarction (40.1 %,187 cases),emphysema (36.3%,169 cases),chronic cystitis (22.7%,106 cases),gallstones or cholecystitis (14.2%,66 cases),acute myocardial infarction (13.7%,64 cases),and gastrointestinal bleeding (12.4 %,58 cases).The leading causes of death were malignant tumor (47.4 %,221 cases),infectious disease(26.6%,124 cases)with pneumonia as the most prevalent type(24.0%,112 cases),and cardiovascular disease (myocardial infraction and heart failure) (24.7%,115 cases).Conclusions The most prevalent diseases in patients aged 80 and over are chronic pyelonephritis,coronary heart disease,bronchopneumonia,and malignant tumor.The top three causes of death in the aged are malignant tumor,cardiovascular disease.and pneumonia.Enhanced screening and management of the above diseases for inpatients aged 80 and over are recommended.
8.Interpretation of Guide to the Quality and Safety of Organs for Transplantation(6th edition): identification and referral of potential donors
Jianhui DONG ; Xuyang LIU ; Hongliang WANG ; Jixiang LIAO ; Dongge YANG ; Qingdong SU ; Haisheng LU ; Liugen LAN ; Haibin LI ; Ning WEN ; Ke QIN ; Xuyong SUN
Organ Transplantation 2020;11(3):395-
Organ shortage is one of the important factors restricting the development of human organ transplantation. The identification and referral of potential donors determine the total scale of organ donation. Whether potential donors can be identified and referred is the most important reason for the difference of organ donation rates in different regions. This paper interprets the chapter of the identification and referral of potential donors in the Guide to the Quality and Safety of Organs for Transplantation (6th edition) issued by European Union in order to provide reference for the staff of organ procurement organization and related medical personnel in China and improve the organ donation rate in China.
9.Clinical study of single kidney transplantation from young pediatric donors after death: 86 cases report
Xuyang LIU ; Xuyong SUN ; Jianhui DONG ; Ke QIN ; Haibin LI ; Song CAO ; Ying HUANG ; Meisi LI ; Liugen LAN ; Zhuangjiang LI ; Xiaocong KUANG ; Ning WEN ; Jixiang LIAO ; Zhao GAO ; Qingdong SU ; Dongge YANG
Chinese Journal of Organ Transplantation 2018;39(2):76-80
Objective By analyzing the perioperative management in our hospital to explore the clinical effect and safety of single kidney transplantation from deceased juveniles' donors.Methods We retrospectively analyze 86 cases of kidney transplantations from deceased juveniles' donors in our hospital from 2007 December to 2015 August.Results The success rate of the operations was 100%.The postoperative complications occurred as fellows:7 cases of acute rejection (8.14%);10 cases of drug intoxication (11.62%);21 cases of DGF (24.44%),4 cases of leakage of urine (4.65%),7 cases of lung infection (8.14%).Two cases (2.32%) died after the operation because of serious lung infection,and by corresponding treatment 47 cases recovered after 2-4 weeks.The creatinine level in 37 cases without any complications was 131.88 ± 44.20 μmol/L during discharge.Conclusion With strict selection,the organ from a deceased juvenile donor is safe and practicable.
10. Clinical and pathological characteristics of heart failure with preserved ejection fraction in advanced elderly patients
Ke CHAI ; Yingying LI ; Yao LUO ; Fang FANG ; Dongge LIU ; Hua WANG
Chinese Journal of Geriatrics 2019;38(9):962-966
Objective:
To analyze the clinical and pathological characteristics of heart failure with preserved ejection fraction(HFpEF)in advanced elderly patients.
Methods:
Systematic anatomical data from pathology database of Beijing Hospital from April 1969 to October 2013 were retrospectively analyzed.The 154 HFpEF patients aged(85.7±7.4)years with left ventricular ejection fractions(LVEF)≥50%, and 49 patients aged(82.8±7.8)years who had heart failure with reduced LVEF ≤40%(HFrEF)were included.Clinical feature and pathological changes of heart and other organs were compared between patients with HFpEF and HFrEF, and between groups aged less 80 years versus over 80 years in HFpEF patients.
Results:
The parameters were higher in HFpEF group versus in HFrEF group as follows: the average age of patients(85.7±7.4