critical incidents are significant for the management of hospitals,and it may even be critical to the survival and development of the hospital.This article introduces a series of practices adopted by the First People's Hospital of Changzhou conducted in cases of crisis,and discusses the strategies and measures in hospital crisis management.

There are three kinds mainly of the present government worldwide management of public hospital management system and public service system.This paper compares the management system of public hospitals of the United States of America,Britain,Singapore and other countries,discussion of foreign public hospital public welfare system arrangement.With a view to put forward effective suggestions for the reform of public hospitals in China and public hospital regression public.

The compensation mechanism reform is the key and difficult point of the public hospital reform.Although current health care reform has been carried out including strengthening public welfare of public hospitals and adjusting the compensation mechanism,the effect is not very obvious.How to conduct the compensation mechanism reform orderly and smoothly has become an important topic.I have analyzed the historical evolution,the status and problems of the hospital compensation mechanism.On the basis I have made views and suggestions about the current drive and the path optimization for the compensation mechanism reform.

Objective To evaluate the efficacy of α2 adrenergic agonists for the prevention of postoperative adverse cardiac events in patients with coronary disease.Methods MEDLINE,EMBASE,CINHAL,Web of Science,CBM and CNKI were searched to identify all randomized controlled trials on the efficacy of α2 adrenergic agonists for the prevention of postoperative cardiac complications following operation performed under general anesthesia in patients with coronary artery disease.The incidence of myocardial ischemia,myocardial infarction,bradycardia and hypotension were evaluated.Meta-analysis was conducted using the RevMan 5.1 software.Results Fifteen trials included 9 high-quality trials,4 medium-quality trials and 2 low-quality trials.A total of 3422 patients were included in this meta-analysis.1790 patients received α2 adrenergic agonists (clonidine and dexmedetomidine) and 1632 patients received placebo; 724 patients underwent non-cardiac surgery and 2698 patients underwent cardiac surgery.Meta-analysis indicated that α2 adrenergic agonists reduced incidence of myocardial infarction following non-cardiac surgery and myocardial ischemia following non-cardiac surgery and cardiac surgery.Alpha-2 adrenergic agonists significantly increased the incidence of postoperative bradycardia.Conclusion Alpha-2 adrenergic agonists can decrease postoperative cardiac adverse events in patients with coronary disease,but can induce bradycardia,and the efficacy of clonidine is consistent with that of dexmedetomidine.

Objective To systematically review the myocardial protective effect of ischemic preconditioning in patients undergoing open heart surgery.Methods PubMed,EMBASE,Highwire,CENTREN and its affiliated clinical trial registration data center,CBM and CNKI were searched to identify all randomized controlled trials involving the myocardial protective effect of ischemic preconditioning in patients undergoing open heart surgery under general anesthesia.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included the incidences of postoperative cardiac death,myocardial infarction and ventricular arrhythmias and postoperative inotropic drug requirement.Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software.Results Twelve randomized controlled trials (8 high-quality trials and 4 medium-quality trials) involving 626 patients were included in our Meta-analysis.Meta-analysis indicated that ischemic proconditioning significantly reduced the incidence of postoperative ventricular arrhythmias and postoperative inotropic drug requirement (P ＜ 0.05) and had no effect on the incidences of postoperative cardiac death and myocardial infarction (P ＞ 0.05).Conclusion Ischemic preconditioning can reduce the postoperative ventricular arrhythmias and have no effect on postoperative cardiac death and myocardial infarction in patients undergoing open heart surgery.

Objective: To evaluate the effect of dietary fiber and phytic acid inositol hexaphosphate (IP6 or Insp6) on 1,2-dimethylhydrazine(DMH) induced colorectal carcinogenesis in Wistar rats. Methods: 86 four-week-old male Wistar rats were divided randomly into 6 groups and fed with either basal fiber free diet or the basal diet supplemented with 10% pectin, 10% cellulose, 2% Na-InsP6 supplemented water, 10% pectin in combination with 2% Na-InsP6 supplemented water, 10% cellulose in combination with 2% Na-InsP6 supplemented water. After four weeks, the rats were given a weekly injection of DMH (20mg/kg bw) for 20 weeks. The rats were killed after 26 weeks. The number of total macroscopically visible neoplasms was counted and the volume of individual neoplasmas was calculated. Proliferation cell nuclear antigen (PCNA) was analyzed. Results: There was no significant difference between the treatment group and the control group in the incidence of tumors. InsP6 significantly reduced the number of tumors in rats and tumor volume. Pectin and Pectin+InsP6 significantly increased the number of tumors in rats. The expression of proliferation marker PCNA was significantly down-regulated by InsP6 and significantly increased by pectin. Conclusion: A treatment regimen of 2% Na-InsP6 in drinking water was effective in significantly reducing the risk of colorectal cancer in Wistar rats. Diet supplemented with pectin could increase the risk of colorectal cancer.

Objective To investigate the value of prothrombotic state (PTS) in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.Methods One-hundred and twenty-eight ASA physical status Ⅰ or Ⅱ elderly patients (NYHA class Ⅰ or Ⅱ) of both sexes,aged 6575 yr,undergoing elective abdominal surgery,were enrolled in the study.Total intravenous anesthesia was performed during surgery.Venous blood samples were collected for detection of the levels of D-dimer,thrombus precursor protein and P-selectin (molecular markers of PTS).Detection of PTS was based on the three indexes mentioned above.The patients were divided into 2 groups according to the cardiac events occurred during surgery and within 3 days after surgery:non-cardiac event group and cardiac event group.The general data of patients and each index during surgery were recorded.Logistic regression analysis was used to pick out the potential risk factors for cardiac events.Results Twenty-nine patients developed cardiac events.There was no significant difference in age,obesity,ratio of diabetes,duration of operation,and ratio of PTS between non-cardiac event and cardiac event groups (P ＜ 0.05 or 0.01).Logistic regression analysis showed that old age,diabetes,prolonged duration of operation,and PTS were independent risk factors for cardiac events (P ＜ 0.01).Conclusion PTS produces some value in prediction of perioperative cardiac events in elderly patients with coronary heart disease undergoing noncardiac surgery.

BACKGROUND: Incidence rate of carcinoma of large intestine increases with the development of national living standard. Many epidemiologic surveys have showed that dietary factors have closely correlation with high risk of carcinoma of large intestine.OBJECTIVE: To observe the effect of dietary fiber and inositol hexaphosphate on the incidence of carcinoma of large intestine by establishing rat models with carcinoma of large intestine.DESIGN: Randomized block design.SETTING: Institute of Nutriology, Medical College, Qingdao University.MATERIALS: The experiment was performed at the Institute of Nutriology, Medical College, Qingdao University from March to December 2004.Totally 86 male Wistar rats of 4 weeks were randomly assigned based on body mass into cellulose group with 14 rats, pectin group with 14 rats, inositol hexaphosphate group with 15 rats, cellulose plus inositol hexaphosphate group with 14 rats, pectin plus inositol hexaphosphate group with 14rats and control group with 15 rats.METHODS: Basic feed without dietary fiber was given in the control group. 10% pectin was added in the pectin group. 10% cellulose was added in the cellulose group. 2% sodium phytate was added in the water of inositol hexaphosphate group. 10% pectin and 2% sodium phytate were added in the water of pectin plus inositol hexaphosphate group. 10% cellulose and 2% sodium phytate drinking water were added in the cellulose plus inositol hexaphosphate group. A total of 86 rats received 1,2-dimethylhydrazine (DMH) by subcutaneous injection to induce carcinoma of large intestine at week 4 after breeding. Incidence rate of large bowel neoplasm,number and volume of tumor were observed. Proliferating activity of large intestinal mucosa cells was determined (the ratio of number of positive cells of proliferating cell nuclear antigen to total count of nucleus).MAIN OUTCOME MEASURES: ①Incidence rate of large bowel neoplasm in each group, changes of mean number and mean volume of tumors of each rat, and ②proliferating activity of large intestinal mucosa cells of rats.RESULTS: ①Most of the rats in each group died during the 20-week trial. Oue rat died in the pectin group, the pectin plus inositol hexaphosphate group and the control group, respectively after 20 weeks. ②There was no significant difference in the incidence rate of large bowel neoplasm of rats compared with the control group (P ＞ 0.05), but the mean number and mean volume of tumors of each rat in the inositol hexaphosphate group were significantly lower than those in the control group [quantity: (1.1±0.2),(4.1±1.2)rats,P ＜ 0.01 ;volume: (176.1±65.5), (1 046.7±469.0)mm3,P ＜ 0.05], and the mean number of tumors of each rat in the pectin plus inositol hexaphosphate group was obviously higher than that in the control group [(7.5±1.9), (7.2±1.0) rats,P ＜ 0.05]. ③The proliferating activity of large intestinal mucosa cells in the inositol hexaphosphate group significantly decreased as compared with the control group. The proliferating activity of large intestinal mucosa cells in the pectin group increased as compared with the control group [(41.8±4.7)%, (83.6±2.9)%,(66.7±7.8)% ,P ＜ 0.01 and 0.05].CONCLUSION: It may increase the incidence rate of carcinoma of large intestine when pectin is added in diet, on the contrary, the rate decreases if inositol hexaphophate is added in the water.

Objective To invcstigate the effects of Maixiansan on insulin-like growth factor binding protein 7 (IGFBP7) and apoptosis in rats with ulcerative colitis related colorectal cancer.Methods The rat model of ulcerative colitis-related coloreetal cancer was induced by dextran sulfate sodium (DSS) and azoxymethane(AOM). 40 male SD rats [weight (160 ± 10) g] were randomly divided into 4 groups: model, Maixiansan and Meisalazine treatment as well as normal group peritoneally irjected with saline.The expression of IGFBP7 and apoptosis in coloreetal tissue were detected by real-time PCR and TUNEL after 16 weeks. Results The numbers of colorectal cancer in model group( 1.2 ± 0.4 ),in Maixiansan group ( 0.70 ± 0.15 ),in Meisalazine group ( 0.60 ± 0.16 )were higher than in normal control (P ＜ 0.05), but no differences were found among model,Maixiansan and Meisalazine groups(P＞0.05).The apoptosis in colonic mucosa for Meixiansan(8.70±3.47) group and Mesalazine group were enhanced as compared with that in model group( 1.20 ±0.26 vs.0.38±0.11,P＜0.05).The mRNA expression of IGFBP7 in colon for Meixiansan group were higher than those in model group,Meisalazine group,and normal control(50.5 ± 14.0 vs.18.0 ±3.9 and 39.3±11.4,46.4±6.0,P＜0.05). Conclusions Maixiansan may resist the occurrence and development of ulcerative colitis-related colorectal cancer through upregulating IGFBP7 expression of colorectal tissue and promoting apoptosis of tumor cell.

Objective To evaluate the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing coronary artery bypass grafting (CABG).Methods We searched PubMed,EMBASE,Highwire,CENTREN and its affiliated clinical trial registration data center,Chinese Biomedical Database,and CNKI from 2000 to 2010 for randomized controlled trials involving the efficacy of different doses of glucocorticoid for prevention of postoperative complications in patients undergoing CABG.The quality of the studies was evaluated by the method recommended by Cochrane Collaboration.Evaluation indexes included development of fibrillation,requirement for insulin treatment because of hyperglycosemia,infection,and death (during stay in hospital or within 30 days after discharge from hospital) after operation and mechanical ventilation time.Meta-analysis was conducted using the RevMan 5.1 software.Results Twenty-one randomized controlled trials involving 1737 patients were included in our meta-analysis.Different doses of glucocorticoid decreased the risk of fibrillation,and did not increase the risk of various causes-induced infection and death.Moderate and large doses of glucocorticoid increased the risk of requirement for insulin treatment because of hyperglucosemia.Large dose of glucocorticoid resulted in prolongation of ventilation time.Conclusion Different doses of glucocorticoid can decrease the development of postoperative fibrillation without increasing the risk of infection and death,moderate and large doses of glucocorticoid increase the risk of requirement for insulin treatment because of hyperglucosemia and large dose of glucocorticoid increases the risk of prolonged ventilation time in patients undergoing CABG.