Objective By comparing the medical complaints and disputes between the two tertiary general hospitals in Beijing and Lhasa, this paper proposed on how to build a harmonious doctor-patient relationship.Methods A study of annual reports of these two hospitals analyzed descriptively patient complaint rate, rate of medical disputes registered for court jurisdiction, makeup of medical disputes, and their solutions.Results In 2016, the patient complaint rate, and rate of medical disputes registered for court jurisdiction were 3.5/10 000 and 12.4/10 000 respectively, much higher than 0.8/10 000 and 1.1/10 000 of the Lhasa counterpart hospital.A significant gap was also found in the makeup of medical disputes, their solutions, and role of hospital leadership between the two hospitals.Conclusions Beijing is recommended to appoint hospital leader on duty, to assist in handling medical complaints and disputes, and ease doctor-patient contradictions.Lhasa is recommended to improve the medical dispute handling mechanism, improve medical service competency and management.

Objective Through the comparative study,we discovered the keys to medical service quality control,and identified science evidences of strengthening hospital's quality of care and enhancing its quality control in general.Methods The paper applied the KPIs for general hospitals' medical service quality in evaluating five general hospitals in 2009.Results The research found problems in each hospital respectively in their efficiency,business performance and quality.Conclusion The hospitals must pinpoint their own setbacks in quality control before their quality of care is enhance.

Objective By systematically analyzing the past literature on medical quality evaluation and the principles of selecting indicators and establishing the evaluate system in comprehensive hospitals in China,we offered valuable references for the establishment of the indicator system for evaluating medical quality.Methods According to the requirements of systematic analysis,we searched all the literatures published in the past decades within CNKI and analyzed them in accord with the inclusive criteria.Results It established 13 items medical quality key evaluation indications including the bed utilization ratio,the average hospitalization days of patients,the yearly average rate of in-patient cares per doctor,the turnover of beds,the degree of nursing effect,the success rate in rescuing critically ill patients,the incidence of nosocomial infections,the curing and improvement rate,the accordant diagnostic rate,the eligibility of basic nursing,the satisfactory ratio of patients,the income per capita,the ratio of drug income in the total revenues,the average medical expense per inpatient.Conclusion China's general hospitals already have in place their principles of KPI selection and their indicator systerm.The methodology to screen quality indicators has also taken shape.This study earmarked 13 key performance indicators for quality of care in its analysis,yet roadblocks still remain in building China' s KPIs for quality of care.

OBJECTIVETo determine whether Toll-like receptor 4 (TLR4) is involved in development of gut leakiness in alcoholic steatohepatitis using an in vivo animal model and an in vitro cell culture system.

METHODSMice were fed an alcohol (ethanol group, EtOH) or isocaloric liquid diet (control group, Ctrl). Successful establishment of the alcoholic steatohepatitis model was assessed at week 6 by measuring serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities and evaluating the liver pathology using hematoxylin and eosin (HandE) staining of liver tissues. Gut permeability was assessed by measuring serum endotoxin and urine lactulose/mannitol (L/M) levels and evaluating HandE-stained colon tissues. Intestinal and colon tissue expression levels of TLR4 were assessed by immunohistochemistry. Cultured Caco-2 cells were exposed to 25 - 400 mmol/L EtOH and changes in TLR4 were assessed by enzyme-linked immunoassay and in permeability were assessed by intracellular uptake of FD4.

RESULTSThe mice in the EtOH group had significantly higher levels of serum ALT (46.5 +/- 6.9 U/L vs. Ctrl: 30.9 +/- 4.4 U/L, P less than 0.01), serum AST (53.3 +/- 7.9 U/L vs. Ctrl: 29.3 +/- 3.8 U/L, P less than 0.01), serum endotoxin (0.33 +/- 0.05 Eu/L vs. Ctrl: 0.27 +/- 0.04 Eu/L, P less than 0.01), and urine L/M (2.59 +/- 0.44% vs. Ctrl: 2.17 +/- 0.31%, P less than 0.05). The mice in the EtOH group also had significantly higher expression levels of TLR4 in intestinal tissues (13.1 +/- 2.0 ng/ml vs. Ctrl: 7.4 +/- 1.2 ng/L, P less than 0.01) and in colonic tissues (18.5 +/- 2.7 ng/ml vs. Ctrl: 9.1 +/- 1.6 ng/ml, P less than 0.01). The intestinal histopathology of the two groups was not different. Immunohistochemical staining of colonic tissues showed brown particles distributed in the endochylema and membrane of the EtOH group, which was almost completely absent in the Ctrl group. EtOH treatment of Caco-2 cells led to a dose-dependent increase in TLR4 expression and in cellular permeability.

CONCLUSIONChronic alcohol exposure induced TLR4 expression and cellular permeability in gut tissues. Activation of TLR4 may be involved in development of gut leakiness in alcoholic liver disease.

Animals ; Disease Models, Animal ; Gastrointestinal Tract ; metabolism ; Liver Diseases, Alcoholic ; metabolism ; pathology ; Male ; Mice ; Mice, Inbred C57BL ; Toll-Like Receptor 4 ; metabolism

The quality of SCI papers is one of the objective indexes of evaluation on scientific and technological strength and research capabilities.This paper introduced a comprehensive management strategy to promote the publication of SCI papers with high impact factors,in terms of such dimensions ass research orientation,financial and technical support,personnel training,and scientific research management platform.The short and long term effects of the comprehensive management strategy system were analyzed using the SCI papers publication data and IF data from 201 1 to 2014 at the hospital,as a reference for building a scientific management system of SCI papers for the administrators.

Objective To understand the status quo of hierarchical diagnosis and treatment effect of medical alliance in Beijing and explore the influencing factors.Methods The convenience sampling method was used to select 26 vertical medical alliances,and the weighted TOPSIS method was used in combination with the index system established in the previous study to evaluate the effect of hierarchical diagnosis and treatment.The factors influencing the effect of hierarchical diagnosis and treatment in medical alliances were summarized through interviews with insiders,and the rank sum test was used to explore the factors influencing the effect of hierarchical diagnosis and treatment in medical alliances.Results The medical alliance B,A2 and A3 ranked high,and the implementation effect was relatively good in the four dimensions of"primary care first consultation,dual-way referral,acute and slow treatment,and vertical linkage";The C2,A8 and F2 medical alliances ranked low,and the implementation effect in the dimensions of"dual-way referral","acute and slow treatment"and"vertical linkage"was significantly lower than that of other medical alliances.The analysis results showed that the differences in the support intensity and core hospital level of different medical alliances were statistically significant(P＜0.05),which affected the hierarchical diagnosis and treatment effect of medical alliances.Conclusion While strengthening the information construction and improving the initiative of grassroots and the signing rate of family doctors,it is necessary to improve the support of core hospitals to promote the sinking of resources.Core hospitals should optimize resource allocation according to local conditions and promote hierarchical diagnosis and treatment.

OBJECTIVE: To study the clinical effect of Treatment of blow-out fracture of medial orbital wall with nasoseptal cartilage under nasal endoscope. METHOD: Under a nasal endoscope, the fracture and the prolapsed orbital contents were reduced to the orbit, and then an autogenous nasoseptal cartilage was grafted into the orbital defect. The variations in the visual acuity, diplopia, enophthalmos degree and eyeball position were detected preoperatively and postoperatively. RESULT: During the follow up of three months to four years after operation, all the 28 cases showed neither loss nor distinct descent of visual acuity. The postoperative mean enophthalmos degree (1.5 +/- 0.6) mm was lower than the preoperation one(3.6 +/- 1.1) mm (P<0.05). Diplopia disappeared completely of 25 cases during 3 month after operation,while it appeared in the primary position of 2 cases. The eye movement was normal of 26 cases after operation t, and the abduction was slightly limited of 2 cases, but which was better than be for). Any displacement of filling material, infection, rejection reaction were not found of all the 28 cases. CONCLUSION The medial orbital blow out fracture with nasal endoscope has many advantages, such as short operative route, clear surgical visual field, simple performance, light injury and no scars, and the effect of which will be really certain in the operative practice.
Adult ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasal Septum ; surgery ; Orbital Fractures ; surgery ; Treatment Outcome ; Young Adult

Objective:To evaluate the benefits and risks of advanced age patients with acute anterior circulation large vessel occlusive stroke (ALVOS) accepted mechanical thrombectomy (MT), and explore the related influencing factors for prognoses in these patients.Methods:Six hundred and eighty patients with acute anterior circulation ALVOS accepted MT in 3 comprehensive stroke centers from January 2014 to December 2020 were sequentially collected. (1) Patients were divided into advanced age group (≥80 years old) and non-advanced age group (<80 years old) according to age, and the differences between the two groups were compared in successful postoperative vascular recanalization rate, incidence of perioperative complications, and good prognosis rate (modified Rankin scale [mRS] scores≤2) and mortality 90 d after onset. (2) Patients were divided into good prognosis group (mRS scores≤2) and poor prognosis group (mRS scores>2) according to the prognoses 90 d after onset; univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the patients after MT. (3) According to the prognoses 90 d after onset, the advanced age patients were divided into good prognosis subgroup (mRS scores≤2) and poor prognosis subgroup (mRS scores>2). Univariate analysis and multivariate Logistic regression analysis were used to investigate the independent factors for prognoses of the elderly patients after MT.Results:(1) In these 680 patients, 92 patients (13.5%) were into the advanced age group and 588 patients (86.5%) were in the non-advanced age group; patients in the advanced age group had significantly lower successful recanalization rate (67.4% vs. 77.9%), significantly lower good prognosis rate 90 d after onset (20.7% vs. 50.2%), and statically higher mortality 90 d after onset (40.2% vs. 21.1%) as compared with the non-advanced age group ( P<0.05); however, there was no significant difference between the two groups in the incidences of symptomatic intracranial hemorrhage (sICH, 15.6% vs. 10.6%) and malignant cerebral edema (MCE, 12.2% vs. 17.6%, P>0.05). The baseline data of the advanced age and non-advanced age patients were further matched with propensity score matching analysis (1:1) and statistically analyzed: the 91 elderly patients had significantly lower good prognosis rate 90 d after onset (20.9% vs. 36.3%) and MCE incidence (12.4% vs. 33.3%) than the 91 non-elderly patients ( P<0.05); there was no significant differences in successful vascular recanalization rate (67.0% vs. 71.4%), sICH incidence (15.7% vs. 17.6%) or mortality 90 d after onset (39.6% vs. 37.4%) between the two groups ( P>0.05). (2) Among the 680 patients, 314 (46.2%) had good prognosis and 366 (53.8%) had poor prognosis. As compared with the good prognosis group, the poor prognosis group had significantly higher proportion of patients at advanced age, significantly lower proportion of male patients, significantly higher proportion of patients with hypertension, diabetes or atrial fibrillation, significantly lower baseline Alberta Stroke early CT (ASPECT) scores, significantly higher baseline National Institutes of Health Stroke Scale (NIHSS) scores, statistically higher proportion of patients with cardiogenic embolism, significantly lower incidence of tandem lesions, significantly shorter time from onset to sheathing, statistically higher proportion of internal carotid artery occlusion, significantly lower proportion of patients with grading 2 collateral circulation, and significantly lower proportion of successful vascular recanalization ( P<0.05). Advanced age ( OR=3.144, 95%CI: 1.675-5.900, P<0.001) was an independent factor for prognoses 90 d after MT, in addition to baseline ASPECT scores, baseline NIHSS scores, diabetes mellitus, successful recanalization, and collateral circulation grading. (3) In the advanced age group, there were 19 patients (20.7%) with good prognosis and 73 patients (79.3%) with poor prognosis. As compared with the good prognosis subgroup, the poor prognosis subgroup had significantly lower proportion of male patients, significantly lower proportion of patients with grading 2 collateral circulation or complete recanalization, and significantly higher baseline NIHSS scores ( P<0.05). Baseline NIHSS score ( OR=1.482, 95%CI: 1.187-1.850, P=0.001) was an independent factor for prognoses 90 d after MT in advanced age patients. Conclusion:Although advanced age is an independent risk factor for prognoses of patients with acute anterior circulation ALVOS accepted MT, there are still some advanced age patients benefiting from MT without increased complications, especially for those with low baseline NIHSS scores.