Construction and application of critical care system based on regional coordination

Journal Article Accepted manuscript Successful pregnancy conception in a young hypertensive woman after screening for secondary hypertension and treating its cause Get access Chen Zhang, Chen Zhang People's Hospital of Henan University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China https://orcid.org/0009-0006-9772-3206 Search for other works by this author on: Oxford Academic PubMed Google Scholar Man Helian, Man Helian Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 4500003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Huiyun Qu, Huiyun Qu People's Hospital of Henan University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Huiyu Du, Huiyu Du People's Hospital of Zhengzhou University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Zhilan Liu, Zhilan Liu Henan University of Chinese Medicine, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Jie Chen, Jie Chen People's Hospital of Henan University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Qi Huang, Qi Huang People's Hospital of Zhengzhou University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Linya Guo, Linya Guo People's Hospital of Zhengzhou University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Bing Nie, Bing Nie People's Hospital of Henan University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Search for other works by this author on: Oxford Academic PubMed Google Scholar Min Liu Min Liu People's Hospital of Henan University, Department of Hypertension, Henan Provincial People's Hospital, Zhengzhou 450003, China Corresponding author: Min Liu, MD. Department of Hypertension, Henan Provincial People's Hospital; Zhengzhou, China. Tel: 86-13353800006; Fax: 0371-65580605; E-mail: liumin136@126.com Search for other works by this author on: Oxford Academic PubMed Google Scholar American Journal of Hypertension, hpad053, https://doi.org/10.1093/ajh/hpad053 Published: 26 May 2023 Article history Received: 05 May 2023 Published: 26 May 2023

With the development of society and economy, the disease spectrum of Chinese residents has undergone a major change, and the public health emergencies have occasionally occurred. The new situation has put forward higher requirements on the emergency capacity, professional technical level and treatment quality of critical care treatment system. Combining with the advantages of hospital aviation, ground and Internet emergency, Henan Provincial People's Hospital established a new construction path of emergency and critical care treatment system, namely "trinity" rescue system of aviation, ground and Internet emergency treatment and the "five-ring" model of critical care treatment system in hospital. The purpose of this paper is to summarize the practical experience of the construction of emergency and critical care system in Henan Provincial People's Hospital, so as to provide reference for the management of emergency and critical care in China.

Dystrophic Epidermolysis Bullosa Pruriginosa: Successfully Treated With Dupilumab.

Objective: To evaluate the performances of a "ready-to-use" liquid chromogenic medium for detecting toxigenic strains of C. difficile from stool specimens, by comparing with the reference method of combined GeneXpert detection with MALDI-TOF MS identification. Methods: This study was a clinical application research. A total of 322 stool specimens from patients with diarrhea in Henan Provincial People's Hospital were detected by using this liquid chromogenic mediumor by combination of GeneXpert and MALDI-TOF MS identification after CCFA culture from March to November 2017. The reference method was combined GeneXpert detection with MALDI-TOF MS identification. Data were analyzed with kappa analysis by use of SPSS 13.0. In this study, the limit of detection and anti-interference capability of chromogenic medium were determined with standard strains. Results: This assay had a sensitivity of 92.86% (52/56), a specificity of 96.99% (258/266), a positive predictive value of 86.67% (52/60), and a negative predictive value of 98.47% (258/262). Furthermore, this assay was well consistent with the reference method (kappa=0.874, P<0.01). The limit of detection of this assay was 10(3) CFU/ml for toxigenic strain of ATCC9689, and there was no interference by non-toxigenic strain of ATCC43593 or Clostridium perfringens (ATCC13124) even.When the concentration of ATCC9689 was as low as 0.5 McFarland. Conclusions: It is worth expanding clinical research for this "ready-to-use" chromogenic medium and preparing for its popularization in primary medical institutions, due to its similar performance to the reference method for detecting toxigenic strains of C. difficile, simple operation and no need of anaerobic condition.

Critical care medicine has developed rapidly and has become an indispensable comprehensive subject in clinical medicine at home and abroad. In recent years, the government has vigorously implemented the "Healthy China" strategy and strived to achieve a higher level of national health. The Henan Provincial People's Hospital has set up a network of interconnected "Wisdom Critical Care Medicine Specialist League" to meet the major strategic needs of the country, and to play a role in attracting large hospitals to promote the sinking of quality medical resources and the improvement of grassroots service capabilities. Complementary advantages and resource sharing are conducive to achieve win-win cooperation and coordinated development between the third-grade class-A hospital and grassroots hospitals.

Objective To investigate the types of common chronic diseases and common drugs in the elderly visiting primary medical institutions in China. Methods Cluster sampling was adopted in eight provinces/cities/autonomous region of Zhejiang, Jilin, Henan, Shanghai, Chongqing, Gansu, Guangxi and Jiangsu.Sampling sites were selected and information was collected through the online reporting system of common diseases and drug costs of the elderly in primary hospitals at all levels in China.On these grounds, the basic situation of primary medical institutions, the common chronic diseases and common drugs for people aged 65 years and above were investigated. Results Primary hypertension(65.7% or 46/70)and arthropathy(10.0% or 7/70)were the most common chronic diseases in the elderly visiting primary medical institutions.The consultation rate of primary hypertension was highest both in rural areas(58.3%, i.e.the ratio of 21 over 36 primary medical institutions)and in urban areas(73.5%, i.e.the ratio of 25 over 34 primary medical institutions). The primary medical institutions with consultation rates of hypercholesterolemia/hyperlipidemia(χ2=5.137, P=0.023), diabetes(χ2=3.868, P=0.049)and dyspepsia(Fisher's exact test, P=0.026)as the top 3 chronic diseases were more often seen in urban areas than in rural areas, while the primary medical institutions with consultation rates of cerebrovascular diseases as the top 3 chronic diseases were more often seen in the rural areas than in urban areas(χ2=9.974, P=0.002). More primary medical institutions with consultation rates of benign prostatic hyperplasia and primary osteoporosis as the top 10 chronic diseases were found in urban areas than in rural areas(χ2=4.054 and 3.861, P=0.044 and 0.049, respectively), while more primary medical institutions with consultation rates of heart failure as the top 10 chronic diseases were found in rural areas than in urban areas(χ2=3.865, P=0.049). Aspirin, nifedipine and simvastatin one by one were most commonly used in people aged 65 years and over in primary medical institutions. Conclusions Primary hypertension is the most common chronic disease among the elderly visiting primary medical institutions in both rural and urban.Common chronic diseases in primary medical institutions are different between the urban and rural areas.Regional differences and urban-rural differences should be taken into account in drug preparation.There are some irregularities in the use of drugs and insufficient stocks of essential drugs in basic-level medical institutions. Key words: Primary medical institutions; Essential drugs; Chronic disease

Objective To forecast the number of healthcare professionals at China′s primary medical institutions from 2016 to 2020, so as to provide the healthcare authorities with references for optimizing healthcare human resource allocation. Methods The Gray model was used to predict numbers of healthcare professionals in China from 2016 to 2020 on the base of health technicians data from 2010 to 2015. Results The forecast results showed that the number of healthcare professionals may be increased to about 600 000 people a year from 2015 to 2020.The number of healthcare professionals at China′s primary medical institutions was expected to grow about 204 000 people a year, and general practitioner may be increased to about 22 000 people a year.The annual growth rates of medical(assistant)practitioners, medical practitioners, registered nurses, pharmaceutical personnel and examiners in China were expected to be 3.20%, 2.81%, 6.88%, 1.53% and 2.16% respectively.The annual average growth rates of postgraduates, undergraduates and junior college graduates were expected to be 16.95%, 12.08% and 5.46% respectively. Conclusions In the future, the requirements for healthcare professionals at primary institutions will still be higher than demand in China, with a gap to be filled and their professional makeup and academic title to be optimized.Therefore greater efforts are required for their development to enhance their competence and professionalism, with reasonable staffing of the human resources. Key words: Health manpower; Primary medical institutions; Personnel administration; Gray model; Forecast

The important manifestation of social civilization proves to meet the demands of patients for medical treatment to the greatest extent through promoting grass-roots medical reform, improving construction of grass-roots medical and health institutions and improving their service capabilities. Chongqing, the youngest municipality in China, has a population of 34.04 million, is also a typical city with a prominent urban-rural dual structure. Construction and development of service system in primary-level medical and health institutions is of great significance for improving health of people in Chongqing. This essay uses observation variables such as “community health service center”, “township health institution” and “village clinic” as it’s basis and puts its research objects on Chongqing Statistical Yearbook 2015-2018, the latest data from the National Bureau of Statistics and from Chongqing Municipal Health Commission Statistics Bulletin 2015-2018. Through statistical methods, collected and sorted data are imported into EXCEL table, and corresponding database is established. While statistical indicators include composition ratio, utilization rate, average and etc. and a descriptive statistical analysis is performed. Research and study are given on changes of observation variables of primary medical institutions in Chongqing from 2015 to 2018. It is found that: the number of primary medical institutions showed a downward trend as a whole; the proportion of patients seeking medical treatment through primary diagnosis and treatment was still relatively high; composition of observation variable in township and village level is unreasonable; and slow growth happens in the number of township first-level medical and health institutions and the number of beds. In view of problems found in the research, the essay puts forward some solutions to improve construction of service system of primary health institutions in Chongqing, namely, to invest more in basic construction of primary medical and health institutions, to guide medical graduates to work in primary medical institutions and to increase training and guidance of primary medical technicians. In this way, we can better promote the development of primary-level medical and health institutions in Chongqing and provide citizens with more and better medical services.

The original article unfortunately contained a mistake. The 3rd author's name should be Cuilian Zhang. In addition, the 4th affiliation should be updated to "Reproductive Medicine Center, Henan Provincial People's Hospital; People's Hospital of Zhengzhou University; Henan Provincial People's Hospital, School of Clinical Medicine, Henan University, Zhengzhou, Henan, China".

Efficacy and safety of efgartigimod in patients with neurological autoimmune diseases.

The use of 3 biomarkers - cystatin-C (Cys-C), retinol-binding protein (RBP), and ischemia-modified albumin (IMA) - for the clinical classification and outcome of coronary heart disease (CHD) has not been adequately evaluated. We explored the serum levels of these 3 markers and evaluated their diagnostic and prognostic values in patients with CHD. This retrospective case-control study, conducted between June 2017 and June 2018, included 201 patients with CHD hospitalized at the Henan Provincial People's Hospital and 127 healthy individuals from Henan Provincial People's Hospital as controls. Cys-C, RBP, IMA levels, and other laboratory parameters in the 2 groups were determined, and patient outcomes were analyzed. Cys-C, RBP, and IMA levels were higher in the case group than in the control group (P < .05). Logistic regression analysis confirmed that these 3 biomarkers were independent risk factors for CHD. Each indicator has clinical significance in the diagnosis and prognosis of CHD, with RBP being the most significant. The AUC value for CHD detection using a combination of the 3 indicators was 0.783, and the sensitivity and specificity values were 78% and 74.6%, respectively. Simultaneous detection of Cys-C, RBP, and IMA could be an optimal method for early diagnosis and prognosis of CHD.

ObjectiveChina has been attempting to control the patients’ choice of high-level medical institutions through series measures of first point of contact at primary medical institutions, but the outcome is considered...

The hierarchical diagnosis and treatment system is at the core of China's new round of medical reforms. We evaluated the operational efficiency of the hierarchical diagnosis and treatment system in primary medical and health institutions in Fujian Province. We used the data envelopment analysis algorithm to calculate 'input-output' data from 2016 to 2018 and established an index system. Regarding results for efficiency value, the implementation efficiency of Xiamen was 1.15, Fuzhou was 1.10, Zhangzhou was 1.09, Ningde was 1.06, Quanzhou was 0.98, Nanping was 0.96, Putian was 0.94, Longyan was 0.92, Sanming was 0.86, and Pingtan was 0.82. There were few and insufficient doctors providing services; in 2018, the number of practicing (assistant) doctors per 1000 permanent residents in primary medical institutions in Fujian was only 0.799. Outpatient and emergency service visits were increasing yearly; in Fujian, they increased by 8.39% from 2016 to 2018. From the incentive system of hierarchical diagnosis and treatment, the redundancy rate of each city was generally high, with only that of Nanping (3.28%) and Longyan (0.00%) being lower. In general, for the hierarchical medical system to succeed, we should start with innovative management policy and explore ways to adapt to local circumstances (such as population, economy, etc.).

BackgroundThe “gatekeepers” for residents’ health are their family doctors. The implementation of contracted services provided by family doctors is conducive to promoting hierarchical diagnosis and treatment and achieving the objective of providing residents comprehensive and full-cycle health services. Since its implementation in 2016, the contract service system for Chinese family doctors has yielded a number of results while also highlighting a number of issues that require further investigation. Consequently, the purpose of this study is to assess the impact of family doctors’ contracted services in a Chinese city from the perspective of demanders (i.e., contracted residents), identify the weak links, and then propose optimization strategies.MethodsIn this study, a city in Shandong Province, China was selected as the sample city. In January 2020, 1098 contracted residents (including 40.5% men and 59.5% women) from 18 primary medical institutions (including township health centers and community health centers) were selected for on-site investigation. Take the PCAT-AS(Adult Short) scale revised in Chinese as the research tool to understand the medical experience of contracted residents in primary medical institutions, and interview some family doctors and residents to obtain more in-depth information.ResultsAmong the four core dimensions of PCAT-AS, the score of Continuous was the highest (3.44 ± 0.58); The score of Coordinated was the lowest (3.08 ± 0.66); Among the three derived dimensions, the score of Family-centeredness was the highest (3.33 ± 0.65); The score of Culturally-competent was the lowest (2.93 ± 0.77). The types of contracting institutions, residents’ age, marital status, occupation, and whether chronic diseases are confirmed are the influencing factors of PCAT scores.ConclusionThe family doctors’ contracted services in the city has achieved certain results. At the same time, there are still some problems, such as difficult access to outpatient services during non-working hours, incomplete service items, an imperfect referral system, and inadequate utilization of traditional Chinese medicine services, it is recommended that the government continue to enhance and increase its investment in relevant policies and funds. Primary medical institutions should improve the compensation mechanism for family doctors and increase their work enthusiasm, improve and effectively implement the two-way referral system, gradually form an orderly hierarchical pattern of medical treatment, provide diversified health services in accordance with their own service capacity and the actual needs of residents, and improve the utilization rate of traditional Chinese medicine services in primary medical institutions.

Objective: This study evaluated the clinical and epidemiological characteristics of patients with confirmed coronavirus disease 2019 (COVID-19).Methods: This retrospective study evaluated 29 patients with confirmed COVID-19 infection admitted to Henan Provincial People's Hospital between January 27 and February 27, 2020, with follow-up until April 01, 2020.Results: The median age of the patients was 56 years. Nineteen (19/29; 65.5%) had underlying conditions including cardiovascular disease, digestive disease, or type 2 diabetes mellitus. Twenty-two (22/29; 76%) had close contact with acquaintances or family members who were confirmed or probable COVID-19 cases. Many patients had white blood cell counts with abnormal neutrophil and lymphocyte numbers, abnormal hemoglobin concentration, coagulation profiles, and blood biochemistry, and increased infection markers. Mottling and multiple ground-glass opacities were seen in X-ray images of 19 patients (19/29; 65.5%). Most patients (23/29; 79.8%) received supplemental oxygen therapy and antibiotics (23/29; 79.8%) in addition to traditional Chinese medicines (26/29; 89.7%). The most frequent presenting symptoms were fever, cough, and sputum production. One patient, an 86-years-old woman with more than one underlying disease, died during follow-up. Patients with severe disease were significantly older and more likely to have been transferred from other healthcare facilities than those with mild disease. Anemia, decreased activated partial thromboplastin time, calcium, and albumin, and increased D-dimer and interleukin-6 were more frequent in severe disease. Need of oxygen therapy, mechanical ventilation, intravascular immunoglobulin, and duration of antibiotic therapy were increased in those with severe disease.Conclusions: Significant differences in demographical and clinical characteristics were observed in patients with moderate and severe COVID-19.