Is Nationwide Special Campaign on Antibiotic Stewardship Program Effective on Ameliorating Irrational Antibiotic Use in China? Study on the Antibiotic Use of Specialized Hospitals in China in 2011–2012

Summary： With dwindling number of new antibiotics and inappropriate use of antibiotics, the emergence and spread of antibiotics resistance occurs commonly in healthcare institutions worldwide. In China, antibiotics are commonly overprescribed and misused. This study is to assess the effect of the nationwide special campaign on antibiotic stewardship program （ASP） at specialized hospitals in China by investigating prescription information from 2011 to 2012. Data on the hospital consumption and prescription of systemic antibiotics were obtained from four specialized hospitals, including maternity, children＇s, stomatological and cancer hospitals. Systematic random sampling was used to select outpatient prescriptions and inpatient cases. A total of 105 specialized hospitals in 2011 and 121 specialized hospitals in 2012 were analysed. The defined daily doses （DDDs） per 100 inpatient days, the percentage of antibiotic use in outpatient prescriptions, and the percentage of antibiotic use in inpatient eases were used as measurements of antibiotic use. The overall antibiotic use density in the selected hospitals decreased between 2011 and 2012 from 39.37 to 26.54 DDD/100 inpatient days （P〈0.001）. The percentage of antibiotic use in outpatient prescriptions （range： 24.12%-18.71%, P=0.109） and inpatient cases （64.85%-60.10%, P=-0.006） also decreased within the two years. Significant changes were observed among regions and different hospitals within the two years. And antibiotic consumption was correlated with the type and size of specialized hospital in 2012, but not with the regions. This analysis of antibiotic consumption of specialized hospitals allows relevant comparisons for benchmarking and shows that national ASP has improved antibiotic rational use in China. The data will assist policymakers in formulating effective strategies to decrease antibiotic overuse and identify areas that require further work.

In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

Nosocomial Infection Surveillance in a Tuberculosis Specialized Hospital in China

Nosocomial infections（NIs） are a critical issue affecting the quality of healthcare. In this study, we performed a retrospective study to explore the incidence rates, mortality rates, and microbial spectrum of NIs in Beijing Chest Hospital, a tuberculosis（TB） specialized hospital in China. Our data demonstrate that the overall incidence rate of inpatients with NIs slightly decreased from 2012 to 2016, which may be associated with the implementation of hand hygiene measures, while the mortality rates associated with NI did not significantly change. In addition, the species distribution of NIs was quite different from that presented in previous reports, and Klebsiella pneumoniae was the most frequently isolated microorganism.

某三级甲等专科医院互联网医院发展的实践与思考

介绍复旦大学附属眼耳鼻喉科医院互联网医院建设历程和运营管理模式。该院互联网医院通过手机即可在线预约、挂号、支付,查看电子病历、检查检验结果、电子发票和药品配送情况等,实现就诊服务全流程移动化,大幅提升患者在线就诊体验。运营3年来,该院互联网医疗数据始终领先于上海各类医院,单科接诊量、周互联网服务量、年互联网服务量、周互联网处方量均保持全市第一。并从患者、医生和医院层面提出未来公立医院互联网医院持续稳定发展的建议和思考。

上海市二级公立专科医院与综合医院的经济运营差异

目的通过分析专科医院与综合医院在主要经济运营指标上的差异,揭示专科医院特殊功能定位下的经济运营特点,为科学评价专科医院经济运营情况提供参考。方法基于2019—2020年上海市101家二级公立医院经济运营数据,综合采用Kruskal-Wallis秩和检验、多重比较法分析专科医院、综合医院经济运营差异。结果二级公立专科医院与综合医院的经济运营指标存在显著差异,其中精神病医院、口腔医院与综合医院间差异最为明显。结论专科医院经济运营同专科医院功能定位存在较为明显的联动关系,与综合医院有较大差异,有必要通过分类评价、设置差异化评价标准等方式对专科医院实施差异化评价。

某研究型专科医院临床研究人才队伍建设的实践与探讨

目的以某三级甲等专科医院构建临床研究队伍为例,探索适合研究型专科医院临床研究队伍建设的有效方式。方法回顾性分析某三级甲等眼耳鼻喉专科医院临床研究队伍的建设工作,从设立临床研究队伍的背景、组建过程、取得的成效等总结经验、发现存在的问题并提出完善建议。结果医院为临床研究队伍提供了高水平的科研平台和保障措施,临床研究队伍的建设已初具规模。近年来,临床研究队伍在论文发表、基金申请、临床试验、专利项目等方面取得了明显进步,但在临床研究队伍的梯队建设、研究型医师与专职研究人员职称评定和绩效考核等方面还存在一些困境。结论临床研究队伍的建立健全有效地提升了医院的临床研究能力,为医药产业发展提供了强有力的支撑,在一定程度上可以为研究型专科医院的人才队伍建设提供参考。

Mid-term Outcomes of Primary Constrained Condylar Knee Arthroplasty for Severe Knee Deformity

This study aimed to examine the clinical and radiographic outcomes of primary total knee arthroplasy（TKA） with use of Nex Gen#174; Legacy#174; Constrained Condylar Knee（CCK） prosthesis for severe knee deformity. Clinical data of 46 patients（48 knees in total, aged 61 years on average） with severe knee deformity who underwent TKA with Nex Gen#174; Legacy#174; CCK prosthesis between December 2007 and February 2012 were retrospectively analyzed. There were 34 knees with severe valgus with incompetent medial collateral ligament, 11 knees with severe flexion contracture with inability to achieve knee balancing in flexion and extension by posterior soft tissue release, 2 knees with Charcot arthritis with severe varus and bone loss, and 1 with traumatic osteoarthritis with severe varus and ligamentous instability. The mean duration of follow-up was 71 months（range 40–90 months）. The New Knee Society scoring（NKSS） system and the Hospital for Special Surgery（HSS） score were used to evaluate the functional and clinical outcomes. Visual Analogue Scale（VAS） was used for pain measurement and Knee Society criteria for evaluation of radiological images. The results showed that, in the total 48 knees, 1 case of loosening due to short-stem tibial component at 3 months post-operatively underwent revision. The 6-year prosthesis survival rate in this cohort was 97.9%. There was no component infection occurring within 6 years. Significant post-operative improvements were found in NKSS and HSS scores. Patient satisfaction was significantly increased. Pain score was decreased significantly. Total functional score was improved from 31.46±11.43 to 86.42±8.87, range of motion（ROM） from 42.42°±23.57° to 95.31°±23.45° and the flexion contracture from 5.31°±7.87° to 0.92°±1.80°. Preoperative radiographic study showed excessive valgus（≥7°） in 37 knees, and varus deformity in 3 knees. Post-operative femorotibial alignment was valgus 3.88°±1.76° in 48 knees. Antero/posterior（A/P） view of X-ray films showed 4 radiolucent lines（RLL） in 48 tibial components. It was concluded that TKA with CCK is effective for the treatment of the severe unstable knee that cannot be balanced by soft tissue.