Research on Hospital Medical Crisis Management Based on 4R Theory: A Case Study of the Crisis Event in the Second Affiliated Hospital of Harbin Medical University

The hospital medical crisis management is the strategy adopted by hospitals for medical crisis.It aims to minimize the loss brought about by medical crisis to the hospital through management.By using 4R theory of crisis management and taking the incident of"sky-high medical expenses"happened in Second Affiliated Hospital of Harbin Medical University as an example,we study how to improve and perfect the medical crisis management strategy of hospitals in our country.As a result,we think hospitals can improve the crisis management strategy from four aspects of curtailment,preparation,reaction and resilience,so as to solve this issue appropriately,protect the legitimate rights and interests of patients to the greatest extent and promote the sustainable development of the hospital.

Numerical Investigation of an Idealized Total Cavopulmonary Connection Physiology Assisted by the Axial Blood Pump With and Without Diffuser

In order to improve the surgical treatment of the congenital heart disease patient with single ventricle defect,two axial flow blood pumps,one with diffuser and the other without diffuser,were designed and virtually implanted into an idealized total cavopulmonary connection(TCPC)model to form two types of Pump-TCPC physiological structure.Computational fluid dynamics(CFD)simulationswere performed to analyze the variations of the hemodynamic characteristics,such as flow field,wall shear stress(WSS),oscillatory shear index(OSI),relative residence time(RRT),between the two Pump-TCPC models.Numerical results indicate that the Pump-TCPC with diffuser has better flow field stability,less damage on endothelial cell of vessel wall,and lower risk of vascular injury and thrombosis formation than that without diffuser.

Effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction

Objective:To study the effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction.Methods: Patients with acute cerebral infarction who received thrombolytic therapy in Dongfang Hospital between May 2014 and October 2016 were retrospectively analyzed, and according to the different ways of thrombolysis, they were divided into rt-Pa group and UK group who accepted alteplase and urokinase thrombolysis respectively. Serum levels of nerve injury markers, nerve cytokines and inflammatory cytokines were detected before as well as 1 d and 7 d after thrombolytic therapy.Results:1 d and 7 d after thrombolysis, serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of both groups of patients were significantly lower than those before treatment while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those before treatment, and serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of rt-Pa group were significantly lower than those of UK group while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those of UK group. Conclusion: Alteplase thrombolysis for acute cerebral infarction can reduce nerve injury, improve neurotrophic state, and inhibit inflammatory response.

INFLUENCE OF ACUPUNCTURE ON INSULIN RESISTANCE IN PATIENTS WITH SIMPLE OBESITY

Objective To investigate clinical therapeutic effect and regulative function of acupuncture on insulin resistance in patients with simple obesity. Methods Acupuncture was applied at the eight points surrounding the umbilicus: bilateral Tianshu (天枢ST 25), Huaroumen (滑肉门ST 24) and Wailing (外陵ST 26), Yinjiao (阴交CV 7) and Shuifen (水分CV 9), and also Guanyuan (关元CV 4) and Zusanli (足三里ST 36), and the ear embedding method was used in combination in 50 cases of simple obesity. The changes in FBG, INS, ISI, TC, TG, LDL-C and HDL-C after the treatment were observed. The changes in waistline (WL) and hip circumference (HC), their ratio (WL/HC), body weight (BW) and body mass index (BMI) after the treatment were also observed, and the therapeutic effects were compared between the patients with obesity in Grade Ⅰ and Grade Ⅱ. The aforementioned values were compared with those in the control group comprised of 30 normal subjects. Results Hyperinsulinemia (HI) appeared in the patients with simple obesity, and the value of ISI was obviously decreased, compared with that in normal subjects ( P<0.01 ). After the treatment, the values of WL, HC, WL/HC, BW and BMI were all obviously decreases ( P<0.05 ), and those of FBG, INS, TC, TG and LDL-C also reduced ( P<0.01 ), but those of ISI and HDL-C obviously increased ( P<0.05 ). Conclusion Acupuncture can not only efficiently improve the parameters in body fat in the patients with simple obesity, but also regulate their abnormal lipid metabolism and improve the situation of insulin resistance.

Effect of the Wall Thickness of the Vessel on FFRCT of Carotid Artery Stenosis

Fractional flow reserve(FFR)computed from computed tomography angiography(CTA),i.e.,FFRCT has been used in the clinic as a noninvasive parameter for functional assessment of coronary artery stenosis.It has also been suggested to be used in the assessment of carotid artery stenosis.The wall thickness of the vessel is an important parameter when establishing a fluid-structure coupling model of carotid stenosis.This work studies the effect of the vessel wall thickness on hemodynamic parameters such as FFRCT in carotid stenosis.Models of carotid stenosis are established based on CTA image data using computer-aided design software.It is assumed that the vessel wall is a linear elastic and isotropic material,and the blood an incompressible Newtonian fluid.Under the pulsating flow condition,ANSYS Transient Structural and CFX are used to simulate the blood flow of fluid-structure coupling in the carotid stenosis model in order to obtain hemodynamic parameters and the corresponding FFRCT.The results show that when the elastic modulus of the vessel wall is fixed,FFRCT will decrease with the increase of the wall thickness.Similarly,FFRCT will decrease with the increase of the elastic modulus when the wall thickness is fixed.The difference in hemodynamic parameters such as FFRCT,however,is relatively small if the stiffness of the two models are close.The results demonstrate that the effect of the vessel wall thickness,especially for a model with small elastic modulus,should be taken into account in using FFRCT for functional assessment of carotid stenosis.Moreover,under the linear elasticity and isotropic material assumptions,the stiffness coefficient may replace the elastic modulus and wall thickness as a parameter reflecting material property of the vessel wall in the carotid stenosis model.

Traditional Chinese Medicine constitution among patients with allergic rhinitis and its correlation with anxiety and depression

OBJECTIVE:To preliminary investigate the distribution of Traditional Chinese Medicine(TCM)constitution among patients with allergic rhinitis(AR)and reveal the related factors with anxiety and depression.METHODS:Between July 2020 and June 2021,specialist doctor recruited AR patients in Beijing and Shanghai.A total of 630 patients admitted to participate in the survey,and 516(81.9%)(male 54.3%,female 45.7%)participants completed the questionnaires.Three scales including Constitution in Chinese Medicine Questionnaire(CCMQ),Generalized Anxiety Disorder Questionnaire(GAD-7)and The Patient Health Queationaire-9(PHQ-9)were applied.Theχ^(2)and the Fisher’s exact test were used to evaluate the classification data,multivariate logistic regression was used to explore the related factors of anxiety and depression.RESULTS:According to 516 AR patients,the most commonly first-constitution was Yang-deficiency(22.1%)and frequent of all constitutions was inherited-special(21.6%).One third of AR patients(33.5%)suffered from anxiety,nearly half of AR patients(46.5%)were found to be depressive.Inherited-special(27.7%)was the most common constitution in patients with anxiety whereas Yang-deficiency(26.7%)was most common constitution in patients with depression.Sex,duration of symptoms,balanced,Qi-deficiency,phlegm-dampness,Qi-stagnation,and inherited-special constitutions were related with anxiety;Sex,income,duration of symptoms,balanced,Qi-deficiency,Yang-deficiency,phlegm-dampness,Qi-stagnation,and inherited-special constitutions were related with depression.CONCLUSIONS:According to our study,the commonly constitution types of AR were Yang-deficiency and inherited-special.We found that the prevalence value of anxiety and depression were high.People with Qi-deficiency,phlegm-dampness,Qi-stagnation,and inherited-special constitutions were more likely to have mental problems than the others.Controlling these influential factors might be beneficial for clinical health management of AR patients,and the government should apply appropriate mental health treatment services to offer psychiatric support.