目的 研究美国国立卫生院脑卒中量表（NIHSS）评分、格拉斯哥昏迷评分（GCS）及指数记分法（BI）量表，预测脑梗死患者发病3个月后二便障碍预后的有效性。 方法 采取队列研究，登记2010年9月－2011年10月入院的脑梗死患者性别、年龄、婚姻、民族、职业，由脑卒中护士全面评定NIHSS评分、GCS评分、BI量表等指标。3个月后回访患者二便障碍恢复情况。 结果 分析显示NIHSS评分、GCS评分分值与脑梗死发病后3个月二便障碍恢复相关，BI量表评分分值与脑梗死发病后3个月二便障碍恢复无关。 结论 NIHSS评分、GCS评分分值可以预测脑梗死患者二便障碍恢复情况及预后情况，具有预测有效性。
Abstract： Objective To validate the value of Cleveland Clinical Score to predict acute renal failure（ARF） requiring renal replacement therapy （RRT） and in-hospital death in Chinese adult patients after cardiac surgery. Methods A retrospective analysis was conducted for all the patients who underwent cardiac surgery from January 2005 to December 2009 in Renji Hospital of School of Medicine, Shanghai Jiaotong University. A total of 2 153 adult patients, 1 267 males and 886 females，were included. Their age ranged from 18 to 99 years with an average age of 58.70 years. Cleveland Clinical Score was used to predict ARF after cardiac surgery. ARF was defined as the need for RRT. Based on Cleveland Clinical Score, the patients were divided into four risk categories of increasing severity：0 to 2 point（n=979）, 3 to 5 point （n=1 116）, 6 to 8 point（n=54）, 9 to 13 point（n=4）. The rates of ARF, multiple organ system failure （MOSF）, and mortality were compared among the 4 categories. The predictive accuracy of postoperative ARF and hospital mortality was assessed by area under the receiver operating characteristic curve （AUC-ROC）. Results In the four categories, the rate of postoperative ARF was 0.92%, 1.88%, 12.96%, and 25.00%, respectively； MOSF rate was 1.23%, 1.88%, 3.70%, and 25.00%, respectively; mortality was 0.92%, 4.21%, 25.93%, and 50.00%, respectively. There was significant dif ference among the four categories in ARF rate （χ2=55.635, P=0.000），MOSF rate（χ2=16.080, P=0.001）, and mortality （χ2=71.470, P=0.000）. The AUC-ROC for Cleveland Clinical Score predicting ARF rate and hospital mortality was 0.775 （95%CI 0.713 to 0.837, P=0.000）and 0.764（95%CI, 0.711 to 0.817, P=0.000）, respectively. Conclusion Cleveland Clinical Score can accurately predict postoperative ARF and hospital mortality in a large, unselected Chinese cohort of adult patients after cardiac surgery. It can be used to provide evidence for effective preventive measures for patients at high risk of postoperative ARF.
Objective To study the USA government’s administrative system about medical device standards as well as the standard making. Methods The relevant documents, regulations, website that USA Food and Drug Administration announced were extensively reviewed, knowing the USA medical device standards synthetically. Results The USA standards system of medical device included regulatory requirements and voluntary consensus standards. This article simply introduced the laws, regulations, performance standards and consensus standards. Conclusion The USA’s administrative system about medical device standards as well as many standards can be referenced.
The development and application of health decision support system (HDSS) in clinical service and health management is efficient in controlling health expenditure rising from overlapped examinations, and in reducing medical errors rising from insufficient decision-making support tools. Typical HDSS in America includes CPOE, MYCIN, QMR, NEDSS etc., which are mainly used in disease diagnosis and treatment, public health emergency management, hospital management, and health insurance management. The successful experiences accumulated in the development of the US health decision support system are worth referring to, such as, integration of management system, decision-makers and ICT, meeting the urgent needs of clinical service and health management, effective E-health construction, and rational development pathway from clinical decision support system to health management decision support system.
Objective To summarize and analyze the working experience of hospital performance evaluation and reporting system in America, so as to provide decision support to China on such work as establishing objective, scientific and effective hospital performance evaluation system, strengthening government’s supervision to health service, and promoting hospitals’ sound development.Methods American official websites and databases were searched to include relative policies, reports and documents on hospitals’ performance evaluation. Results Typical hospital performance evaluation and reporting system in America included National Healthcare Quality Report (NHQR), Consumer Assessment of Healthcare Providers and System (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS), Leapfrog Group Evaluation System and Thomson Reuters 100 Top Hospitals. Conclusion The enlightenments of American performance performance evaluation systems to China include: a) more attention should be paid to performance evaluation; b) combined evaluation models and results application methods should be considered; c) comparatively scientific evaluation methods and comprehensive evaluation contents should be established.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.
【摘要】 目的 对脑梗死患者施行静脉溶栓治疗前后的相关状况和指标进行评价分析。 方法 2003年1月-2010年11月对神经内科收治的29例脑梗死患者予以静脉溶栓治疗及护理，并就治疗前后各相关时间点血压监测及美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评分情况进行分析。 结果 溶栓前后血压对比显示:溶栓后2 h收缩压相对于溶栓前和溶栓后24 h升高（Plt;0.05）；溶栓前后NIHSS评分差异有统计学意义（Plt;0.05）。 结论 溶栓后患者收缩压出现升高，护理上应该加强血压监控，为临床治疗提供支持。【Abstract】 Objective To investigate the correlated condition and clinical index changes before and after the intravenous thrombolysis of the cerebral infarction patients. Methods The blood pressure and the National Institutes of Health stroke scale (NIHSS) score of 29 cerebral infarction patients with the intravenous thrombolysis treatment between January 2003 and November 2010 were measured and analyzed. Results Two hours after the thrombolysis, the systolic blood pressure significantly increased compared with those before the intravenous thrombolysis and 24 hours after intravenous thrombolysis （P＜0.05）. NIHSS score was significantly decreased after the thrombolysis （P＜0.05）. Conclusions Systolic blood pressure significantly increases after the intravenous thrombolysis. Intensive blood pressure monitoring and controlling may be beneficial to the treatment and prognosis.