Objective To evaluate the effect of day surgery with diagnosis-related groups (DRG) evaluation indicators. Methods The inpatients undergoing surgery in Beijing Tongren Hospital of Capital Medical University between March and September 2022 were enrolled in this study. The medical quality, medical efficiency, hospitalization cost, DRG insurance payment and other DRD-related indicators were retrospectively collected and compared between day surgery patients and non-day surgery patients, and the average length of hospital stay and hospitalization costs were compared between the two surgery modes within DRGs. Chi-square test was used for enumeration data, and t-test and Mann-Whitney U test were used for measurement data. Results A total of 29339 day surgery patients and 19019 non-day surgery patients were enrolled. In the day surgery group, the proportions of local patients (71.71% vs. 68.62%), routine discharge (99.93% vs. 99.78%), and class A incisions (99.92% vs. 99.55%) were better than those in the non-day surgery group (P<0.05), and the average length of hospital stay [(1.00±0.00) vs. (6.98±5.00) d] and the average hospitalization costs [(7306.62±4605.73) vs. (24913.97±24623.54) yuan] were lower than those in the non-day surgery group (P<0.05). The top 2 reduction of average length of hospital stay were in the CB49 group and CB39 group, decreasing by 87.45% and 86.24%, respectively. The top 2 reduction of hospitalization costs were in the DC19 group and CC15 group, decreasing by 84.15% and 73.61%, respectively. DRG payment balance of medical insurance in the day surgery group was higher than that in the non-day surgery group (22.95% vs. 5.98%). Conclusions Day surgery not only ensure the medical quality, but also shorten the length of hospital stay and reduce the burden of medical expenses. Day surgery can effectively improve the utilization efficiency of hospital bed resources, it is an effective measure to promote the high quality development of hospital and comply with DRG payment reform.
Dyspnea is the most common symptom in patients with acute heart failure syndrome (AHFS), and relieving dyspnea is an important goal in clinical practice, clinical trials and new drug regulatory approval. However, in clinical and scientific research, there is still no consensus on how to evaluate dyspnea, and there is still a lack of unified measurement methods. This article introduces the pathophysiological mechanism of dyspnea in acute heart failure, the measuring time of dyspnea, the posture of patients during measurement, the measuring conditions, and the common measurement methods of dyspnea in clinical trials and their advantages and disadvantages, so as to provide references for the selection of measurement methods of dyspnea in clinical trials of acute heart failure.
Beijing Tongren Hospital of Capital Medical University (Beijing Tongren Hospital) is one of the earliest tertiary public hospitals to offer day surgery in China. Over the past decade, the proportion of day surgery has exceeded 60%. Beijing Tongren Hospital has restructured its medical resources according to the functional positioning of each division, establishing four types of day surgery centers or wards characterized by “platform” “discipline” “disease type” and “service” to meet patients’ diverse needs. At the same time, it ensures homogeneous services for patients through unified admission standards, pathway processes, and quality control indicators. This effectively balances the standardization and individualization of day surgery across different hospital districts, further enhancing the quality and efficiency of day surgical services. This article summarizes the management experience and effectiveness of day surgery at Beijing Tongren Hospital.
Objective To evaluate the feasibil ity and effectiveness of allograft osteochondral transplantation with arthroscopic assistance for osteochondritis dissecans (OCD) associated with large osteochondral defects. Methods From January 2004 to May 2007, 13 patients with OCD with large osteochondral defects were treated. There were 7 males and 6 females, aged 18-59 years with an average of 35.8 years. The locations were left side in 8 cases and right side in 5 cases. The disease course was 7 days to 20 years with the median duration of 42 months. Four cases had obvious sprained history. The involved locations were lateral portion of the medial femur condyle (MFC) in 5 cases, thochlea area of MFC in 2 cases and lateral femur condyle in 6 cases. The range of motion was (95.0 ± 13.5)° and the Lysholm score was 62.23 ± 7.79. According to International Cartilage Repair Society classification system and the Guhl classification of OCD under arthroscopy, all the patients were type IV. Defect areas were 3-7 cm2 with an average of 4.32 cm2. The depths of defects were 0.8-2.0 cm with an average of 1.55 cm. Allograft osteochondral transplantation combining with adsorbable screw was appl ied for the lesions. The patients were closely instructed to do exercise through following up. Results The wounds all healed by first intention Thirteen cases were followed up for 2.2 years (14 months to 4 years) after operation. Three months after operation, 2 cases had pain after continuous exercise for 1 hour, they were directed in the methods of functional exercise and to strengthen their quadriceps femoris. Medicine was given in 2 patients who had sign of friction feel ing of joint 6 months after operation. The range of motion at the last follow-up was (137.0 ± 9.8)°, showing statistically significant difference when compared with that before operation (P lt; 0.05). The X-rays and EMRI examinations at following-up indicated that bone healed well and articular facet was integrity. The Lysholm score was 92.08 ± 7.64 one year after operation, showing statistically significant difference when compared with that before operation (P lt; 0.05). Conclusion Allograft osteochondral transplantation with arthroscopic assistance is a useful method in treatment of OCD with large osteochondral defects of the knees.
ObjectiveTo investigate the long-term effectiveness of microgenia treatment with natural coral, and the volume relationship between the implant and the new bone. MethodsA retrospective analysis was made on the cl inical data of 12 patients with microgenia treated by horizontal genioplasty with natural coral implantation between October 1998 and September 2004. There were 7 males and 5 females with the average age of 18.5 years (range, 15-28 years). The cephalometric data on the photo and X-ray films were collected at pre-operation, immediate after operation, and last follow-up. The vertical distance between lower lip point and inferior mental point, the vertical distance between inferior alveolar point and inferior mental point, the vertical distance of the osteotomic gap, and the distance between pogonion and the line between nasion and inferior alveolar point were measured, and the recurrence rates were caculated. ResultsAll incisions healed by first intention, and no complication occurred. All patients were followed up 8-12 years (mean, 9.2 years). X-ray films showed that the natural coral was replaced by new bone formation in the mental osteotomic gap; the new bone had good strength and firmly attached to the mentalis and periosteum. At last follow-up, the vertical distance between lower lip point and inferior mental point, the vertical distance between inferior alveolar point and inferior mental point, and the vertical distance of the osteotomic gap were decreased when compared with the ones at immediate after operation, and the mean recurrence rates were 6.1%, 22.9%, and 31.7%, respectively; and no obvious change was observed in the vertical distance between pogonion and the line between nasion and inferior alveolar point. Nine patients were satisfied with operation effectiveness; chin morphology was adjusted again in 3 patients. ConclusionNatural coral is a safe and effective bone substitute with enough stable new bone and good long-term effectiveness.
Beijing Tongren Hospital, Capital Medical University is a multi-zone hospital, adopting a mixed mood of centralized and decentralized management of ambulatory surgery. In order to guarantee the medical quality and safety, and improve the quality of ambulatory surgery, during the past three years, through homogeneity management in three dimensions, including quality control, efficiency connotation, and service safeguard, the number of ambulatory surgery disease types carried out in the hospital increased from 121 to 251; the working efficiency of the day operating room was improved, and the rate of doctors’ temporary cancellation of operations was reduced from 3.04% to 1.68%; the medical quality index was improved, the rate of unplanned reoperation decreased from 0.173‰ to 0.078‰, and the patient satisfaction increased from 94% to 99%. It shows that the homogenization management is an effective management method to effectively guarantee the quality and safety of medical treatment and improve the quality of ambulatory surgery in multi-zone and mixed management mode.
ObjectiveTo investigate the effectiveness of free sensate intercostal artery perforator flap for the hand soft tissue reconstruction.MethodsBetween March 2010 and September 2015, 19 cases of hand soft tissue defect were repaired with free sensate intercostal artery perforator flap, including 16 males and 3 females, aged from 18 to 53 years, with an average of 35.2 years. The defect was located in the dorsum of the hand in 15 cases and in the palm in 4 cases. The causes of injury were traffic accident injury in 8 cases, hot crush injury in 5 cases, strangulation injury in 4 cases, and avulsion injury in 2 cases. All of them were full-thickness skin and soft tissue defects of hand with exposure of phalanges, tendons, blood vessels, and nerves. The size of defect was 10.0 cm×7.0 cm to 17.0 cm×8.0 cm. There were 12 cases of emergency operation and 7 cases of selective operation. The thickness of flap was 10-25 mm, and the size of the flap ranged from 10.0 cm×7.5 cm to 17.0 cm×8.0 cm. The vascular pedicle of the flap was anastomosed with the snuff nest branch of the radial artery (12 cases), the main radial artery (7 cases), and there accompanying vein, and the intercostal nerve cutaneous branch of the flap was anastomosed with the lateral cutaneous nerve of the forearm. The donor site was closed directly (14 cases) or repaired with medium thickness skin graft (5 cases).ResultsAll of the flaps and skin grafts survived; the wounds in the donor and recipient sites healed by first intention. All 19 patients were followed up 10- 18 months, with an average of 12.7 months. After operation, the appearance and function of the hand recovered well, and there was no flap bloated. The two-point discrimination of the flap was 7-11 mm, with an average of 8.8 mm. Only linear scars left in the patients with direct closure of the donor site. The sensory function of the donor site was not significantly affected, and the hand function recovered satisfactorily. Conclusion Free sensate intercostal artery perforator flap is a valuable and reliable technique for the hand soft tissue defect.
The master protocol platform trial is a trial in which multiple treatments or different combinations of treatments are consistently evaluated in the context of a single disease, possibly within several sub-studies for different disease subtypes, allowing multiple treatments to enter or exit the trial platform based on a certain decision algorithm. Compared with the traditional clinical trial design, the master protocol platform trial as a scientific innovative model of clinical trial can accelerate drug evaluation to deal with the contradiction between the awaited evaluation of numerous drugs and lack of effective therapy for diseases. By using the large-scale randomized controlled clinical trial for COVID-19 inpatients (RECOVERY) led by the University of Oxford in the UK in 2020 as an illustration, this paper introduced the concept, design principle, and basic trial process of the master protocol platform trial to provide methodological references for clinical research of drugs.
ObjectiveTo systematically review the difference in 30-day readmission rates among acute heart failure patients between real-world studies vs. randomized controlled trials (RCTs). MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect clinical studies on 30-day readmission rates in patients with acute heart failure from inception to April 12th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using Stata 16.0 software. ResultsA total of 33 real-world studies and 11 RCTs involving 106 722 subjects were included. The results of meta-analysis showed that the 30-day heart failure-related readmission rates in the real-world studies and RCTs were 10.8% (95%CI 9.3% to 12.3%) and 6.9% (95%CI 5.3% to 8.4%), respectively. The 30-day all-cause readmission rates in real-world studies and randomized controlled studies were 18.6% (95%CI 15.7% to 21.4%) and 14.2% (95%CI 12.0% to 16.3%), respectively. There were statistically significant differences between two kinds of studies (P<0.05). ConclusionsCurrent evidence suggests that the 30-day heart failure-related and all-cause readmission rates in patients of acute heart failure in real-world studies are significantly higher than those in patients of RCTs. Due to the limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusions.