ObjectivesTo explore the impact of the medical consortium of a tertiary grade A hospital on the economic benefits and business levels of the community hospitals, to summarize the problems of the current medical joint mode, and to provide suggestions for promoting the medical association model.MethodsWe collected the data of economic benefit and business level of a tertiary grade A hospital and its affiliated community hospitals before and after the implementation of the medical consortium model [2016 (pre-implementation) and 2017 (post-implementation)], and analyzed the differences between the two groups. Patients were selected by stratified sampling method before and after the implementation, investigations and follow-up were conducted. The satisfaction and compliance were analyzed.ResultsCompared with the data in 2016, in 2017, the total income of community hospitals increased by 25.13% (2.671 2 million yuan vs. 2.134 7 million yuan), the number of outpatients increased by 15.55% (7 496 vs. 6 487 cases), the number of hospitalizations increased by 59.49% (1 673 vs. 1 049 cases), and the number of students increased the most, reaching 366.67% (14 vs. 3). Finally, a total of 472 patients were included, including 213 in pre-implementation group and 259 in post-implementation group. There was no significant difference in the general data between the two groups (P>0.05). The patients’ satisfaction and compliance in post-implementation group were better than those in pre-implementation group (P<0.05). In June and December 2017, the hospital’s medical staff business test level increased significantly compared with those in the same period in 2016 (t=−7.467、−9.998, P<0.001), and the results in December 2017 were significantly higher than those in June 2017 (t=−4.719, P<0.001). But there was no significant difference in the performance of business level assessment between the results in June 2016 and in December 2016 (t=−1.158, P=0.250).ConclusionAn effective “Three Construction and One Management” model can promote the advancement of medical standards in community hospitals while promoting the effective improvement of economic benefits and improving the patients’ satisfaction.
【Abstract】 Objective To study the role of house dust mite ( HDM) induced airway epithelium TLR4 expression and T lymphocyte activation in asthmatic inflammation. Methods Thirty BALB/ c mice were randomly divided into an ovalbumin ( OVA) group, a HDMgroup, and a control group. The mice in the OVA group were sensitized with OVA and Al( OH) 3 , and repeatedly exposed to aerosolized OVA. The mice in the HDMgroup and the control group were sensitized and challenged with HDMand saline, respectively.Histopathology changes of pulmonary tissue and airway were observed under light microscope. Levels of IL-4, IL-5, IL-13, IL-17, and IFN-γin BALF were measured by ELISA. Total and differential cell counts in bronchoalveolar lavage fluid ( BALF) were also measured. The mRNA and protein expressions of TLR4 weredetected by quantitative real-time PCR and Western blot, respectively. Th1, Th2, and cells in the peripheral blood were detected by flow cytometry. Results Light microscope revealed eosinophil specific inflammatory cells infiltration around the peribronchovascular region,mucus gland hyperplasia, and airway mucous plug inthe OVA group. The HDM group showed more severe alveolar and intersititial congestion and neutrophils infiltration. The control group showed intact alveolus with few mucous plug and inflammatory cells.Compared with the OVA group, significant increases in the number of total cells and neutrophils, as well as significantly higher expression of IL-4, IL-5, IL-13, and IL-17 were detected in the HDMgroup ( P lt;0. 05) ,while IFN-γexpression had no significant change ( P gt;0. 05) . The expression of TLR4 mRNA and protein significantly increased in the HDMgroup( P lt; 0. 05) , and did not change significantly in the other two groups ( P gt;0. 05) . The percentages of Th2 and Th17 cells in peripheral blood in the HDMgroup were significantly higher than the OVA group ( P lt;0. 05) . Conclusion HDM may induce inflammatory cells infiltration andactivation of Th2 and Th17 lymphocyte cells via up-regulation of TLR4 expression in airway epithelium,which might play an important role in asthmatic inflammation.
Dose-response meta-analysis (DRMA) is one of the branches of meta-analysis, which has provided important evidence for clinical research. Since introducing into China, it has gained great attention. In order to improve the reporting quality of DRMA, Dr. Chang Xu et al. developed the reporting guideline for DAMA——G-Dose Checklist. It was published in Chinese Jouranl of Evidence-based Medicine in 2016. This paper interprets the checklists so as to promote the understanding and use of it.