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Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

《医学前沿（英文）》 2023年 第17卷 第4期   页码 675-684 doi: 10.1007/s11684-022-0970-x

摘要： This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015−2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ≥15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%×nosocomial infection management + 17.97%×compliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

关键词： critical care medicine     quality control     evaluation     exploratory factor analysis (EFA) model    

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Multi-stage emergency medicine logistics system optimization based on survival probability

Ke WANG, Yixin LIANG, Lindu ZHAO

《工程管理前沿（英文）》 2017年 第4卷 第2期   页码 221-228 doi: 10.15302/J-FEM-2017020

摘要： Using sudden cardiac deaths as an example and maximizing survival rate as the goal, this paper studies the influence of multi-stage medical logistics system optimization on the survival rate of sudden illness. A distribution model of survival is built, drone and ambulance arrival probability over time are discussed, a formula is proposed for maximum possible survival rate based on the probability of emergency medical logistics reaching the patient, and the results are analyzed using empirical data fitting distribution and numerical experiments performed with the model. The model is discussed as a reference point for management decision making by changing model parameters. Results show that compared to using current ambulance vehicles, ambulance drones delivering medical equipment for first aid on-site in emergencies can significantly increase survival rate, and the effect of collaborative multi-stage logistics optimization is better than that of any single stage logistics response optimization. Simulation results show that the medical rescue logistics service radius, speed, loading capacity and performance of ambulance drones impact the probability of survival, and there is an optimal service radius depending on the shape of probability distribution, which provides new information for management decisions.

关键词： emergency medicine logistics     ambulance drone     survival probability     critical illness    

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Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy

null

《医学前沿（英文）》 2013年 第7卷 第3期   页码 386-388 doi: 10.1007/s11684-013-0278-y

摘要：

A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

关键词： thoracic trauma     differential diagnosis     critical care     pneumothorax     pneumomediastinum     CT scan     pitfalls     lung and airways physiology    

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Socialized care services for the aged population: System construction and support measures

《工程管理前沿（英文）》 2023年 第10卷 第2期   页码 339-353 doi: 10.1007/s42524-022-0208-2

摘要： Given the aging society, an increase in social demand, information- and communication technology-driven culture, and government policy support emerges to enable the development of the socialized care services system for the aged (SCSSA). The development of the SCSSA would be a significant step toward addressing China’s aging population. However, the construction of the SCSSA challenges the theories and methods of traditional elderly care service system construction. Specifically, the implementation path for such elderly care service policies is unclear, the necessary technological support is insufficient, and the mechanism for integrating intelligent information technology remains underexplored. Thus, this paper focuses on the needs of the elderly, grounded in the context of the changing elderly care service policies in China, and proposes a research paradigm that integrates system construction and support measure embedding. We then construct the original SCSSA, which includes “material + spirit + medical treatment + healthcare” and propose a method of optimization and iteration. Finally, we build the research framework of systematic support measures from the perspectives of policy reconstruction, institutional embeddedness, and technical support. Our work provides theoretical support and practical guidance for the construction and dynamic optimization of the SCSSA, thus making a significant contribution that will help China effectively cope with its aging society.

关键词： socialized     care service for the elderly     system construction     support measure    

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Advancing pediatric care before birth

《医学前沿（英文）》 2023年 第17卷 第2期   页码 352-354 doi: 10.1007/s11684-022-0974-6

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Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai

《医学前沿（英文）》 2022年 第16卷 第1期   页码 126-138 doi: 10.1007/s11684-021-0897-7

摘要： This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43±8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95±5.53 (SD) years. The percentage of patients who achieved the target level for HbA1c (<7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP)<130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c)<2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (<140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

关键词： type 2 diabetes     quality of care     macrovascular complication     microvascular complication     treatment pattern     epidemiology    

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Chinese herbal medicine reduces mortality in patients with severe and critical coronavirus disease 2019

Guohua Chen, Wen Su, Jiayao Yang, Dan Luo, Ping Xia, Wen Jia, Xiuyang Li, Chuan Wang, Suping Lang, Qingbin Meng, Ying Zhang, Yuhe Ke, An Fan, Shuo Yang, Yujiao Zheng, Xuepeng Fan, Jie Qiao, Fengmei Lian, Li Wei, Xiaolin Tong

《医学前沿（英文）》 2020年 第14卷 第6期   页码 752-759 doi: 10.1007/s11684-020-0813-6

摘要： This study aimed to evaluate the efficacy of Chinese herbal medicine (CHM) in patients with severe/critical coronavirus disease 2019 (COVID-19). In this retrospective study, data were collected from 662 patients with severe/critical COVID-19 who were admitted to a designated hospital to treat patients with severe COVID-19 in Wuhan before March 20, 2020. All patients were divided into an exposed group (CHM users) and a control group (non-users). After propensity score matching in a 1:1 ratio, 156 CHM users were matched by propensity score to 156 non-users. No significant differences in seven baseline clinical variables were found between the two groups of patients. All-cause mortality was reported in 13 CHM users who died and 36 non-users who died. After multivariate adjustment, the mortality risk of CHM users was reduced by 82.2% (odds ratio 0.178, 95% CI 0.076–0.418; <0.001) compared with the non-users. Secondly, age (odds ratio 1.053, 95% CI 1.023–1.084; <0.001) and the proportion of severe/critical patients (odds ratio 0.063, 95% CI 0.028–0.143; <0.001) were the risk factors of mortality. These results show that the use of CHM may reduce the mortality of patients with severe/critical COVID-19.

关键词： COVID-19     CHM     mortality     a retrospective cohort study    

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Determination and occurrence of endocrine disrupting compounds, pharmaceuticals and personal care products

Yong YU,Laosheng WU

《环境科学与工程前沿（英文）》 2015年 第9卷 第3期   页码 475-481 doi: 10.1007/s11783-014-0640-6

摘要： Endocrine disrupting compounds (EDCs), pharmaceuticals and personal care products (PPCPs) have attracted much attention due to widespread contamination in aquatic environment. In this study, we determined 13 EDCs and PPCPs in fish blood, bile and muscle by using gas chromatography-mass spectrometry (GC-MS). The limits of quantitation (LOQ) were in the ranges of 0.23–2.54, 0.22–2.36 ng·mL , and 0.24–2.57 ng·g dry weight (dw) for fish blood, bile and muscle, respectively. Recoveries of target compounds spiked into sample matrices and passed through the entire analytical procedure ranged from 65% to 95%, from 60% to 92% and from 62% to 91% for blood, bile and muscle, respectively. The methods were applied to the analysis of fish from a lake in California. Target compounds were relatively low in bile, and only bisphenol A (BPA) and diclofenac were measurable near the LOQ. Seven of 13 compounds were detected in blood, with total concentrations up to 39 ng·mL . Only BPA was frequently found in muscle, with mean concentration of 7.26 ng·g dw. The estimated daily intake of BPA through fish consumption for U.S. resident was significantly lower than the tolerable daily intake recommended by the European Food Safety Authority. This study showed that the exposure to the bisphenol A from fish diet is unlikely to pose a health risk.

关键词： endocrine disrupting compounds (EDCs)     pharmaceuticals and personal care products (PPCPs)     fish     bisphenol A (BPA)     risk assessment    

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Primary health care for all by 2020: The systematic reform of the medical and health system in China

《医学前沿（英文）》 2010年 第4卷 第1期   页码 3-7 doi: 10.1007/s11684-010-0024-7

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Arthrogryposis multiplex congenita: classification, diagnosis, perioperative care, and anesthesia

null

《医学前沿（英文）》 2017年 第11卷 第1期   页码 48-52 doi: 10.1007/s11684-017-0500-4

摘要：

Arthrogryposis multiplex congenita (AMC) is a rare disorder characterized by non-progressive, multiple contractures. In addition to affected extremities, patients may also present microstomia, decreased temporomandibular joint mobility. Although the etiology of AMC is unclear, any factor that decreases fetal movement is responsible for AMC. Thus, accurate diagnosis and classification are crucial to the appropriate treatment of AMC. The development of ultrasound technology has enabled prenatal diagnosis. Very early treatment is favorable, and multidisciplinary treatment is necessary to improve the function of AMC patients. Most patients require surgery to release contracture and reconstruct joints. However, perioperative care is challenging, and difficult airway is the first concern of anesthesiologists. Postoperative pulmonary complications are common and regional anesthesia is recommended for postoperative analgesia. This review on AMC is intended for anesthesiologists. Thus, we discuss the treatment and perioperative management of patients undergoing surgery, as well as the diagnosis and classification of AMC.

关键词： arthrogryposis     amyoplasia     distal arthrogryposis     anesthesia    

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Screening of indicator pharmaceuticals and personal care products in landfill leachates: a case study

《环境科学与工程前沿（英文）》 2023年 第17卷 第9期 doi: 10.1007/s11783-023-1716-y

摘要：

● A systematic framework was developed to identify i-PPCPs for landfill leachate.

关键词： Landfill leachates     PPCPs     Indicator     Screening criteria     Source-specificity    

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我国老年智慧康养平台建设路径研究

侯汉坡,位鹤,王颍超,于今,邱贵兴

《中国工程科学》 2022年 第24卷 第2期   页码 170-178 doi: 10.15302/J-SSCAE-2022.02.023

摘要：

我国正处于老年人口数量较多、老龄化速度加快、应对人口老龄化任务繁重的阶段，利用现代化技术建立老年智慧康养平台是解决我国养老问题的有效途径。本文阐述了建设老年智慧康养平台的背景以及相关概念与发展现状，以杭州市西湖区老年智慧康养平台为案例，深入分析了老年智慧康养平台的建设模型与发展面临的问题，进而总结了我国老年智慧康养平台的共性特征。研究提出了我国老年智慧康养平台的建设路径：以科技手段助力实现健康中国为建设目标，以全国康养信息和数据的互联互通为建设基础，构建“社区嵌入型”智慧康养服务综合体来调动服务资源，开展远程健康数据监测和健康管理来强化信息支撑，发挥地域优势并促进本土康养产业升级。为此建议，推动康养产业及科技转化，健全老年人精神需求保障机制，完善老年人能力评估体系，构建智慧康养标准体系，协调城乡智慧康养产业发展。

关键词： 老龄化     健康中国     社区居家养老     智慧健康养老     养老服务     康养平台    

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Individualized medicine, health medicine, and constitutional theory in Chinese medicine

null

《医学前沿（英文）》 2012年 第6卷 第1期   页码 1-7 doi: 10.1007/s11684-012-0173-y

摘要：

The patterns of modern science and changes in the medical model can result in the transformation of the current state of individualized and health medicines into being the primary trend in medical development. Chinese and Western medical systems are dissimilar in terms of value orientations, thinking style, and research directions because of their different historical and cultural backgrounds. Individualized treatment in modern medicine is mainly established based on individual genome information and the differences in mononucleotide polymorphi-sms. However, such treatment method is expensive, creates an uncertain genetic marker, and leads to different result interpretations, among other problems. The Chinese constitutional theory developed in the 1970s expresses the principle behind Chinese health medicine and individual treatment and provides the corresponding methods. The Chinese constitutional theory divides the constitution of the Chinese population into nine categories based on established classification criteria. It promotes the study of the relationship of each constitution to diseases and Chinese medicine preparation toward adjusting the constitution and preventing diseases. The theory also provides methods and tools for individualized treatment. Constitution identification shows the direction and provides the core technology for the evaluation of the health status. By combining the developments in modern biotechnology, new diagnostic techniques and treatment models of constitution-differentiation, disease-differentiation, and syndrome-differentiation can be established for the development of individualized Chinese medicine treatment and health medicine for the international medical community.

关键词： individualized medicine     health medicine     constitutional theory in Chinese medicine    

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Determination of 27 pharmaceuticals and personal care products (PPCPs) in water: The benefit of isotope

Xueqi Fan, Jie Gao, Wenchao Li, Jun Huang, Gang Yu

《环境科学与工程前沿（英文）》 2020年 第14卷 第1期 doi: 10.1007/s11783-019-1187-3

摘要： • Isotope dilution method was developed for the determination of 27 PPCPs in water. • The established method was successfully applied to different types of water samples. • The correction effect of corresponding 27 ILSs over 70 d was investigated. • Benefit of isotopic dilution method was illustrated for three examples. Pharmaceuticals and personal care products (PPCPs) are a unique group of emerging and non-persistent contaminants. In this study, 27 PPCPs in various water samples were extracted by solid phase extraction (SPE), and determined by isotope dilution method using liquid chromatography coupled to tandem triple quadruple mass spectrometer (LC-MS/MS). A total of 27 isotopically labeled standards (ILSs) were applied to correct the concentration of PPCPs in spiked ultrapure water, drinking water, river, effluent and influent sewage. The corrected recoveries were 73%–122% with the relative standard deviation (RSD)<16%, except for acetaminophen. The matrix effect for all kinds of water samples was<22% and the method quantitation limits (MQLs) were 0.45–8.6 ng/L. The developed method was successfully applied on environmental water samples. The SPE extracts of spiked ultrapure water, drinking water, river and wastewater effluent were stored for 70 days, and the ILSs-corrected recoveries of 27 PPCPs were obtained to evaluate the correction ability of ILSs in the presence of variety interferences. The recoveries of 27 PPCPs over 70 days were within the scope of 72%–140% with the recovery variation<37% in all cases. The isotope dilution method seems to be of benefit when the extract has to be stored for long time before the instrument analysis.

关键词： Pharmaceuticals and personal care products (PPCPs)     Isotopically labeled standard (ILSs)     Water     Solid-phase extraction (SPE)     LC-MS/MS    

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efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care

Feng Zhu, Zhijian Yao, Wenliang Ji, Deye Liu, Hao Zhang, Aimin Li, Zongli Huo, Qing Zhou

《环境科学与工程前沿（英文）》 2020年 第14卷 第3期 doi: 10.1007/s11783-020-1228-y

摘要： A hydrophilic resin (GCHM) was facile synthesis and characterized. Average absolute recovery of GCHM (75.6%) performs better than Oasis® HLB. Detection limits of method (SPE-UPLC-MS/MS) ranged between 0.03 and 0.6 ng/L. 22 PPCPs were determined in environmental waters ranging from 0.5 to 1590 ng/L. In this study, a hydrophilic resin named GCHM was fabricated based on poly(N-vinyl pyrrolidone-co-divinylbenzene), characterized, and applied as a solid-phase extraction (SPE) material. Up to 44 pharmaceuticals and personal care products (PPCPs) belonging to 10 classes were recovered in environmental water samples. Different variables affecting extraction, such as adsorbent amount, sample pH, and loading speed, were optimized. Under optimal conditions, the average absolute recovery of 44 PPCPs was 75.6% using GCHM, indicating a better performance than the commercial Oasis® HLB. SPE with home-made hydrophilic polymeric sorbent followed by ultra-performance liquid chromatography and tandem mass spectrometry was validated, and the method achieved good linearity (r2>0.991, for all analytes). In addition, the method detection limits of target compounds ranged from 0.03 to 0.6 ng/L. The developed method was applied to determine PPCPs in 10 environmental water samples taken from the Yangtze River, Huaihe River, and Taihu Lake, 1 groundwater sample from Changzhou in Jiangsu Province, 1 wastewater sample from Xiamen and 2 seawater samples from the Jiulong River in Fujian Province, China. In these samples, 22 compounds were determined at levels ranging from 0.5 to 1590 ng/L.

关键词： Hydrophilic resin     Solid phase extraction     Pharmaceuticals and personal care product     Ultra-performance liquid chromatography and tandem mass spectrometry     Environmental water    

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标题 作者 时间 类型 操作

Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

期刊论文

Multi-stage emergency medicine logistics system optimization based on survival probability

Ke WANG, Yixin LIANG, Lindu ZHAO

期刊论文

Trauma-induced “Macklin effect” with pneumothorax and large pneumomediastinum, disguised by allergy

null

期刊论文

Socialized care services for the aged population: System construction and support measures

期刊论文

Advancing pediatric care before birth

期刊论文

Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai

期刊论文

Chinese herbal medicine reduces mortality in patients with severe and critical coronavirus disease 2019

Guohua Chen, Wen Su, Jiayao Yang, Dan Luo, Ping Xia, Wen Jia, Xiuyang Li, Chuan Wang, Suping Lang, Qingbin Meng, Ying Zhang, Yuhe Ke, An Fan, Shuo Yang, Yujiao Zheng, Xuepeng Fan, Jie Qiao, Fengmei Lian, Li Wei, Xiaolin Tong

期刊论文

Determination and occurrence of endocrine disrupting compounds, pharmaceuticals and personal care products

Yong YU,Laosheng WU

期刊论文

Primary health care for all by 2020: The systematic reform of the medical and health system in China

期刊论文

Arthrogryposis multiplex congenita: classification, diagnosis, perioperative care, and anesthesia

null

期刊论文

Screening of indicator pharmaceuticals and personal care products in landfill leachates: a case study

期刊论文

我国老年智慧康养平台建设路径研究

侯汉坡,位鹤,王颍超,于今,邱贵兴

期刊论文

Individualized medicine, health medicine, and constitutional theory in Chinese medicine

null

期刊论文

Determination of 27 pharmaceuticals and personal care products (PPCPs) in water: The benefit of isotope

Xueqi Fan, Jie Gao, Wenchao Li, Jun Huang, Gang Yu

期刊论文

efficient resin for solid-phase extraction and determination by UPLCMS/MS of 44 pharmaceutical personal care

Feng Zhu, Zhijian Yao, Wenliang Ji, Deye Liu, Hao Zhang, Aimin Li, Zongli Huo, Qing Zhou

期刊论文