25 December 2020, Volume 27 Issue 6

    

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  Investigation and thinking on the development of primary medical situations in Yantai

  Bao Xinyong, Jin Ling, Wang Shengping, Yu Ziwei, Lu Ning, Jiang Xiaoming, Li Guoliang, Chen Zhenduo

  journal1. 2020, 27(6): 481-483. https://doi.org/10.3969/j.issn.1006-5253.2020.06.001

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  Medical and health have always been a great concern of the public. With the launch and execution of series policies of medical reform, the medical and health care in Yantai has developed rapidly. The contradiction between supply and demand of health resources has been alleviated to a certain extent, but some new problems have also arisen. The most prominent problem is the difficulty in the development of primary medical institutions. In order to solve this problem, we conducted a field investigation on the primary medical institutions in Yantai, analyzed the reasons behind the current difficulties, and then proposed targeted measures. Because the developmental difficulties of primary medical institutions are common in our country, our solutions and suggestions might have certain reference value for the development of primary medical and health institutions.

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  Realization of public welfare in public hospitals from the perspective of healthy China

  Huang Jin, Cong Xin, Wang Guohua

  journal1. 2020, 27(6): 484-486. https://doi.org/10.3969/j.issn.1006-5253.2020.06.002

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  The Communist Party 19th National Congress of China made the important decision of implementing the healthy China strategy, which will promote the maintenance of people's health to the strategic height. With the indepth implementation of the healthy China strategy, it has become an inevitable requirement to build a moderately prosperous society in all respects to adhere to the public welfare nature of public hospitals, give full play to public welfare functions of public hospitals, and safeguard people's health. This paper analyzes the public welfare requirements of healthy China for public hospitals and the practical significance of public hospitals' implementation of public welfare. Then, taking The Yantai Affiliated Hospital of Binzhou Medical University as an example, this paper introduces the realization path of public hospitals' public welfare, and further clarifies the responsibility and mission of public hospitals in the healthy China strategy.
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  Urgent need to be exerted of medical help for construction of healthy China

  Jiang Fangfang, Zhang Jintao, Xu Bin

  journal1. 2020, 27(6): 487-489. https://doi.org/10.3969/j.issn.1006-5253.2020.06.003

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  The construction of a healthy China has become a national strategy. The implementation of the healthy China strategy involves the wide participation of large public hospitals and grassroots public hospitals. Due to the difference of talent policy, economic base and other factors, primary medical units are not competent in their role in the implementation of healthy China strategy because of equipment allocation and talent reserve. The medical help of large public hospitals to local primary medical units has become an effective way to solve the current problems. This paper introduces the forms, requirements and objectives of the current medical support work from three aspects, emphasizes the important role and role of the party building guidance, group support and the help of the business dean in the medical assistance, and provides a certain reference for the medical support work of large public hospitals in the future.
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  Study on the influencing factors of breast conserving surgery for early breast cancer based on multiple correspondence analysis

  Li Xi, Liu Meina, Zhang Qiuju

  journal1. 2020, 27(6): 490-493. https://doi.org/10.3969/j.issn.1006-5253.2020.06.004

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  Objective To use multiple correspondence analysis (MCA) to obtain the influencing factors of receiving breast conserving surgery (BCS) for early breast cancer patients, so as to provide data supports for improving the adherence rate of BCS. Methods We collected the case data of early breast cancer patients who underwent BCS and mastectomy. Chi square tests were used to investigate the relationship between the influencing factors and operation methods in the contingency tables; the twodimensional graph of MCA was used to show the corresponding relationship between influencing factors and breast conserving surgery, and the influencing factors were determined according to the corresponding relationship between different factors and their different classifications in the graph. Results Totally 2 423 cases with early breast cancer were collected, and the rate of breast conserving surgery was 7.88%. The results of chi square tests showed that there were 10 influencing factors with statistical significance. MCA showed that the most important factor affecting patients receiving the BCS was times of birth, followed by the age of patients, tumor histological grade and stage. Conclusion In patients with indications of breast conserving therapy, the proportion of BCS was relatively low, so we may make relevant policies to improve the breast conserving therapy according to the influencing factors obtained in this paper. It is suggested that we should improve the level of operation and communication between doctors and patients, increase the promotion of BCS, and improve the prognosis and quality of life of early breast cancer patients.
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  Relationship between serum uricemic, blood glucose and coronary heart disease in patients with nonalcoholic fatty liver disease

  Wang Xiaohan, Shen Liang, Chen Yunqing, Shen Yueyu, Gao Chen, Hou Zhentao, Han Feng, Ji Zizhong

  journal1. 2020, 27(6): 494-497. https://doi.org/10.3969/j.issn.1006-5253.2020.06.005

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  Objective To analyze the relationship between serum uricemia, blood glucose and coronary heart disease in patients with nonalcoholic fatty liver disease (NAFLD). Methods Two hundred and nineteen NAFLD patients with coronary angiography admitted to our hospital from January 2016 to December 2016 were enrolled. Ultrasound or CT examination was used to diagnose fatty liver. Factors affecting coronary artery disease were analyzed by Logistic multivariate regression. Results Among all NAFLD patients, 62 were nonCHD patients and 157 were NAFLD patients with CHD. In NAFLD patients with coronary heart disease, ALT, AST, GGT, Cr, SUA and GLU increased and HDL decreased compared with NAFLD patients, and the differences were statistically significant. Multivariate Logistic regression analysis showed that increased risk of coronary heart disease was associated with blood glucose (OR=1.426, 95%CI:1.077-1.887) and serum uric acid (OR=1.005，95%CI:1.001-1.009) in males(OR=2.296, 95%CI: 1.153-4.572). Conclusion In patients with NAFLD complicated with coronary heart disease, it is necessary to timely understand the risk factors, control blood glucose level and serum uric acid level, strengthen intervention, and reduce the incidence of coronary heart disease.

   
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  Diagnosis of minimal change disease based on optimized logistic regression model

  Zhang Xingzhen, Huang Jian, Xi Weiwei, Ying Jun

  journal1. 2020, 27(6): 498-501. https://doi.org/10.3969/j.issn.1006-5253.2020.06.006

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  Objective Minimal change disease (MCD) is one of the main causes of idiopathic nephrotic syndrome (NS). Renal biopsy has been the gold standard for clinical diagnosis of MCD. Because renal biopsy causes substantial harm to patients, this study aims to establish a mathematical diagnostic model based on biological parameters to achieve noninvasive diagnosis of MCD. Methods The AUC was used to evaluate the biological parameters for the differentiation between the MCD group and the control group in 798 patients with idiopathic nephrotic syndrome. Logistic regression methods were used to establish diagnostic models and calculate the Youden index, sensitivity, specificity, and accuracy to assess the clinical diagnostic value of the model. Results The AUC of seven biological parameters was greater than 0.70, including albumin (AUC=0.821), total cholesterol (AUC=0.800), plasma fibrinogen (AUC=0.706), high density lipoprotein cholesterol (AUC=0.747), low density lipoprotein cholesterol (AUC=0.777), total protein (AUC=0.824), and thrombin time (AUC=0.804). Further analysis showed that total cholesterol, high density lipoprotein cholesterol and thrombin time were risk factors for MCD, and total protein was a protective factor for MCD. The optimized logistic regression model includes four biological parameters (total cholesterol, high density lipoprotein cholesterol, total protein, and thrombin time). The model has an AUC of 0.870, an Youden index at the optimal cutoff point of 0.617, a sensitivity of 80.43%, a specificity of 81.31%, an accuracy of 81.26%, and an associated criterion of 0.073 5, which means that if PRE2>0.073 5, MCD patients will be determined, otherwise they will be other kidney disease patients. Conclusion The 4-parameter logistic regression model established in this study has high accuracy and can be used for clinical diagnosis of MCD.
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  Application of lasso-logistic model in the analysis of septic shock influencing factors after percutaneous nephrolithotripsy

  Xiang Fengming, Zhou Jie, Zhang Danyun, Zhang Xian

  journal1. 2020, 27(6): 502-505. https://doi.org/10.3969/j.issn.1006-5253.2020.06.00

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  Objective To analyze the influencing factors of septic shock after percutaneous nephrolithotomy based on lasso of logistic regression variable selection method, and provide valuable guidance for reducing the occurrence of septic shock. Methods The clinical data of 802 patients who underwent percutaneous nephrolithotripsy in Wenzhou Central Hospital from March 2009 to January 2020 were retrospectively analyzed. Lasso logistic model was performed to identify the influencing factors of septic shock after percutaneous nephrolithotomy. Cross validation method was used to choose λ for lasso-logistic model．In addition, the fitting accuracy and prediction effect of lasso-logistic regression model, full-variable logistic regression model and stepwise logistic regression model were compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). Results Lasso-logistic regression model showed that sex, stone size, preoperative urine culture, decrease in hemoglobin, and operation time were independent influencing factors of septic shock after percutaneous nephrolithotomy. The AIC and BIC of lasso-logistic regression model were 143.747 and 169.854, respectively, which were lower than those of full-variable logistic regression model and stepwise logistic regression model. Conclusion Lasso-logistic regression model of septic shock after percutaneous nephrolithotomy based on the above five factors has good fitting accuracy and predictive effect.
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  Analysis on epidemiological characteristics of falling injury among children from hospital-based surveillance in Wenzhou from 2018 to 2019

  Jiang Xuexia, Li Jiangfeng

  journal1. 2020, 27(6): 506-509. https://doi.org/10.3969/j.issn.1006-5253.2020.06.008

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  Objective To understand the epidemiologic characteristics of fall in people of 18 years old and below in Wenzhou, and to provide evidence for the development of prevention and control measures of fall in young population. Methods Data of fall in people of 18 years old and below from six sentinel hospitals in Wenzhou during 2018-2019 were collected through Zhejiang chronic disease surveillance and management system for the descriptive epidemiologic analysis. Results Totally 1 073 cases of fall were reported in people aged 18 years old and below during 2018-2019, accounting for 31.71% of total injury cases. The male/female ratio of fall cases was 1.87. Distribution of injuries varied in different sex and age groups, exhibited a statistically significant difference(χ2=9.790, P<0.05). The age at which children fall frequently was 6-12, 0-5 and 13-15 years old. Falls mainly occurred in March to May and September to November. Most fall injuries took place in schools and at home, accounting for 85.65%. The top two activities when falls could occur were recreation activities (41.57%) and sports activities (36.44%). The common injury sites were lower limbs (36.07%), head (35.69%) and upper limbs (24.79%). Children aged 5 years old and below were more likely to experience head injuries. The fall injuries were mainly mild (59.55%). Accordingly, the cases of fall mainly returned home after treatment (96.64% ). Conclusion Falling has become the second cause of children injury in Wenzhou. We should carry out appropriate interventions based on the distribution of children of different gender and age.

   
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  Analysis of epidemiological characteristics and fatal risk factors in 534 patients with multiple injuries

  Wu Xiaoqing, Lei Guihua, Shen Hejuan

  journal1. 2020, 27(6): 510-513. https://doi.org/10.3969/j.issn.1006-5253.2020.06.009

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  Objective To investigate the epidemiological characteristics and fatal risk factors of 534 patients with multiple injuries, and to provide theoretical references for formulating clinical emergency plans and rational use of medical resources. Methods Five hundred and thirtyfour cases of patients with multiple injuries admitted in our hospital from January 2017 to December 2019 were selected as the subjects of this study.The epidemiological characteristics of patients with multiple injuries were investigated and multifactor logistic regression analysis model was used toanalyze the fatal risk factors of patients with multiple injuries. Results The patients with multiple injuries were more common in men (63.11%) and <60 years old (57.68%). The incidence was high in summer, and the main causes of injuries were traffic injuries and fall injuries from heights. The univariate analysis showed that there was a close correlation between the death of patients with multiple injuries and age, the time from injury to admission, ISS score, shock, and the number of trauma (P<0.05). Multivariate logistic regression analysis showed that patients aged ≥60 years old, injury to admission to hospital for ≥3 h, ISS score ≥16 points, shock, and trauma number ≥4 were independent fatal risk factors for patients with multiple injuries (P<0.05). Conclusion The fatal risk factors for patients with multiple injuries are mainly age ≥60 years, the time from injury to hospital admission ≥3 h, ISS score ≥16 points, shock, and the number of traumas ≥4, etc. Therefore, it is necessary to formulate a targeted emergency treatment plan in order to improve the quality of life of patients with multiple injuries.
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  Investigation and analysis of job satisfaction and influencing factors in a children′s hospital

  Xue Yan, Gao Dehai

  journal1. 2020, 27(6): 514-517. https://doi.org/10.3969/j.issn.1006-5253.2020.06.01

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  Objective Employee satisfaction is closely related to the medical service quality of the hospital. By investigating the current employee satisfaction of a children′s hospital in Jinan, the key restricting factors affecting the improvement of human resources in children′s specialized hospital were found out, so as to facilitate the establishment of reasonable measures and systems. Methods According to the characteristics of specialized children′s hospitals and the performance assessment requirements of tertiary public hospitals of the National Health Commission, a questionnaire on staff satisfaction of tertiary public children′s hospitals with 23 indicators was developed. An anonymous questionnaire was used to investigate all the current employees of the hospital, and SPSS 19.0 software was used for analysis. Results The overall satisfaction score of the present employees was 3.81±0.49. The most volatile categories focused on the work environment, the relationship between superiors and coworkers, and job satisfaction. Employees with primary and intermediate titles scored 3.83 (3.43, 4.22) M(P₂₅～P₂₅) mainly due to the large gap between their salary and work pressure. The scores of doctors and pharmacists were low, respectively 3.70 (3.43～4.04) and 3.63 (3.36, 4.00), which were consistent with the current situation of talents in children′s specialized hospitals in China. Conclusion The comprehensive quality of staff, work pressure and management level have become the factors restricting the development of the hospital, so it is necessary to strengthen the publicity, improve the doctorpatient relationship and perfect the working process, so as to promote the cultivation and construction of the talent team related to pediatrics.
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  Analysis of the initial hospitalization expenses and its influencing factors for children with acute leukemia

  Liu Wenhao, Wang Jiu

  journal1. 2020, 27(6): 518-521. https://doi.org/10.3969/j.issn.1006-5253.2020.06.011

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  Objective To analyze the information and composition of the initial hospitalization expenses of children with acute leukemia, and to discuss the influencing factors and changing trend of the initial hospitalization expenses of children with acute leukemia. Methods Medical record data were collected of children aged 0 to 13 years old admitted to the paediatric internal medicine department of a tertiary hospital and diagnosed with acute leukemia in recent five years. The primary hospitalization information of children with acute leukemia was statistically described and the influencing factors of primary hospitalization cost were analyzed by single factor analysis and multiple linear regression analysis. Results Totally 124 cases were included, the average hospitalization cost was 2 3284.39 yuan, and the average daily hospitalization cost was 1 071.63 yuan. Univariate statistical analysis results showed that the age, admission year and length of stay of pediatric leukemia children were statistically significant, while the multivariate statistical analysis found that the admission to ICU was statistically significant.Conclusion In the total cost of the first hospitalization of children with leukemia, western medicine expenses and other expenses account for a large proportion. The length of hospital stay was the main factor influencing the total cost of the first hospitalization for acute leukemia in children. Factors such as whether or not to be admitted to the ICU are the main influencing factors of the average daily hospitalization cost. Properly reducing the western medicine cost and reducing ineffective or inefficient hospitalization days can effectively reduce the family economic burden of children with acute leukemia.
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  Survey of the cognition, attitude and medical treatment behavior of urban and rural residents on the hierarchical diagnosis and treatment system in a city

  Liu Haixia, Chen Shuai, Du Qing, Hu Naibao, Sun Hongwei,Zhao Haiquan

  journal1. 2020, 27(6): 522-526. https://doi.org/10.3969/j.issn.1006-5253.2020.06.01２

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  Objective To investigate the residents′ cognition, attitude, medical seeking behavior and its influencing factors through questionnaire survey, and provide reference for effectively promoting and improving hierarchical medical system.Methods A selfdesigned questionnaire was used to conduct an onsite questionnaire survey on some urban and rural residents in a city. Descriptive statistics methods were used to analyze the residents′ cognition, attitude and medical behavior choice, and multiple correspondence analysis was used to analyze the influencing factors of residents′ willingness to transfer to lower level hospitals.Results (1) The awareness rate of hierarchical medical system was 36.06%, and the awareness rates of twoway referral (9.83%) and medical association (18.03%) were relatively low. And 64.75% of the respondents were very satisfied or relatively satisfied with the hierarchical medical system. The main reasons for dissatisfaction were that the medical conditions of primary medical institutions were poor, the hierarchical medical system in different regions was lack of unified norms, and the medical security system was not perfect. (2) The top three medical institutions preferred by residents were: County/city/district hospital (31.97%), health room/station (22.13%), and private clinic (21.31%). The main reasons affecting their choice of medical institutions were: severity of diseases, advanced level of medical equipment and medical insurance reimbursement. (3)Multiple correspondence analysis showed that residents living in rural areas with family income less than 20　000 yuan would refer to lower level hospitals for treatment depending on the situation. Male, inservice, with junior high school education or below, income of 20 000 to less than 40 000 yuan or 60 000 to less than 80 000 yuan, who did not agree with the implementation of hierarchical medical system in China, were more reluctant to transfer to lower level hospitals for the treatment. Conclusions Residents′ awareness of the hierarchical medical system was low. The main reasons for not choosing grassroot medical treatment or referral were that the Internet mechanism of hierarchical medical system was imperfect, the quality of primary medical services was not trusted, and the lack of grassroot talents. It was suggested that we should strengthen the Internet construction in the process of hierarchical medical system, improve the level of primary medical service and medical environment, and promote the quality of medical resources to the primary medical institutions.
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  Analysis for prediction of death in a district of Suzhou from January to June 2020

  Wang Congju, Dong Haoyu, Ji Wen, Sun Hongpeng

  journal1. 2020, 27(6): 527-531. https://doi.org/10.3969/j.issn.1006-5253.2020.06.013

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  Objective To compare predicted death value and actual value in a district of Suzhou from January to June in 2020, analyze the data of death causes, and determine the change trend of the cause of death. Methods Based on the cause of death monitoring data from January 2017 to December 2019, the database of death monitoring was used to establish the causes of death data prediction model through expert modeling method to predict the predicted value of death from January to June 2020, and the predicted value of death was compared with the actual value; meanwhile, the corresponding death data for 2020 and 2019 were compared to determine the changes in causes of death. Results The predicted total number of deaths in January-March 2020 was higher than the actual value, which was 4.41%, 8.93% and 6.37%, respectively. The actual number of deaths in January-June showed a U-shaped trend of first decreasing and then increasing. In February 2020, the predicted values of poisoning and injury, respiratory diseases and endocrine and metabolic diseases were 47.06%, 11.54 % and 25.00 %, higher than actual values. Compared with the same period in 2019, the total number of deaths in February and March 2020 decreased by 13.56% and 14.35% respectively, the number of deaths from all causes of death except malignant tumors was lower than that in 2019, and the number of deaths from heart disease and endocrine and metabolic diseases in March 2020 was significantly lower than that in the same period in 2019, with a decrease of 40% and 38.46% respectively. Conclusion The total number of deaths, poisoning and injuries, respiratory diseases and causes of heart diseases decreased to varying degrees from January to June in 2020 in a district of Suzhou.
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  Incidence trend analysis of infectious diseases in Pingyi of Shandong Province from 2008 to 2019

  Chang Kaifeng, Xiang Longwei, Kong Lei, Peng Xintao, Liang Yan, Yang Fan.

  journal1. 2020, 27(6): 532-536. https://doi.org/10.3969/j.issn.1006-5253.2020.06.014

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  Objective To understand the epidemic characteristics and change law of infectious diseases in Pingyi County, so as to provide basis for better prevention and control strategies. Methods Descriptive epidemiological analysis was conducted on the data of infectious diseases from 2008 to 2019 in the Chinese Disease Prevention and Control Information System.Results From 2008 to 2019, 26 kinds of statutory infectious diseases were reported in Pingyi County, including 32 276 cases, with an average incidence of 284.18/100 000. From 2008 to 2019, tuberculosis, hepatitis B, hand-foot-and-mouth disease were always listed in the top five diseases. From 2008 to 2019, respiratory infectious diseases and blood-borne and sexually transmitted infectious diseases were the main types of B infectious diseases, accounting for 43.52% and 52.15%, respectively.From 2008 to 2019, the largest number of cumulative cases appeared in the third quarter (July to September, 9 355 cases) and the second quarter (April to June, 9 099 cases). Conclusion The incidence of infectious diseases in Pingyi is on the upward trend from 2008 to 2017, and the spectrum of infectious diseases has changed.It should be noted that the prevention and control strategies should be adjusted in time to reduce the incidence of the diseases and the outbreak of infectious diseases.
  
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  Evaluation of the effect of multi-mode rewarming management on patients with traumatic hemorrhagic shock

  Jin Qinghe, Yan Leilei, Huang Xiu.

  journal1. 2020, 27(6): 537-540. https://doi.org/10.3969/j.issn.1006-5253.2020.06.015

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  Objective To study and analyze the application of multi-mode rewarming management in patients with traumatic hemorrhagic shock and its effect on patients with hypothermia and stress response. Methods One hundred and four patients with traumatic hemorrhagic shock admitted to our hospital from March 2019 to April 2020 were selected as the subjects of this study. All patients were divided into the control group and the intervention group according to random number table method, with 52 cases in each group. The patients in the control group received conventional rewarming management mode, and the patients in the intervention group received multimode rewarming management. The levels of hemodynamics and stress response indexes of the two groups of patients before and after intervention were compared, so were the incidences of complications such as average fluid volume, shock index, hypothermia after intervention. Results After the intervention, the average fluid volume (1 208.22±114.15) mL and shock index (0.78±0.26) of the patients in the intervention group were significantly lower than those in the control group ［(4 218.27±274.29) mL, (1.84±0.42)］ (P<0.001). The hemodynamic parameters PI, PSV, RI, and EDV levels of the two groups of patients increased after intervention, and the difference in the increase of each index of the intervention group was higher than that of the control group (P<0.001). After the intervention, the levels of serum stress response NE, ACTH, Cor, and GLU increased in the two groups, and the differences in the reduction of indicators in the intervention group were higher than those in the control group (P<0.001). The incidences of complications such as hypothermia, chills, restlessness, and hypoxemia in the intervention group were significantly lower than those in the control group (P<0.05). Conclusion The application of multimode rewarming management in patients with traumatic hemorrhagic shock has a definite effect, which can effectively relieve the shock status of patients with traumatic hemorrhagic shock, improve hemodynamics and stress response indicators, and reduce the amount of fluid replacement and hypothermia and chills risk of other complications.
  
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  Effect evaluation of pay-per-disease reform based on clinical pathway

  Yuan Xiaohong, Kou Gaoshang, Sun Xiaojun, Qin Dawei.

  journal1. 2020, 27(6): 541-543. https://doi.org/10.3969/j.issn.1006-5253.2020.06.016

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  Objective To explore the significance of pay-per-disease reform by analyzing the medical quality and safety, hospitalization expenses and settlement cost between the internal fixation removal of lumbar fracture patients with pay-per-disease based on clinical path and patients without pay-per-disease. Methods One hundred and thirty-four internal fixation removal of lumbar fracture patients were selected. Among them, patients with pay-per-disease were set as the single-disease group, while patients without pay-per-disease were set as the control group, and the medical quality and safety, hospitalization expenses and settlement cost were analyzed. Results In terms of medical quality and safety, there were no significant differences in the incidence of complications and mortality, and other indicators were significantly different between the single-disease group and the control group. In terms of hospitalization expenses, there were no significant differences in medical income and the proportion of examination income, and other indicators were significantly different between two groups. In terms of hospitalization settlement cost, there were significant differences in the reimbursement and self-payment. Conclusion The use of pay-per-disease based on clinical path can effectively save health resources, improve the quality of medical services, reduce the economic burden of patients, relieve the pressure on medical insurance funds, and achieve the goal of multiwin.
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  Establishment and evaluation of the centralized examination reservation center with multidepartment cooperation

  Liu Ruihong, Zhu Li, Zhang Chuanmeng, Zhang Ji, Wang Hailan, Zhang Xiaohong.

  journal1. 2020, 27(6): 544-548. https://doi.org/10.3969/j.issn.1006-5253.2020.06.017

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  Objective To evaluate the practice effect of multi-department collaborative centralized examination reservation center. Methods Through practical measures such as personnel and environment configuration, reservation information software development, system improvement and process optimization, the centralized examination reservation center with multi-department cooperation was established. This study intends to evaluate the operation practice of the examination reservation center. Results Compared with those before centralized appointment examination, the patient′s examination appointment time and waiting time significantly shortened. Among them, the time of CT decreased from (22.4±4.1) minutes and (9.0±2.6) minutes to (14.1±3.6) minutes and （5.5±1.3） minutes, respectively (P<0.001); the time of B-ultrasound decreased from （28.7±5.6) minutes and (11.3±3.8) minutes to (22.4 ± 4.9) minutes and (8.8±2.6) minutes respectively (P<0.001); and the time of MRI decreased from (75.2±13.4) minutes and (54.4±8.6) to (24.3±5.2) minutes and (6.8±2.1) minutes (P<0.001). The average hospital stay of the patients decreased from (11.4±3.9) days to (6.8±2.1) days (P<0.001), and examination satisfaction significantly improved (P<0.001). At the same time, compared with those before centralized appointment examination, the monthly outpatient visits and examinations have increased significantly. Among them, the monthly outpatient visits increased from (11 897.0±322.9) cases to (13 763.0±304.6) cases (P<0.001); the number of monthly CT examinations increased from (4 378.4±135.5) times to (6 873.5±201.4) times (P<0.001); the number of monthly B-ultrasound examinations increased from 2 765.3±112.3 times to (3 618.6±135.6) times (P<0.001); and the number of monthly MRI examinations increased from (496.7±34.8) times to (884.3±54.3) times (P<0.001).  Conclusion The smooth development of multidepartment collaborative centralized examination reservation center helps to improve patients′ medical experience, increase the economic benefits of hospital resources, and improve the work efficiency of examination.
  
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  Analysis on the trend of hospitalization and death of key monitoring diseases in a tertiary hospital from 2015 to 2019

  Zhang Guanrong.

  journal1. 2020, 27(6): 549-553. https://doi.org/10.3969/j.issn.1006-5253.2020.06.018

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  Objective To analyze the changes of hospitalization and mortality of key monitoring diseases in a hospital, and the influencing factors of death of inpatients with acute myocardial infarction (AMI). Methods Data of discharge summary records were collected of patients with 18 key monitoring diseases admitted to a hospital between 2015 and 2019. Trend analysis was used to explore the changes of hospitalization and mortality of diseases, and mixed effect logistic models were used to assess the risk factors of death of AMI inpatients. Results From 2015 to 2019, the number of inpatients with key diseases increased yearly, with an estimated annual percentage change of 9.72%, while the inpatient mortality showed a decreasing trend (χ2=13.97，P<0.001). The main influencing factors of inpatient death of AMI were clinical pathway, older age and critical illness. Conclusion The capacity and quality of medical service for key diseases in this hospital has gradually improved since 2015. The implementation of clinical pathway and intensive care for highrisk patients can be beneficial to reduce the nosocomial mortality, and improve the medical quality.
  
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  R markdown and its application in repetitive hospital statistical analysis report

  Han Dong, Ye Yunshao

  journal1. 2020, 27(6): 554-557. https://doi.org/10.3969/j.issn.1006-5253.2020.06.019

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  It is often necessary to write periodic reports in hospital statistical work, but the separation of data analysis and completed reports will lead to low efficiency and errors. This article introduces the basic syntax of markdown and the Rlanguage rmarkdown and knitr software packages, taking the common content of hospital statistics as an example, in order to demonstrate the function of generating analysis reports based on R markdown documents. Using R markdown documents to write periodic reports can effectively improve the work efficiency of hospital statisticians, reduce the error rate of reports and easily trace the source of errors.
  
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  Exploration of WeChat platform for the learning of medical statistics in teaching practice

  Zhang Qi, Du Zeyu, Chen Yimin, Zhu Shuming, Lin Zhuochen, Ge Qi, Gu Jing, Zhang Jinxin.

  journal1. 2020, 27(6): 558-560. https://doi.org/10.3969/j.issn.1006-5253.2020.06.020

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  Medical statistics is a discipline mainly focused on application. It is necessary for students to fulfill enough assignments in order to grasp the statistical theory well. If statistical software is used when they accomplish the assignments of medical statistics, they may pay more efforts on digesting and absorbing the special logics in statistics instead of only repeating what is taught in class. This will make them experience more on how to solve the practical questions by choosing proper and flexible statistical methods. Since the detailed definitions and options will cost too much time in class, it is not allowed to provide the complete instructions by the lecturer. The teaching team from Sun Yatsen University established a WeChat platform (yxjtx2015) for students majoring in medical sciences and medical researchers in order to help them to accomplish the statistical computations in the environment of SPSS and SAS, what′s more, to learn well the critical concepts in medical statistics, especially those correlated with important statistical techniques. We introduce the WeChat platform briefly in this article so as to bring convenience for a larger audience who will take medical statistics as tools in their own researches. 
  
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  Influence of admission conditions on the classification of diseases

  Zhong Qianjun, Huang Liyan, Li Huixia.

  journal1. 2020, 27(6): 561-563. https://doi.org/10.3969/j.issn.1006-5253.2020.06.021

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  Objective The condition of admission on the first page of the medical record has a certain influence on the code of diagnosis of the same disease.Through retrospective analysis of 3 typical discharge disease diagnosis cases of moderate anemia, intrauterine device, and pubic symphysis of pregnancy, this paper analyzes the influence of admission conditions on the diagnostic code of the same disease, improves the accuracy of the code, and improves the quality of the data on the first page of medical records. Methods According to the basic coding rules of the International Classification of Diseases, this paper analyzed the influence of admission conditions on the diagnosis code of the same disease in three typical cases of discharge diagnosis, namely, moderate anemia, intrauterine device, and pubic symphysis separation of pregnancy. Results In the discharge diagnosis of the same disease on the first page of the medical records, the classification and coding of the disease are different according to whether the patient is diagnosed or not at the time of admission.The accuracy of admission information directly affects the accuracy of disease classification code. Conclusion Coders have to code more precisely, classifying not only the naming, nature, development, and pathology of the disease, but also the diagnosis of the disease at the time of admission. As to the diagnosis of the same disease, the admission condition is different, so the disease code is also different.
  
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  Code analysis of Lauge-Hansen typing of ankle fracture

  Liu Jiyang.

  journal1. 2020, 27(6): 564-567. https://doi.org/10.3969/j.issn.1006-5253.2020.06.022

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  Objective As a common disease in orthopedic clinic, ankle fracture is usually classified, diagnosed and treated by Lauge-Hansen standard, and coders should establish the corresponding relationship between them through ICD-10. Methods By understanding the anatomical structure of the ankle bone, five types of Lauge-Hansen classification, such as supination-external rotation, pronation-external rotation, supination-internal adduction, pronation-external abduction and vertical compression, were deeply understood, and were analyzed by ICD-10. Results The ICD-10 codes of supination-external rotation type, pronation-external rotation type, pronation-internal adduction type, supination-external abduction type and vertical compression type were established respectively according to their respective damage mechanism, specific index and involved sites. Conclusion Coders should not only be familiar with the specific connotation of Lauge-Hansen classification, but also need to combine the course records, operation records and important positive signs of imaging examination to ensure the obvious complications and concomitant symptoms of fracture were not omitted for coding.
  
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  Review of the comprehensive evaluation methods of quality of care

  Wang Chao, Liu Meina.

  journal1. 2020, 27(6): 568-571. https://doi.org/10.3969/j.issn.1006-5253.2020.06.023

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  The comprehensive evaluation of the quality of care is one of the effective methods to measure the overall treatment quality of medical service institutions. This article summarizes the existing comprehensive evaluation methods of non-latent variables and latent variables. It aims to provide ideas for a reasonable and comprehensive evaluation, and promote that it could not only provide an objective basis for the improvement of the quality of care of hospitals and doctors, but also achieves the purpose of connecting hospital grades and doctors' performance.
  
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  Introduction to data visualization specification and discussion on its key elements

  Guo Zhiwu.

  journal1. 2020, 27(6): 572-576. https://doi.org/10.3969/j.issn.1006-5253.2020.06.024

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  Data analysis and data visualization has been widely used in various industries. This article introduces the main content of IBCS, Material Design data  visualization design specifications and AntV data visualization specifications, and discusses the key elements of data visualization specifications.