Objectives This study aimed to assess whether the national centralised volume-based procurement policy and the Shanghai government’s supportive measures (coronary stent policies) implemented in Shanghai, China, on 20 January 2021 affected the cost-effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in the year after surgery.Design A retrospective cohort study based on real-world data and propensity score (PS)-matched data was conducted to compare the cost-effectiveness of PCI before and after policy implementation.Patients and setting Patients with ACS who had undergone first-time PCI over 1 year previously in hospitals in Shanghai and were discharged between 1 March 2019 and 30 April 2022 were included in the study.Outcome measures In the present study, cost was defined as total direct medical expenses, and effectiveness was defined as the prevention of major adverse cardiac events (MACEs). Incremental cost-effectiveness ratios (ICERs) were used to measure the cost-effectiveness of PCI in patients with ACS 1 year after surgery.Results The study included 31 760 patients. According to real-world and PS-matched data, the implementation of coronary stent policies in Shanghai reduced the total medical cost of patients with ACS 1 year after PCI by 24.39% (p<0.0001) and 22.26% (p<0.0001), respectively. The ICERs were ¥−1131.72 and ¥−842.00 thousand per MACE avoided, respectively. The ICERs were robust to parameter uncertainty, and there was a substantial chance for policy implementation to improve the cost-effectiveness of PCI among patients with ACS in the short term.Conclusions The implementation of coronary stent policies has improved the cost-effectiveness of PCI for patients with ACS in the short term. The long-term impact of coronary stent policies on the cost-effectiveness of PCI in patients with ACS or other coronary heart diseases should be assessed in the future.

Objective This study aimed to analyze the effect of coronary stent policies implemented in Shanghai on the risk of percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) inpatients based on real-world data. Methods Two retrospective cohorts of inpatients with a first diagnosis of ACS who had undergone PCI for the first time in the previous year in Shanghai hospitals were examined (one for the postpolicy period and the other for the prepolicy period). χ2 tests were used to compare categorical variables between the two cohorts. Single- and multivariate Cox proportional hazards models were used to compare the risk of major adverse cardiovascular events (MACEs) between the two cohorts. Results A total of 31,760 ACS patients were included in this study. The proportion of ACS inpatients who had at least one bid-winning stent and 3 or more coronary stents implanted for first-time PCI in the postpolicy cohort was higher than that in the prepolicy cohort (86.52% vs. 55.67% and 6.27% vs. 4.39%, respectively; all p values < 0.0001). The single- and multivariate Cox proportional hazards models revealed that the unadjusted and adjusted hazard ratios for MACEs at 1 year after PCI for the postpolicy cohort relative to the prepolicy cohort were 0.869 (P<0.0001) and 0.814 (P = 0.0007), respectively. Conclusions The implementation of coronary stent policies changed coronary stent utilization but had no significant adverse effects on the risk of PCI among ACS patients in Shanghai in the short term. However, the reasons for changes in the number of coronary stents implanted should be analyzed and addressed in the future.

目的 分析2022年和2021年上海市公立医疗机构门诊患者满意度.方法 通过对2022年和2021年上海市公立医疗机构门诊患者的问卷调查,分析门诊患者对医疗服务的满意率和满意度评分,了解门诊患者希望得到改善的医疗服务,并采用多层广义线性混合模型比较了2022年与2021年的满意度评分.结果 2022年和2021年上海市公立医疗机构门诊患者的总体满意率分别为96.60%和95.30%,总体满意度分别为4.83分和4.76分,且多层广义线性混合模型显示在控制其他因素后,2022年门诊患者总体满意度和对医生服务满意度的评分均高于2021年.但是,被调查的门诊患者认为门诊等候时间、就医环境、医疗服务态度与沟通、适老化服务等方面还需要改善.结论 上海市公立医疗机构门诊患者满意度保持高水平,但还需根据患者的关切不断改善.

Objective:To review systematically the management of medical support for large-scale events.Method:The relevant literatures published between January 2011 and November 2021 that met the requirements were obtained by searching the databases of CNKI,Wanfang Database, PubMed and Web of Science.Result:Systematic review showed that the management of medical support for large-scale events involved organizational structure, program planning, management of personnel, materials and on-site medical services, support of information technology, as well as document management.However, no relevant normative documents or guidelines were found in our country.Conclusion:Considering medical support for large-scale events is a systematic program, the guidelines or normative documents for medical support for large-scale events should be made, the management of medical support for large-scale sport events should be improved, and the relevant research should be strengthened in China.

目的 分析上海市公立医疗机构门诊和住院患者对医患共享决策和医疗价值的感知.方法 通过对2022年和2021年上海市公立医疗机构门诊和住院患者的问卷调查,分析患者对医患共享决策和医疗价值的感知,并采用多层广义线性混合模型分析影响患者对医患共享决策和医疗价值评价的因素.结果 2022年和2021年,上海市公立医疗机构门诊患者相比于医疗服务的医疗费用合理性评分均值分别为4.79分和4.71 分,住院患者对医患共享决策和医疗价值总体评分均值分别为4.46分和4.50分.但2022年81.87%和80.55%的住院患者认为自费外购药物或器械会增加医疗不便和经济负担,比2021年(74.85%和72.43%)显著增加.此外,多层广义线性混合模型分析显示,患者对医患共享决策和医疗价值的感知受患者社会人口特征、健康状况、门诊就诊时间和诊疗状况等因素影响.结论 医疗服务的提供不能忽略患者的社会属性,应更多考虑患者的期望与偏好,以体现高质量发展和价值竞争的核心.

目的 分析门诊患者预约、就诊总时间与总体满意度的关联性,为持续提升患者满意度提供决策参考.方法 于2022年和2021年在上海市公立医疗机构开展了门诊患者问卷调查.采用多分类logistic回归分析和多层广义线性混合模型分析门诊患者预约、就诊总时间与总体满意度的关联性.结果 2022年上海市公立医疗机构门诊患者预约率为67.87%,就诊总时间小于2小时的比例为70.92%,部分门诊检查预约天数小于7天的比例为89.33%,比2021年分别增加了7.4、5.4和5.0个百分点.研究显示,门诊预约可减少门诊就诊总时间,而缩短门诊就诊总时间可提高门诊患者总体满意度和向亲朋好友推荐就诊医疗机构的意愿.此外,门诊老年患者预约率显著低于非老年患者(2022年分别为43.67%和72.91%,2021年分别为35.17%和66.51%).结论 门诊便捷就医服务提高了门诊预约率、降低了门诊就诊总时间、提高了门诊患者满意度,但需提高门诊老年患者预约率、门诊医疗资源有效利用的效率.

通过检索国内外6个文献数据库以获取2010年1月～2020年7月干细胞制备伦理风险的文献,并对不同类型干细胞制备过程中存在的伦理风险进行系统性综述.对64篇与干细胞制备伦理风险相关的纳入文献进行分析后发现,干细胞制备过程的伦理风险不仅涉及生物材料供体和组织来源的选择,还涉及干细胞制备各个环节的安全性.鉴于目前干细胞的制备技术尚未成熟,建议干细胞制备过程中应严格控制生物材料供体和组织来源,不断改进制备工艺,控制制备过程质量,以确保人体移植的安全性.

目的 分析上海市3所三级公立医院专家对以国家三级公立医院绩效考核指标为主的定量绩效考核指标引入职能部门定量绩效考核的认知.方法 通过2轮医院管理、临床和医技专家的咨询,了解他们对医院职能部门定量绩效考核的认知.结果 咨询专家对以国家三级公立医院绩效考核指标为主的定量绩效考核指标引入职能部门定量绩效考核,总体评价不高,各级指标重要性评分均未超过9.00分(满分10分).对质量安全和学科建设中的部分指标以及医务人员满意度的重要性评分相对较高,而对患者满意度的重要性评分不高.结论 质量安全和学科建设应是三级公立医院职能部门定量考核的重点,但患者满意度和医务人员的满意度也应受到关注.

目的 分析国家谈判机制和基本医疗保险覆盖对非小细胞肺癌患者靶向药物使用状况的影响.方法 收集上海市胸科医院2018年2月—2019年8月每月非小细胞肺癌靶向药物使用情况的数据,利用间断时间序列模型分析使用趋势,采用多层logistic回归模型分析影响因素.结果 5种靶向药物通过国家谈判并纳入上海市基本医疗保险后,上海市胸科医院门急诊和住院非小细胞肺癌患者(上海市)平均每月使用5种靶向药物的总人次数分别增加5.09倍和18.89倍.结论 国家谈判机制和基本医疗保险的覆盖大幅增加了靶向药物的可及性.

对干细胞生物材料来源及其伦理风险进行系统性综述.干细胞生物材料来源主要有骨髓、脂肪、胚胎、脐带等组织.本次纳入的178篇有关不同来源的干细胞伦理风险文献中,近60％篇次是特指间充质干细胞、胚胎干细胞和造血干细胞的伦理风险,且对生物材料供者和干细胞受者以及社会伦理风险关注最多的是胚胎干细胞相关风险.此外,供者的伦理风险主要在招募、知情同意、公平性等方面.作者建议干细胞来源的生物材料供者应该得到充分的知情同意,干细胞生物材料的获取需要有严格的伦理管控,以使干细胞研究更符合伦理规范,保护供者的权益.

ObjectiveTo analyze the effectiveness and safety of clinical use of different types of stem cells to provide evidence for governmental supervision of key issues in clinical utilization of stem cells.MethodsSix literature databases in China and abroad were searched for relevant literature published from January 2010 to July 2020， and a systematic review was conducted.ResultsThe study showed 72 studies concerning the effectiveness and safety of different types of stem cells in clinical utilization. Although clinical utilization of stem cells had some therapeutic effects for certain diseases， their long-term effect and safety need to be further evaluated， especially their potential risk of tumorigenicity.ConclusionTo protect the patients’ interest， physicians should fully weigh the benefits against the risks of clinical utilization of stem cells， and relevant governmental departments should strengthen supervision of ethics of clinical research and therapies involving stem cells as well as supervision of stem cell products.

通过检索国内外6个文献数据库以获取发表于2010年1月～2020年7月研究相关的文献,并对干细胞来源的生物材料采集的供者健康风险进行了系统性综述.50篇相关文献分析显示,在许多情况下,生物材料采集可使供者承受健康风险,包括麻醉、粒细胞集落刺激因子或促排卵药物使用、中心静脉导管放置、穿刺等带来的风险.此外,生物材料采集还可影响供者的心理健康.根据上述发现,建议干细胞来源的生物材料采集需要严格的伦理管控,以保障生物材料供者的健康权益.

目的 在控制门诊患者的人口学和临床特征后,比较不同类型公立医疗卫生机构的门诊患者满意度,为公立医疗卫生机构和卫生行政部门开展绩效考核提供参考信息.方法 对上海市107所公立医疗卫生机构开展门诊患者满意度问卷调查,通过多层混合线性模型分析和Snijders?&Bosker法比较不同类型公立医疗卫生机构的门诊患者满意度.结果 在控制医疗卫生机构的随机效应以及其他固定效应后,公立三级综合医院和三级专科医院的门诊患者满意度相对较低,且高住院病例组合指数组医院的门诊患者总体满意度和对医生服务满意度有走低趋势.此外,公立医疗卫生机构类型可解释69.13％的机构间门诊患者总体满意度差异.结论 诸多因素可能导致公立三级医院门诊患者总体满意度相对较低,医疗卫生机构应聚焦于可控因素以提升门诊患者满意度.

目的 分析公立医院职能部门绩效考核与绩效薪酬的意义、存在的问题,并提出改善建议.方法 通过查阅国内外相关文献数据库(如中国知网、OVID)、已出版的书籍、政府网站等,收集相关文献.结果 加强公立医院职能部门绩效考核并使之与绩效薪酬密切挂钩,可促进医院高质量发展.但目前我国公立医院职能部门的绩效考核仍存在一些问题.结论 在公立医院高质量发展时期,公立医院职能部门绩效考核应与医院发展战略相联系、定性与定量考核相结合,使定量考核指标反映医院质量与效率并具有可靠性,同时职能部门绩效薪酬应具有引导性和公平性.

目的 分析上海市公立医疗卫生机构出院患者对医疗服务的满意度及满意度测评方法的利弊,为完善住院医疗服务及其满意度测评方法提供决策参考.方法 就上海市99所公立医疗卫生机构出院患者对医疗服务的满意度开展电子问卷调查.结果 2020年上海市公立医疗卫生机构出院患者对医疗服务总体满意度的平均分为4.58分,总体满意率为90.78％.出院患者对住院伙食或治疗饮食的不满意或较不满意率为6.35％.与对住院患者的调查结果相比,出院患者的调查应答率较低且存在应答对象偏倚,从中可更多了解患者的抱怨并提出改善建议.结论 上海市公立医疗卫生机构需进一步加强住院患者的伙食管理,住院患者或出院患者调查需提高可靠性.

目的 分析上海市3所三级公立医院医务人员对所在医院职能部门管理人员绩效考核与绩效薪酬分配的认知.方法 通过问卷调查,了解医务人员对所在医院职能部门管理人员绩效考核与绩效薪酬分配的认知.结果 被调查的医务人员总体上认为所在医院职能部门管理人员绩效考核与绩效薪酬分配良好,但对绩效考核制度了解程度不高,对管理人员绩效考核过程的透明度和管理人员之间绩效薪酬水平差异性的恰当性评价不高.超过半数的被调查管理者认为未来职能部门管理人员的平均绩效薪酬应为医生平均绩效薪酬的0.9倍或1.0倍.结论 公立医院应完善职能部门管理人员的绩效考核与绩效薪酬制度,职能部门管理人员绩效薪酬的平均水平不应显著低于医生的平均水平.

In the paper， national and international ethical requirements and supervision on stem cell research and clinical application were analyzed after literature review. It is suggested that the development of stem cell technology should be timely tracked， prospective ethical research related to stem cells should be enhanced， and that stem cell research and clinical translation should comply with relevant international ethical guidelines and national regulations in China. In addition， it is indicated that the oversight of stem cell products and their clinical use will be continuously improved in our country.

目的 分析2020年上海市公立医疗卫生机构的门诊患者满意度,为上海市公立医疗卫生机构改善服务质量和卫生行政部门加强服务质量的监管提供决策依据.方法 对上海市107所公立医疗卫生机构进行门诊患者满意度调查.结果 门诊患者对医疗服务满意度的总体评分平均为4.78分,但门诊患者对等候时间不满意或较不满意率相对较高.此外,机构间总体满意率差异较大.结论 2020年上海市公立医疗卫生机构门诊患者的满意度处于高水平,但部分公立医疗卫生机构应采取有效措施提高患者满意度,门诊等候时间应进一步缩短.

目的 分析5种靶向药物的基本医疗保险政策改变对非小细胞肺癌靶向药物费用的影响.方法 收集上海市胸科医院2018年和2019年各月非小细胞肺癌靶向药物的使用人数和费用数据,并利用间断时间序列模型进行费用趋势分析.结果 5种靶向药物通过国家谈判和纳入上海市基本医疗保险后,上海市胸科医院的上海市非小细胞肺癌门急诊和住院患者5种靶向药物的平均每月人均总费用降幅达80％左右,而其他靶向药物的此项指标较政策实施前出现了下降趋势.结论 基本医疗保险政策可有效降低昂贵药物的价格.

目的 分析上海市A区3所区属公立综合医院3个代表性病种的住院抗菌药物的使用合理性.方法 通过病案评阅,分析3个代表性病种的抗菌药物使用的合理性.结果 住院急性单纯性/化脓性阑尾炎(行腹腔镜阑尾切除术)、社区获得性肺炎和输尿管结石(行输尿管镜碎石取石术)的抗菌药物使用不规范且医院间存在较大的差异,有预防性抗菌用药不合理或抗菌药物用药超量的问题.结论 应通过强化管理改变医疗机构及其临床医师抗菌药物的不合理使用习惯.