目的 提出中心化平均住院日和标准化平均住院日的概念和计算方法,并研究二者作为绩效指标的有效性,为科学评价医院运行效率提供思路.方法 基于统计理论给出中心化平均住院日和标准化平均住院日的计算方法,利用2021 年上海市30余家三级甲等医院数据,比较中心化平均住院日、标准化平均住院日、平均住院日及时间消耗指数,并进行统计分析.结果 中心化平均住院日和标准化平均住院日具有消除数据偏移和量纲差异的优势,可以更合理地反映医院工作效率,减少医方为降低平均住院日指标,进而挑选患者、推诿疑难危重症患者的可能性.结论 中心化平均住院日和标准化平均住院日可以作为医院绩效评价中较为合理、有效的指标,有助于提高医院绩效评价的准确性和合理性,对医疗管理和运营决策有重要意义.

长三角生态绿色一体化发展示范区是实施长三角一体化发展战略的先手棋和突破口.本文通过探讨如何通过中医医联体全面建设来增强区域医疗联动的发展,以期不断强化中医药资源配置和优化中医药资源布局,汇聚名医名家人才和技术,搭建长三角的中医特色优势服务平台,进而实现一体化示范区中医医疗技术下沉、人才持续培养、医疗资源合理、百姓就医方便的目标.

疾病诊断相关分组(DRG)支付方式作为医保支付制度改革的重要举措,目前在全国范围内推行.2021年上海市中医医院确定为试点医院.医院通过DRG数据PDSA质控环建设,提高上传数据质量;建立新的管理模式,迎接DRG支付挑战;立足于医联体建设,探索DRG支付应用等多方面的实践探索.医院2021年1月—2021年9月病史上报率达到100％,核心数据质控通过率达到100％,2021年1月—2021年8月稳定组DRG支付率为101.74％.医院病种支付补偿率明显提高,医院运营状况得到明显改善.

为深入贯彻落实国家卫生健康委员会、国家中医药管理局《关于印发医疗联合体管理办法(试行)的通知》和上海市《关于进一步推进上海市中医医疗联合体建设和发展工作的通知》有关要求,结合中医医联体建设的不断推进,进一步加强基层骨干中医师的培养,不断提升基层中医药服务能力,探索建立医联体内双向人员互聘、柔性流动制度,促进医联体内部资源的紧密协同,上海市卫生健康委、上海市中医药管理局决定自2020年起定期举办上海市中医医联体基层骨干研修班,对此进行了分析探讨.

目的 观察辨证分型治疗遗忘型轻度认知损害的疗效.方法 选择遗忘型轻度认知损害患者158例,根据辨证进行分型,对最常见的4种证型进行干预,每种证型内均随机分为观察组和对照组.观察组按照辨证分型分为4组:肾精亏虚型,使用地黄益智方;痰浊蒙窍型,使用半夏白术天麻汤;气血不足型,使用归脾汤;瘀阻脑络型,使用血府逐瘀汤.所有中药每天2次,每次1袋.对照组患者使用茴拉西坦胶囊,每天3次,每次200 mg.所有患者治疗周期均为6个月.分别记录治疗前后各组患者简易智能量表(MMSE)、治疗有效率、蒙特利尔认知评估量表(MoCA)、阿尔茨海默病评价量表-认知分表(ADAS-Cog)、日常生活能力评定量表(ADL)和中医证候积分量表的变化,并对检测值进行统计学分析和比较.结果 所有患者治疗后MoCA和MMSE分值升高,ADL、ADAS-Cog和中医证候积分较治疗前降低,差异均有统计学意义(P＜0.05).观察组在MoCA、ADAS-Cog和中医证候积分较对照组改善明显,而MMSE和ADL积分差异均无统计学意义(P＞0.05).肾精亏虚和气血不足型中的观察组在MoCA、中医证候积分、MMSE、ADAS-Cog、ADL积分方面相较于对照组的效果得到明显改善.痰浊蒙窍和瘀阻脑络型中观察组在MoCA、ADAS-Cog、中医证候积分较对照组的效果得到明显改善,在MMSE、ADL积分比较差异无统计学意义(P＞0.05).所有患者治疗前后血、尿、肝肾功能等安全性指标均正常.有效率方面,观察组显效8例,有效38例,无效12例,总有效率79.3％.对照组显效5例,有效27例,无效27例,总有效率54.2％.观察组比对照组更有效(P＜0.05).结论 辨证分型治疗遗忘型轻度认知损害,疗效显著,有效率更高,可以改善患者生活质量.

目的:研究乳腺癌患者先天运气学特征分布情况与后天发病的相关性.方法:选取2013年1月至2020年12月在上海市仁济医院和上海市中医医院住院的乳腺癌患者954例作为研究对象,探索乳腺癌患者的出生日期在不同季节、天干、岁运、主气、客气、司天之气、在泉之气、运气相合特点的分布差异性.结果:乳腺癌患者的出生日期在不同天干、岁运和主气分布方面存在显著差异性.出生日期天干为丁年,岁运为木运,主气为阳明燥金时段者,更易罹患乳腺癌;出生日期天干为辛年,岁运为水运,主气为少阴君火时段者,不易罹患乳腺癌.另外,出生在非平和之年者(天符年、同天符、太乙天符、小逆年、不和年、天刑年、非平气之年),罹患乳腺癌的概率显著高于出生在平和之年(岁会年、同岁会、顺化年、平气之年)者.结论:人群乳腺癌后天的发病与先天的运气学禀赋有一定的相关性.

Objective:To analyze the clinical effect of ezetimibe combined with rosuvastatin in the treatment of early onset coronary atherosclerotic heart disease(CHD)acute myocardial infarction.Methods:A total of 100 patients with acute myocardial infarction with early CHD were enrolled in department of Cardiology in Shanghai Traditional Chinese Medicine Hospital from January 2019 to December 2020, including 54 males and 46 females, aged(56.2±6.3)years old, ranging from 45 to 77 years old.According to the treatment methods, they were divided into ezetimibe group and combination group, with 50 patients in each group.Patients in both groups were treated with conventional treatment measures, ezetimibe group was treated with ezetimibe tablets, and combination group was treated with ezetimibe tablets combined with rosuvastatin tablets.The clinical treatment effect, serum lipid indexes, serum inflammatory factors indexes and the incidence of adverse reactions were compared between the two groups before and after treatment.Results:The total effective rate in the combination group[92.0%(46/50)]was higher than that in the ezetimibe group[76.0%(38/50)], and the difference was statistically significant( χ2=4.762, P=0.029). After treatment, triglycerides[(1.4±0.3)mmol/L]and total cholesterol[(3.0±0.6)mmol/L]in the combination group were lower than those in the ezetimibe group[(2.1±0.5)mmol/L, (4.0±0.8)mmol/L]. Tumor necrosis factor-α[(20.6±5.2)ng/L]and interleukin-6[(120.3±17.5)ng/L]in the combination group were lower than those in the ezetimibe group[(35.4±6.0)ng/L, (161.6±20.5)ng/L], with statistical significance( P<0.05). There was no significant difference in the incidence of adverse reactions between ezeimibe group [8.0%(4/50)]and combination group[6.0%(3/50)], ( χ2=1.238, P=0.114). Conclusion:Ezetimibe combined with rosuvastatin has high efficacy and safety, can effectively reduce the level of blood lipid in patients with CHD, delay the progression of the disease, so as to improve the treatment effect of acute myocardial infarction, and is worthy of promotion.

在分析经典理论教学现状与重要性的基础上,从多方位设计经典理论教学在实习阶段的教学方案,改革教学方法,最终对改革效果进行调查,总结经验.文章探索中医经典课程教学模式和改革思路.

Abstract Background Mild cognitive impairment (MCI) is generally considered a transitional stage between normal aging and AD dementia. This study aimed to analyze the efficacy of Di-Huang-Yi-Zhi (DHYZ) formula in treating amnestic Mild Cognitive Impairment (aMCI) for the patients in high altitude area (Qinghai Tibet Plateau). Method: A total of 106 patients in Shigatse, Tibet were randomly allocated into two groups. One group were to receive DHYZ decoction (150 ml each time, twice a day), the other group were to have aniracetam capsule (200 mg each time, three times a day) ,with 53 patients in each group. Changes in neuropsychological scales including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), the Barthel Index for activities of daily living (ADL) and TCM symptoms were detected during a 12-month treatment period. After one year follow-up, the conversion rate of AD was observed. Result There was no significant difference between the two groups in baseline characteristics and scale scores (P > 0.05). Compared with the aniracetam group, the DHYZ group showed statistically higher MMSE and MoCA score and lower TCM score at the 9-month and 12-month. In addition, the ADAS-Cog and ADL scores in DHYZ group at 12-month were lower than that in the aniracetam control group. After one year follow-up, the conversion rate of AD in DHYZ group was 10% (5/50), and aniracetam group was 15.69% (8/51). The conversion rate of AD in DHYZ group was significantly lower than that in aniracetam group. Conclusion DHYZ formula can improve the cognition behavior and global function of patients with aMCI, it can also delay the conversion to AD. This is represents a new treatment option for the patients.

目的:急诊科临床实习中引入微课视频教学法及Mini-CEX教学评估法,使学生们能更好地掌握急诊科重点疾病、临床操作等问题的一般处理模式.方法:学生按照实习批次随机分为教改组及常规组,在实习结束后通过考试比较两组教学成绩差异;问卷了解教学效果的优劣.结果:教改组成绩优于常规组,问卷结果也优于常规组.结论:微课与Mini-CEX结合在急诊临床实习所获取的教学效果优于常规临床实习教学.

Objective To observe effect and safety of Lishukang capsules in treatment of patients with lacunar infarction accompanied by vertigo.Methods Clinical data of 80 patients with lacunar infarction accompanied by vertigo during November 2014 and February 2016 was retrospectively analyzed,and the patients were divided into treatment group and control group (n =40 for each group) according to treatment methods.Control group was treated with routine treatment,decreasing level of blood lipids and improving cerebral circulation,while treatment group was treated with Lishukang capsules on the basis of treatment for control group.The treatment was lasted for 2 weeks.Transcranial Doppler (TCD) indexes,total effective rate,times and duration of vertigo attacks and improvement conditions were observed between the two groups before and after treatment.Results The total effective rates for neural function and vertigo in treatment group were significantly higher than those in control group (P ＜ 0.05).Improvement conditions of TCD indexes (Vp,Vm and Vd) in low flow state and high flow state in middle cerebral artery and basilar artery in treatment group were significantly better than those in control group (P ＜ 0.05).After treatment,the values of frequency and duration of vertigo in treatment group were significantly lower than those in control group (P ＜ 0.05).Conclusion Lishukang capsules is safe and effective in treatment of patients with lacunar infarction accompanied by vertigo.It can significantly reduce the frequency of vertigo,shorten the duration of vertigo and improve condition of cerebral blood flow.

OBJECTIVE:To observe the effects and safety of Congrong yishen granule combined with Donepezil hydrochloride tablet on mental state and quality of life in patients with Parkinson disease with dementia(PDD). METHODS:A total of 60 PDD patients were randomized into control group and treatment group,with 30 cases in each group. Both groups were given drugs for Parkinson disease. Control group was additionally given Donepezil hydrochloride tablet 5 mg,qd;treatment group was additionally given Congrong yishen granules 2 g,bid,on the basis of control group. The treatment lasted for 6 months in both groups. MMSE, MoCA,ADAS-Cog,ADL-R and TCM symptom score were observed in 2 groups before and after treatment. The occurrence of ADR were compared between 2 groups. RESULTS:Before treatment,there was no statistical significance in MMSE,MoCA, ADAS-Cog,ADL-R or TCM symptom score between 2 groups (P>0.05). After treatment,MMSE and MoCA score of 2 groups were increased significantly,while ADAS-Cog,ADL-R and TCM symptom score were decreased significantly;the treatment group were better than the control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups. CONCLU-SIONS:Congrong yishen granule combined with donepezil hydrochloride tablet can significantly improve mental state and cogni-tive ability of PDD patients,and relieve clinical symptoms with good safety.

血管性认知损害是近年来临床关注的热点,非痴呆型血管性认知损害是血管性认知损害最常见的亚型及早期表现.因而,积极防治非痴呆型血管性认知损害对延缓痴呆的发生意义重大.文章即介绍使用中医药补肾填精、开窍活血法对非痴呆型血管性认知损害进行干预的成果.

Amnestic mild cognitive impairment (aMCI) represents the early stage of Alzheimer disease (AD). Early diagnosis and treatment of aMCI is essential for preventing AD conversion. To investigate the effects of Di-Huang-YiZhi (DHYZ) formula in aMCI. We perform a prospective, open-label and parallel-control trial, with aniracetam treatment as a positive control. After randomization, patients in DHYZ group were administered with orally with DHYZ decoction (75 ml each time, twice a day) in 12 months. Patients in aniracetam group received aniracetam tablet (400 mg each time, three times a day). The efficacy outcome included score changes in mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), the Barthel Index for activities of daily living (ADL) and Traditional Chinese medical (TCM) symptoms before and after treatment. Patients showed significant improvement in scores in MMSE, MoCA, ADAS-Cog, ADL and TCM (P < 0.05) after treatment in both groups. Meanwhile, more obvious changes were obtained in patients with TCM treatment than those with aniracetam treatment (P < 0.05). Considering the primary outcome in TCM syndrome score scale, there was a remarkable improvement on memory before and after treatment, while changes in score were more obvious after DHYZ treatment compared to that after aniracetam treatment (P < 0.05). Additionally, both DHYZ and aniracetam treatment were safe and well-tolerated. The traditional medicine DHYZ formula is effective for treating patients with aMCI and preventing AD conversion from MCI.

Objective To observe the therapeutic effect of cong-rong-yi-shen granule for the patients with vascular cognitive impairment with no dementia( VCIND) . Methods Sixty VCIND patients were randomized into control group and treatment group with 30 cases in each group. On the basis of the treatment targeting risk factors of blood vessels,patients in the treatment group were treated with cong-rong-yi-shen granule,while those in the control group were treated with Aniracetam. The therapeutic course was six months. The clinical effect was observed through mini-mental state examination ( MMSE ) , Montreal cognitive assessment(MoCA),activities of daily living(ADL), scores of Chinese medical symptoms before and after the treatment. Results After the treatment, the scores of MMSE, MoCA were significantly increased,while the scores of Chinese medical symptoms decreased in both groups(P<0. 05 or P<0. 01). Treatment group showed obvious effects in the score of MMSE and scores of Chinese medical symptoms&nbsp;compared with control group. There was no significant difference in blood routine,urine,stool routine,liver function,renal function and cardiogram after the treatment in both groups. Conclusions Cong-rong-yi-shen granule is effective for VCIND.

目的：观察银杏酮脂片治疗血管性认知功能损害非痴呆型病人的临床疗效。方法将60例血管性认知功能损害非痴呆型病人随机分为治疗组和对照组各30例。两组均予以脑血管基础治疗措施，治疗组在此基础之上加用银杏酮脂片，对照组加用盐酸多奈哌齐。两组疗程均为4个月，观察简易智能精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MOCA)、日常生活活动量表(ADL)。结果两组治疗后MMSE、MOCA、ADL评分均较治疗前明显改善(P<0.05)，治疗组ADL积分改善较对照组更明显(P<0.05)。结论银杏酮脂片可改善血管性认知功能损害非痴呆型病人的认知功能，疗效与盐酸多奈哌齐相当，日常生活能力改善较盐酸多奈哌齐有效。

Mini-CEX是一种评价医师临床能力的测评工具.中医思维实训室是锻炼实习生临床思维能力,加强医患沟通,综合、全面地掌握临床知识的场所.将Mini-CEX运用到中医思维实训室中,可以使学生将课本与临床更好地融会贯通,更深刻地了解中医.

目的:观察地黄益智方治疗帕金森病痴呆(PDD)患者的临床疗效及安全性.方法:共收集60例PDD患者,随机分为30例治疗组和30例对照组,所有患者均在服用帕金森病药物的基础上,予以盐酸多奈哌齐片,每次5mg,每天1次口服,同时治疗组在此基础上加用地黄益智方,每次l袋,每天2次口服,两组均治疗6个月.治疗前后进行简易智能量表(MMSE)、蒙特利尔认知评估量表(Montreal cognitive assessment,MOCA)、AD评定量表认知部分(ADAS-Cog)、日常生活活动量表(ADL)、中医症状积分量表测评.结果:两组治疗后MMSE、MOCA升高,ADAS-Cog、ADL、中医症状积分降低,与本组治疗前相比较,MMSE、MOCA、ADAS-Cog、ADL评分差异均有统计学意义(P＜0.05或P＜0.01),治疗组变化更明显(P＜0.01),对照组中医症状积分改善不明显,而治疗组积分下降显著.两组患者血、尿、粪、肝肾功能及心电图等安全性指标治疗前后的差异无统计学意义(P＞0.05).结论:地黄益智方对PDD患者疗效肯定.

Objective To observe the therapeutic effect and safety of Ping-Xuan Capsule for patients with Vertigo of Hyperactivity of liver-yang.Methods 60 patients with Vertigo of Hyperactivity of liver-yang were randomized into treatment group of 30 cases and control group of 30 cases. Ping-Xuan Capsule was added to the treatment group with 3 capsules each time,three times a day. The Flunarizine Hydrochloride Capsules was given to control groups 5 mg per time,once everynight. The treatment lasted for 14 days. The clinical effect was observed through TCD、Blood viscosity、and the comparison of seizure frequency and duration before and after the treatment. Results After the treatment of Ping-Xuan Capsule and Flunarizine Hydrochloride Capsules,Two groups of vertigo attack frequency and duration are falling,TCD possess the ability to improve blood flow velocity,blood viscosity index were improved. Ping-Xuan Capsule group has signiifcant difference while compared with the control group(P<0.05).There was no significant different in blood routine、urine、stool routine、liver function、renal function and cardiogram after the treatment in both groups(P>0.05).Conclusion Ping-Xuan Capsule is effective for a patients with Vertigo of Hyperactivity of liver-yang.

目的:观察地黄益智方治疗aMCI肾精亏虚兼痰瘀阻络证的临床疗效及安全性.方法:100例aMCI肾精亏虚兼痰瘀阻络证患者随机分为治疗组50例和对照组50例,治疗组予以地黄益智方,每次1袋,每天2次口服,对照组给予茴拉西坦片,每次200mg,每天3次口服,两组治疗疗程均为3个月.2组治疗前后均进行简易智能量表(MMSE)、AD评定量表认知部分(ADAS-Cog)、蒙特利尔认知评估量表(MoCA)、中医证候积分量表测评.结果:两组MMSE和MoCA量表的评分均有提高,而ADAS-Cog量表评分、中医症侯积分均降低,与本组治疗前相比较,差异均有统计学意义(P＜0.05或P＜0.01).地黄益智方组在MMSE评分、证候总积分及记忆减退、腰膝酸软、耳鸣、多梦症状积分改善方面作用明显,与茴拉西坦组比较,差异显著(P＜0.01).两组患者血、尿、粪常规,肝、肾功能及心电图等指标治疗前与治疗后均正常.结论:地黄益智方治疗aMCI肾精亏虚兼痰瘀阻络证患者疗效肯定.