目的 探讨团体体检据实结算的方法，提高体检中心接检人员的工作效率和质量。 方法 采用六西格玛法, 并通过其定义、测量、分析、改进、控制5个步骤，研究并改进团体据实结算的方法，同时对比分析方法改进前后，“清理分检未完”的单次工作量、单次制表时间、单次核实时间以及缺陷发生率。 结果 方法改进后，“清理分检未完”的单次工作量变化无统计学意义（P＞0.05）；单次制表时间由（4.23 ± 0.43）h缩短至（0.06 ± 0.01）h、单次核实时间由（3.18 ± 0.46） h缩短至（1.07 ± 0.01）h、缺陷率从4.83%降至0.69%（P＜0.01）,达到了预期目标。 结论 运用六西格玛法可以发现流程中存在的关键问题,从而提出有针对性的改进措施,提高工作效率和质量。
【摘要】 目的 探讨如何通过流程优化应对体检高峰期。 方法 通过体检高峰期流程优化前后（2008年与2010年）的管理成效对比，评估高峰期流程控制的有效性。 结果 体检高峰期流程优化后，平均候检人数由8人下降至3人、平均侯检时间由11.9 min下降至4.2 min，平均体检时间由175 min下降至130 min。体检者对体检环境、服务态度和服务质量的满意度均高于优化前，差异有统计学意义（Plt;0.05）。 结论 通过流程优化与控制有效地缓解了高峰期体检人员等候时间过长现象，极大地提高了体检者满意度，保障了健康体检工作质量。【Abstract】 Objective To explore how to cope with the peak flow of physical examination through the process optimization. Methods Evaluate the utility of the process control at physical examination peak flow, by contrasting the management effect before and after the physical examination peak flow optimization (2008 and 2010). Results After the process optimization in peak flow, the average number of people waiting to be checked is down to 3 from 8, the consumers′ satisfaction with the medical environment, service attitude and the service quality is higher than before optimization, the difference was significant (Plt;0.05). Conclusion Through the process optimization and control effectively relieve the time for waiting to be examined, greatly enhance the satisfaction of people who take physical examinations and ensure the quality of physical examination.
目的：探讨妇科癌症患者疼痛的护理措施。方法：60例妇科癌症患者随机分为常规护理、特殊护理，观察疼痛治疗效果。结果：特殊护理患者疼痛缓解明显。结论：护理干预能改善患者疼痛。
Objective Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.
目的 总结分析急诊观察室患者流行病学特点及临床疗效，为临床急诊治疗提供指导。 方法 以2007年1月－2010年12月收治的247 312例急诊观察室患者为研究对象，按年龄、性别、地域分布、疾病种类、发病时间、好转率、收入院百分率、死亡率等因素进行流行病学分析。 结果 各年度患者人数呈增加趋势，2010年减缓；城镇患者占91.5%；20～40岁患者占45.9%，40～60岁患者占27.2%，＞60岁占21.3%；疾病种类分布中呼吸系统占42.4%，心血管疾病患者数量呈升高趋势，以老年人为主，中毒患者呈下降趋势。全年6、7、8月份因发热、上呼吸道感染患者较多，总数增加明显，其次11、12、1月份因慢性支气管炎急发患者较多，总数也有升高趋势；白天工作时间患者数量占66.2%；平均每天就诊人次为169.4人次，节假双休日平均每天就诊人次为191.1人次（P＜0.01）；各年度好转率呈升高趋势，收入院百分率无显著变化，死亡率无显著区别。 结论 近年急诊观察室患者以呼吸系统疾病为主，好转率呈升高趋势，但心血管疾病数量呈升高且有年轻化趋势，值得重视。
ObjectiveTo study the effect and mechanism of lipopolysaccharide (LPS) on osteoclasts formation and its bone resorption function.MethodsBone marrow-derived macrophages (BMMs) were extracted from the marrow of femur and tibia of 4-week-old male C57BL/6 mice. Flow cytometry was used to detect BMMs. The effect of different concentrations of LPS (0, 100, 200, 500, 1 000, 2 000 ng/mL) on BMMs activity was examined by cell counting kit 8 (CCK-8) activity test. In order to investigate the effect of LPS on osteoclastogenesis, BMMs were divided into macrophage colony-stimulating factor (M-CSF) group, M-CSF+receptor activator of nuclear factor κB ligand (RANKL) group, M-CSF+RANKL+50 ng/mL LPS group, M-CSF+RANKL+100 ng/mL LPS group. After the completion of culture, tartrate resistant acid phosphatase (TRAP) staining was used to observe the formation of osteoclasts. In order to investigate the effect of LPS on the expression of Connexin43, BMMs were divided into the control group (M-CSF+RANKL) and the LPS group (M-CSF+RANKL+100 ng/mL LPS); and the control group (M-CSF+RANKL), 50 ng/mL LPS group (M-CSF+RANKL+50 ng/mL LPS), and 100 ng/mL LPS group (M-CSF+RANKL+100 ng/mL LPS). The expressions of Connexin43 mRNA and protein were detected by Western blot and real-time fluorescent quantitative PCR, respectively. In order to investigate the effect of LPS on osteoclast bone resorption, BMMs were divided into M-CSF group, M-CSF+RANKL group, M-CSF+RANKL+50 ng/mL LPS group, and M-CSF+RANKL+100 ng/mL LPS group. Bone absorption test was used to detect the ratio of bone resorption area.ResultsThe flow cytometry test confirmed that the cultured cells were BMMs, and CCK-8 activity test proved that the 100 ng/mL LPS could promote the proliferation of BMMs, showing significant differences when compared with the 0, 200, 500, 1 000, and 2 000 ng/mL LPS (P<0.05). TRAP staining showed no osteoclast formation in M-CSF group. Compared with M-CSF+RANKL group, the osteoclasts in M-CSF+RANKL+50 ng/mL LPS group and M-CSF+RANKL+100 ng/mL LPS group were larger with more nuclei, while the osteoclasts in M-CSF+RANKL+100 ng/mL LPS group were more obvious, and the differences in the ratio of osteoclast area between groups were statistically significant (P<0.05). Western blot result showed that the relative expression of Connexin43 protein in LPS group was significantly higher than that in control group (P<0.05). Real-time fluorescent quantitative PCR showed that the relative expression of Connexin43 mRNA in control group, 50 ng/mL LPS group, and 100 ng/mL LPS group increased gradually, and the differences between groups were statistically significant (P<0.05). Bone resorption test showed that osteoclast bone resorption did not form in M-CSF group, but the ratio of bone resorption area increased gradually in M-CSF+RANKL group, M-CSF+RANKL+50 ng/mL LPS group, and M-CSF+RANKL+100 ng/mL LPS group, and the differences between groups were statistically significant (P<0.05).ConclusionLPS at concentration of 100 ng/mL can promote the expression of Connexin43, resulting in increased osteoclastogenesis and enhanced osteoclastic bone resorption.
In recent years, immune checkpoint inhibitors have begun to be used in targeted cancer therapy. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events. Neuromuscular disease is more common among adverse events involving the nervous system. With the increasing use of immune checkpoint inhibitors, the early recognition and treatment of neuromuscular immune-related adverse events are very important. In this review, we are focused on the epidemiology, pathogenesis, clinical manifestations, evaluation, diagnosis, and treatment of neuromuscular diseases (including peripheral neuropathy, myasthenia gravis, and myositis) caused by immune checkpoint inhibitors, aiming to provide a theoretical basis for improving the diagnosis and treatment ability of users of immune checkpoint inhibitors for such neuromuscular diseases and reducing the disability rate and mortality rate caused by immune checkpoint inhibitors.
Objective To evaluate the clinical efficacy and safety of domestic sparfloxacin in the treatment of acute bacterial infections. Methods A multicenter randomized controlled clinical trial was conducted. 117 patients were treated with domestic sparfloxacin 200-300 mg qd for 5-14 days and 114 patients were treated with domestic lomefloxacin 300 mg bid for 5-14 days. Results The cure rates and the efficacy rates in each group were 84.62%, 74.56% and 94.87%, 92.98%, respectively. The bacterial clearance rates were 94.28% and 92.02%, respectively. Adverse drug reactions rates were 7.69% and 11.40%, most of them were mild. There were no significant differences of above results between the two groups (Pgt;0.05). Conclusions The results suggest that sparfloxacin with wide antibacterial spectrum, satisfactory activity, is an effective and safe antibacterial agent in treatment of mild to moderate acute bacterial infections.
Objective To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Methods Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients’ age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70° (mean, 40.1°). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm × 1.3 cm to 4.0 cm × 2.0 cm. Results After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.
Objective To evaluate the effects of delicacy management applied in branch health management sub-center. Methods From July 2013 to December 2015, integrated delicacy management was applied throughout the whole process of the preparation for the establishment and the running of the branch health management sub-center. The strengths and weaknesses of the management, the management of the details and the control of the emphasis were analyzed. And the medical visits and incomes after the application of delicacy management were also analyzed. Results From July 2013 to December 2015, the monthly average medical visits were 1 870.17±609.93, 2 842.50±1 247.60 and 3 717.92±1 257.98, while the monthly average incomes were (2 136.0±585.1) thousand yuan, (3 620.5±1 559.9) thousand yuan and (4 921.1±1 837.2) thousand yuan, which increased significantly. Conclusion The application of delicacy management in the branch health management sub-center could ensure the quality of service, promote the steady growth of performance, and improve the understanding of the surrounding population of health management, thus we can improve the economic and social benefits of the health management sub-center.