Microfluidic chips can be used to realize continuous cryoprotectants (CPA) loading/unloading for oocytes, reducing osmotic damage and chemical toxicity of CPA. In this study, five different Y-shape microfluidic chips were fabricated to realize the continuous CPA loading/unloading. The effects of flow rate, entrance angle, aspect ratio and turning radius of microchannels on the mixing efficiency of microfluidic chips were analyzed quantitatively. The experimental results showed that with the decrease of flow rates, the increase of aspect ratios and the decrease of turning raradius of microchannel, the mixing length decreased and the mixing velocity was promoted, while the entrance angle had little effect on the mixing efficiency. However, the operating conditions and structural parameters of the chips in practical application should be determined based on an overall consideration of CPA loading/unloading time and machining accuracy. These results would provide a reference to the application of microfluidic chip in CPA mixing.
Objective To analyze the dynamic efficiency of township hospitals. Methods Based on the DEA-Malmquist index, this research analyzed the change of the total factor productivity indices and the decomposition items of 281 township hospitals in Hunan province with panel data from 2000 to 2008. Results Among 281 township hospitals, less than half increased their scale efficiency, while more than half increased their total factor productivity, technology, whole efficiency and technical efficiency. Increasing technology and whole efficiency was the best way to improve total factor productivity. Besides, increasing technical efficiency and scale efficiency was the best way to improve whole efficiency. Conclusions The improvement of scale efficiency is key to developing the central township hospitals, while the improvement of technology is the key to developing general township hospitals.
Objective To establish a cooperative decision-making model of county-level public hospitals, so as to freely select the best partner in different decision-making units and promote the optimal allocation of medical resources. Methods The input and output data of 10 adjacent county-level public hospitals in Henan province from 2017 to 2019 was selected. Based on the traditional data envelopment analysis (DEA) model, a generalized fuzzy DEA cooperative decision-making model with better applicability to fuzzy indicators and optional decision-making units was constructed. By inputting index information such as total number of employees, number of beds, annual outpatient and emergency volume, number of discharged patients, total income and hospital grade evaluation, the cooperation efficiency intervals of different hospitals were calculated to scientifically select the best partner in different decision-making units.Results After substituting the data of 10 county-level public hospitals in H1-H10 into the model, taking H2 hospital as an example to make cooperative decision, among the four hospitals in H1, H2, H7 and H10 of the same scale, under optimistic circumstances, the best partner of H2 hospital was H7 hospital, and the cooperation efficiency value was 1.97; in a pessimistic situation, the best partner of H2 hospital was H10 hospital, and the cooperation efficiency value was 0.98. The model had good applicability in the cooperative decision-making of county-level public hospitals. Conclusion The generalized fuzzy DEA model can better evaluate the cooperative decision-making analysis between county-level public hospitals.
Objective To evaluate the teaching effect of case-based learning (CBL) combined with team-based learning (TBL) pedagogy in laboratory diagnostics education. Methods The data of the undergraduate clinical-medical students who completed the laboratory diagnostics course between September 2021 and July 2023 at West China School of Medicine of Sichuan University were retrospectively collected. Among them, the undergraduates of grade 2020 adopted the CBL+TBL combined pedagogy, while the undergraduates of grade 2019 assumed the traditional lecture-based learning (LBL) teaching method. Based on the cluster sampling method with the whole grade as the sampling unit, comparative effectiveness was assessed via examination scores and questionnaire feedback. Results A total of 303 students received the CBL+TBL teaching method (CBL+TBL group), while 289 students received the LBL teaching method (LBL group). Compared with the LBL group, the CBL+TBL group had higher scores on the clinical case discussion (90.28±4.05 vs. 88.39±5.19, P<0.001) while lower scores on the theoretical quiz (83.89±12.55 vs. 88.77±10.46, P<0.001). The overall performance of the CBL+TBL group was worse than the LBL group (61.28±3.83 vs. 61.98±3.98, P=0.028). A total of 161 valid copies of questionnaire were collected from the CBL+TBL group. Among them, more than 70% of the students believed that CBL+TBL pedagogy could improve learning motivation, independent learning ability, and team communication and assistance ability. Compared with the LBL teaching mode, 74.5% of the students preferred the CBL+TBL pedagogical approach. Conclusion The CBL+TBL pedagogy can help to improve autonomic learning, teamwork, and problem-solving ability, and a combination with LBL teaching may be utilized to enhance theoretical scores.
ObjectiveTo explore the effect of continuous improvement of quality control system on the emergency treatment efficiency for patients with acute ST segment elevation myocardial infarction (STEMI) after the establishment of Chest Pain Center. MethodsWe retrospectively analyzed the differences of theory examination scores acquired by the Chest Pain Center staff one month before and after they got the system training. Moreover, we designated the STEMI patients treated between May and August 2015 after the establishment of Chest Pain Center but before optimization of process to group A (n=70), and patients treated from September to December 2015 after optimization of process to group B (n=55). Then we analyzed the differences between these two groups in terms of the time from patients' arriving to registration, the time from arriving to first order, the length of stay in Emergency Department, and even the time from door to balloon (D2B). ResultsThe scores acquired by Chest Pain Center staff before and after system training were 69.89±6.34 and 87.09±4.39 respectively, with a significant difference (P＜0.05). All the time indicators of both group A and group B were shown as median and quartile. The time from patients' arriving to registration of group A and group B was 6.0 (0.0, 11.0) minutes and 1.0 (0.0, 3.0) minutes (P＜0.05); the time from arriving to first order was 12.8 (9.0, 18.0) minutes and 5.0 (3.0, 9.0) minutes (P＜0.05); the length of stay in Emergency Department was 54.0 (44.0,77.0) minutes and 33.0 (20.0, 61.0) minutes (P＜0.05); and the time of D2B was 107.5 (89.0, 130.0) minutes and 79.0 (63.0, 108.0) minutes (P＜0.05). ConclusionAfter taking measures such as drawing lessons from the past, training staff and optimizing process continuously, we have significantly shortened the acute STEMI patients' length of stay in the Emergency Department, which has saved more time for the following rescue of STEMI patients.
ObjectiveTo measure the operational efficiency and explore the phenomenon of the economy of scale in secondary public general hospitals of China for improving the health service efficiency.MethodsFrom February to August 2019, the data set of two input indicators (the number of employees and actual open beds) and two output indicators (the numbers of outpatients and discharges) in 511 secondary general hospitals of Shandong, Anhui, Shanxi, Hubei and Hainan provinces in 2018 were collected for data envelopment analysis. The analysis processes were three folds: First, the technical efficiency, pure technical efficiency, scale efficiency and scale compensation status of the sample hospitals were calculated respectively. Second, the comparative analysis of efficiency value and scale compensation status was carried out in 5 groups according to the bed scale. Finally, the input and output projection analysis was carried out on the ineffective decision making units.ResultsThe medians of technical efficiencies, pure technical efficiencies, and scale efficiencies of the 511 secondary general hospitals were 0.472, 0.531, and 0.909, respectively. In the 511 hospitals, 493 hospitals (96.5%) were in ineffective state, of which 321 hospitals (62.8%) were in the state of decreasing return to scale. The staff redundancy of the group with beds >100 and ≤300 was 23.86%, and its service quantity could be increased by 39.37%.ConclusionsThe overall operating efficiencies are inefficiency in secondary general hospitals of China and the optimal scale of actual open beds is between 300 and 500 beds from the perspective of scale efficiency.
ObjectiveTo investigate the perioperative hemodynamic changes of off-pump coronary artery bypass grafting (OPCABG) patients monitored by pulse recorded analysis method (MostCare/PRAM devices) and its relationship with the prognosis.MethodsA total of 89 patients who underwent OPCABG from October 2016 to January 2017 in Beiijng Anzhen Hospital were included, including 53 males and 36 females aged 60.50±8.40 years. The hemodynamic changes were recorded. The patients were divided into two groups (a major adverse cardiovascular events group and a stable group) according to whether major adverse cardiovascular events occurred or not. The difference of hemodynamic changes between the two groups was analysed.ResultsThe mean percentage increases of stroke volume (SV) in the passive leg raising (PLR) test before opening chest and after chest closure were 23.00%±3.20% and 29.40%±3.70%, respectively. Hemodynamic data were analysed seven times, namely, anaesthesia, opening chest, heparin administration, coronary artery bypass grafting, protamine administration, thoracic closure and after operation. SV was significantly decreased during above periods, while systemic vascular resistance index (SVRI) was significantlyincreased. Cardiac circle efficiency (CCE) and maximum pressure gradient (dP/dT) were decreased after anaesthesia, and decreased to the lowest value during the procedure of bypass grafting, and then they began to increase gradually after the manipulation of bypass grafting was finished. Stroke volume variation (SVV) and pulse pressure variation (PPV) were slightly decreased during anaesthesia, then increased significantly through the whole surgery. Major adverse cardiovascular events occurred in 9 patients and 4 of them died. The basic mean values of SVRI, SVV and PPV of patients in the major adverse cardiovascular events group before opening chest were significantly higher than those of patients in the stable group. There was no significant difference in the mean values of CCE, dP/dT or SV between the two groups. There was no significant correlation between the prognosis and the mean values of SVRI, SVV, PPV, CCE, dP/dT or SV.ConclusionThe hemodynamic indexes are not stable, thus, it is necessary to monitor the perioperative hemodynamic changes of OPCABG patients timely by MostCare/PRAM device and adjust treatment measures accordingly.
Mesenchymal stem cells (MSCs) are pluripotent stem cells with high self-proliferation and multidirectional differentiation potential. They also have other functions including immune regulation, paracrine and so on, playing an important role in repairing injured tissues. In recent years, a lot of research has been done on how MSCs promote skin injury repair, and a lot of progress has been made. Compared with direct injection of MSCs in the wound area, some special treatments or transplantation methods could enhance the ability of MSCs to repair skin injury. This paper mainly discusses the role of MSCs in skin injury repair and technical ways to improve its repairing capacity, and discusses the existing problems in this field and prospects for future research directions.
With chronic kidney disease becoming a public health problem in the world, dialysis treatment model has also become the focus of attention from all walks of life. Sustained low-efficiency dialysis, which adopts the mode of low blood flow and low dialysis volume, is a kind of hybrid renal replacement therapy combining continuous renal replacement therapy and intermittent hemodialysis. It has unique advantages in the treatment of patients with acute and severe renal injury, as well as the dialysis duration, patient activity range and cost. It is the most widely used hybrid renal replacement therapy too. This review summarizes the clinical application and nursing points of sustained low-efficiency dialysis to provide guidance for clinical practice.
Objective To analyze the current situation of the centralized treatment mode for daytime treatment (excluding daytime surgery) services in a large-scale military hospital, and provide practical support for the management and operation of the centralized treatment mode for daytime treatment. Methods Data on patients undergoing centralized daytime treatment in the Department of Ambulatory Medicine, First Medical Center of PLA General Hospital were retrospectively collected between February 7, 2021 and December 31, 2023. The patients’ condition, daytime treatment operation indicators, and quality control indicators were statistically analyzed. Results A total of 14903 patients underwent daytime treatment, including 8548 females and 6355 males. The patients’ age ranged from 18 to 74 years old. There were 9757 patients (65.47%) who had been hospitalized ≥ 2 times. The main payment method for patients was medical insurance (83.16%). Breast cancer accounted for the highest proportion (26.45%). The main treatment methods for patients were targeted therapy and immunotherapy (68.03%). The patients experienced a total of 1146 drug-related adverse reactions, mainly involving anti-tumor drugs. Among them, 15 cases were drug-related adverse reactions treated on the day of treatment, and the other 1131 cases were drug-related adverse reactions that occurred outside the hospital. After optimizing the entire process of daytime hospitalization (timed based treatment) in January 2023, compared to 2022, the average waiting time for patients after admission was reduced by 26.89%, the bed utilization rate increased by 9.09%, and patient satisfaction increased to 98.98%. In 2023, the default rate of daytime treatment was 1.15%, the cancellation rate of daytime treatment on the day of treatment was 4.39%, and the discharge follow-up rate reached 100%. Conclusions The daytime treatment under the centralized treatment mode in the the Department of Ambulatory Medicine, First Medical Center of PLA General Hospital focuses on breast cancer patients, and the main treatment methods are targeted therapy and immunotherapy. Time based treatment is beneficial for shortening the average waiting time of patients after admission, improving bed utilization and patient satisfaction.