ABSTRACT
Objective:To investigate the clinical characteristics of dermatomyositis (DM) patients with positive anti-melanoma differentiation-associated protein 5 (MDA5) antibody-complicated with pneumomediastinum.Methods:Clinical data of patients with anti-MDA5 antibody-positive DM with or without pneumomediastinum from March 2017 to December 2019 in Ningbo First Hospital were collected and analyzed. The international literature were reviewed and compared. T-test or Mann-Whitney U test was used for measurement data, chi-square test or Fisher exact probability was used for count data. Logistic regression analysis was used to analyze the risk factors for anti-MDA5 antibody-positive DM with pneumomediastinum. Results:Twelve DM patients with -positive anti-MDA5 antibody without pneumomediastinum, and 1 DM patient with positive anti-MDA5 antibody-complicated with pneumomediastinum. Pooling with literature review, 16 DM patients with positive anti-MDA5 antibody-complicated with pneumomediastinum were compared. It was found that the serum ferritin (SF) level [991.6(548.5, 2875.1) ng/ml vs 355 (143.5, 395) ng/ml, Z=-2.506, P=0.012] and the rate of rapid progressive pulmonary interstitial disease (RPILD) in the pneumo-mediastinum group [76.5% vs 16.7%, χ2=10.076, P=0.002] were significantly higher than those in the non-pneumome-diastinum group. Further Logi-stic regression analysis did not show male gender [ OR=0.192, 95% CI(0.009, 4.125), P=0.291]; SF [ OR=1.002, 95% CI(0.998, 1.006), P=0.279]; RPILD[ OR=0.084, 95% CI(0.003, 2.178), P=0.136]; CADM[ OR=0.258, 95% CI(0.009, 7.419), P=0.429] was risk factor for pneumomediastinum. Conclusion:DM patients with positive anti-MDA5 antibody and high seral SF level and rapid progression of pulmonary interstitial disease are more likely to complicate with pneumomediastinum.
ABSTRACT
Objective To discuss the socialized management model of medical transportation service in large-scale grade three hospital.Methods Selected a company through a competitive bidding,using dual management model of company and nursing department.The nursing department developed and implemented a unified regulatory system,introduce competition mechanism,participate incentives reform quality inspection programs,hold multi-sect oral coordination meetings regularly and also the hospital and company projeot management meetings.Results Socialization of medical transportation service not onlyreduced the problem of the hospital management cost to solve the hospital's birth control and labor,but also improved the satisfaction of patients and medical staff to the transportation members,it provided a strong support system to clinical service.Conclusions Implementation of social management in allied transportation service in hospital is feasible.The company management,nursing supervision model is a new path for transportation management.It is a guarantee of mechanism innovation,intensive training,strict management and supervision of a stable multi-party transport team to provide high-quality transportation service.