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Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.
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Objective:To investigate the application value of peri-gastric devasculariza-tion without dissociation of esophagus for portal hypertension.Methods:The retrospective and descriptive study was conducted. The clinical data of 94 patients with portal hypertension who were admitted to three medical centers, including 75 cases in the People′s Hospital of Ningxia Hui Autonomous Region, 12 cases in the People′s Hospital of Wuhai and 7 cases in the People′s Hospital of Wuzhong, from July 2018 to December 2022 were collected. There were 68 males and 26 females, aged 46(range, 21-70)years. All 94 patients underwent peri-gastric devascularization without dissociation of esophagus. Observation indicators: (1) intraoperative condition; (2) postoperative complications; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measure-ment data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Intraoperative condition. All 94 patients underwent surgery success-fully without operation death, including 82 cases receiving open surgery and 12 cases receiving laparoscopic surgery. The operation time and volume of intraoperative blood loss were (183±85)minutes and 289(range, 158-560)mL, respectively, for the 94 patients. (2) Postoperative complications. Of 94 patients, early portal vein thrombosis occurred in 24 cases, intra-abdominal infection occurred in 2 cases, hepatic encephalopathy occurred in 1 case, pulmonary embolism occurred in 1 case, intra-abdominal hemorrhage requiring operation to stop bleeding occurred in 1 case and pleural effusion requiring drainage occurred in 1 case. All patients with postoperative complications were cured after treatment. None of the 94 patient had postoperative esophageal complications such as odynophagia or dysphagia. (3) Follow-up. All 94 patients were followed up for 38(range, 6-60)months. Of the 45 patients with paraesophageal vein, there were 36 cases of thinner and 9 cases of occlusion of the distal subphrenic paraesophageal vein after surgery, respectively. Cases with esophageal varices disappearance, cases with mild and moderate residual of esophageal varices, cases with severe residual of esophageal varices, cases with recurrence of esophageal varices, cases with esophageal varices bleeding were 7, 70, 9, 4, 4 in the 94 patients after surgery. Cases with esophageal varices disappearance was 7 in the 45 patients with paraesophageal vein, versus 0 in the 49 patients without paraesophageal vein, showing a significant difference between them ( P<0.05). Of 94 patients, 17 cases developed postoperative late portal vein thrombosis and cavernous transformation, 7 cases developed liver cancer, 1 case had hepatic encephalopathy, and 6 cases died. Conclusion:Peri-gastric devascularization without dissociation of esophagus is safe and feasible for the treatment of portal hypertension.
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Objective:To study the clinical results of personalized surgical treatment for portal hypertension based on portal venous hemodynamics.Methods:A retrospective study was performed on patients with portal hypertension who underwent surgical treatment from January 2016 to December 2020 at the People’s Hospital of Ningxia Hui Autonomous Region and Wuhai People’s Hospital. Of 229 patients included into this study, there were 156 males and 73 females, with age of (4±11) years old. Portal vein CT and ultrasound doppler examination were performed preoperatively and portal vein manometry and ultrasound doppler examination were performed intraoperatively to evaluate portal venous hemodynamics. Based on the evaluation results, different surgical treatments were adopted. Postoperative complications and results of the operations were recorded. Long-term outcomes were evaluated by the rate of recurrence of gastroesophageal varices which was classified as disappearance, mild, moderate and severe according to endoscopic findings.Results:All the 229 patients completed the operations successfully. All together 13 operative treatments were used: (1) simple splenectomy ( n=11); (2) devascularization ( n=176), including 86 patients with splenectomy combined with extensive devascularization, 44 patients with splenectomy combined with selective devascularization and with preservation of paraesophageal veins, 39 patients with splenectomy combined with selective devascularization and reconstruction of spontaneous portosystemic shunt (34 patients with selective devascularization and reconstruction of spontaneous gastrorenal shunt and 5 patients with selective devascularization and reconstruction of spontaneous splenorenal shunt), 4 patients with secondary devascularization for variceal recurrence and 3 patients with devascularization and preservation of spleen; (3) shunt procedures were performed in 42 patients including 21 patients with splenectomy combined with coronary renal shunt, 11 patients with splenectomy combined with coronary-caval shunt, 6 patients with distal splenorenal shunt, 2 patients with proximal splenorenal shunt combined with devascularization, 1 patient with right gastroepiploic vein-inferior vena cava shunt and 1 patient with trans-inferior mesenteric vein coronary renal shunt. There were no operative deaths. The Clavien-Dindo grade 3 and above postoperative complication rate was 6.6% (15/229). Two hundred and eight patients were followed up for 6-60 months, with a median follow-up of 38 months. Severe recurrent varices were found in 21 patients (10.1%, 21/208), with 5 patients (2.4%, 5/208) presented with variceal bleeding. The rate of severe varices after selective shunting and selective devascularization by reconstructing the spontaneous portosystemic shunt (4.2%, 3/72) was significantly lower than that of the other devascularization procedures (13.7%, 17/124)(χ 2=4.53, P=0.033). Conclusion:Better clinical results were achieved by selecting the appropriate surgical procedures based on portal venous hemodynamic characteristics of patients. Selective shunting and selective devascularization by reconstructing the spontaneous portosystemic shunts significantly reduced the recurrence rate of severe varies.
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Objective To investigate the effect of Hydroxychloroquine plus Leflunomide on the lipid profile and disease activity index in patients with rheumatoid arthritis (RA).Methods A total of 140 elderly patients with RA who met the American College of Rheumatology (ACR) criteria were treated with Hydroxychloroquine (Group A,n =70) or leflunomide combined with hydroxychloroquine (Group B,n=70),and 100 healthy volunteers were selected as controls.The lipid profile was compared between the patient groups and control group.Lipid levels,Disease Activity Score 28 (DAS28),erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured before treatment and 6 months after treatment between Group A and Group B.Results Compared with the control group,RA patients exhibited higher levels of total cholesterol (TC,P＜0.05),low-density lipoprotein cholesterol (LDL-C,P＜0.05) and triglycerides (TG,P＜0.01),and lower levels of high-density lipoprotein cholesterol (HDL-C,P＜0.05).After 6 months of treatment,the disease activity index (DAS28,P＜0.01),the duration of morning stiffness (P＜0.01),ESR,CRP,swollen joint count (SJC) and tender joint count (TJC) decreased in RA patients,compared with controls (P＜0.01 or 0.05).HDL-C levels increased and LDL-C levels decreased in Groups A and B after treatment,compared with pretreatment (P＜0.05 for all).After treatment,TC levels decreased in Group B,compared with Group A (P＜ 0.05),while TG levels had no significant difference between the two groups (P＞0.05).TC and LDL-C levels,ESR,CRP,DAS28,SJC and TJC were lower in Group B than in Group A (all P＜0.05).Conclusions Hydroxychloroquine in combination with Leflunomide therapy can not only control inflammation but also improve the lipid profile,and is more effective than single-drug therapy.The combination may reduce the risk of atherosclerosis and cardiovascular events in patients with RA.
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Objective To analyze the influencing factors of AVM bleeding for surgical treatment.Methods The 64 cases of bleeding AVM patients,clinical informations,condition of surgery and inspection of pathology were summarized.Results The prognosis was evaluated by Glasgow outcome scale(GOS)for every patient after the operation.36(53.3 %)recovered well,13(20.3 %)moderately disabled,4(6.4 %)severely disabled,and 11(17.3 %)died.Conclusions The effect of surgical treatment in patients with the age of onset,the site of hematoma,the bleeding volume and timing of surgery-related.The incidence between the ages of 8～14 years of age,the amount of bleeding
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Objective To design a handhold emergency suction apparatus, in order to meet the needs of clinical therapy, field and on-site emergency treatment. Methods The apparatus was divided into such components as handle, grab handle, L tie, piston, waste liquid tank and its cap, and the junction between the parts, and then the optimum design of the components were performed. Results Through the optimum design, the apparatus was improved from the aspects of portability, easy-to-use and reliability. Conclusion It is proved by practice that the apparatus also can reduce the labor intensity of healthcare staff, and definitely satisfy the clinical rescue and the treatment needs.
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The continuous artery-vein infusion method was used for the study of the origin, number, course, anastomosis, point of penetration and distribution of external arteries on 60 sides and internal arteries on 18 sides of the brain stem (mesencepha- lon and medulla oblongata) in Chinese under magnifiers (10-16?). The arteries of the brain stem can be divided into four groups: the anteromedial, anterolateral, lateral and posterior arteries. Each group originates from several different arteries. The spot where external arteries penetrate into the substance of brain stem is called the point of penetration, several points of penetration concentrating together make the dense penetrating area. The dense penetrating areas on mesencephalon are the interpeduncular fossa and sulcus lateralis and those on the medulla oblongata are the fissurae mediana anterior and sulcus posterior to olive. There are fine arterial networks in the pia mater of the brain stem. In the mesencephalon and the closed portion of the medulla oblongata, the internal arteries traverse centripetally while in the open portion of the medulla oblongata, they course towards the floor of the fourth ventricle. The calibre of arteries in each group decreases anteroposteriorly. A comparatively constant blood supply area is available to each group.