ABSTRACT
From February 1 to April 30, 2021, 48 general practice resident physicians in the First Affiliated Hospital of Naval Medical University were randomly divided into study group and control group with 24 in each group. The common comorbidities of the community-dwelling elderly, namely diabetes, diabetic retinopathy and osteoporosis were selected as teaching cases. The residents in control group received conventional teaching, while the scenario simulation teaching model of multicomorbity co-treatment was applied for the study group. The teaching effect, satisfaction and self-efficacy scores were compared between two groups. After training, the knowledge levels, the mastery of referral indicators and the performance of fundus ophthalmoscopy in the study group were significantly better than those in the control group ( t=2.27, 6.34, 4.09; P<0.05). They were (80.96±11.27) vs. (73.96±10.09), (10.33±2.41) vs. (6.38±1.88), (70.27±10.44) vs. (63.50±7.98), and students′ satisfaction and self-efficacy evaluation were higher than those of the observation group (all P<0.05). It is suggested that the simulation teaching of multi-disease co-treatment scenario is more beneficial than the traditional teaching to improve the comprehensive care ability of standardized training physicians in general practice for patients with chronic disease.
ABSTRACT
Objective:To use the methods of Health Care Failure Mode and Effects Analysis to reduce the paediatric wards noise pollution, Ensure the physical and mental health of medical staff and children, and maintain a good medical environment.Methods:The sampling method is adopted, noise investigation questionnaire was used in our study and we use the noise instrument to monitor the sound, and the focus source, the key time period and the key section of the room noise are obtained, then the HFMEA is carried out, we listed the work flow of the pediatric ward, and the flow is analyzed and discussed, calculate the Risk Priority Number (RPN). Then, some improvement measures were carried out aimed at the failure mode ,the noise survey questionnaire were used for evaluation.Results:After the implemented the HFMEA , The RPN value was significantly decreased ( P < 0.05). the degree of noise interference of children and their families decreased from 38 to 29, the difference was statistically significant ( χ2 value was 21.82, P<0.05) , and the satisfaction with control noise was improved from 18 to 30, the difference was statistically significant ( χ2 value was 36.28, P<0.05) .The intensity of noise key areas, The intensity of noise source and intensity in each period of the day were significantly improved and the difference was statistically significant ( P < 0.05), and the critical value was significantly decreased. Conclusion:Applying HFMEA can reduce ward noise pollution, improve patient satisfaction, ensure the physical and mental health of medical staff and children, and create a good medical environment.
ABSTRACT
Objective To investigate the expression of inflammatory mediators in renal tubular epithelial cells in patients with diabetic nephropathy (DN) and to explore the possible clinicopathological significance. Methods Twenty-three patients with DN diagnosed by renal biopsy and 10 patients with renal cell carcinoma undergone nephrectomy were allocated into DN group and control group, respectively. The renal expression of NF-κB p50, NF-κB p65, NF-κB p65 mRNA, MCP-1, OPN, α-SMA, and FN was detected by immunohistochemical or in situ hybridization assay. Serum creatinine, urinary N-acetylglucosaminedase (NAG), urinary albumin and 24-hour urinary protein were detected. The correlation between these inflmmnatory markers and clinicopathological data were analyzed. Results (1)Among all the 23 DN patients, granular degeneration of the renal tubular epithelium, focal tubular atrophy, infiltration of inflammatory cells and interstitial fibrosis were apparent, and none of these were found in control group. (2) Immunohistochemical and in situ hybridization assay showed that, compared with control group, expression of these factors increased significantly in renal tubular cells or interstitium in DN patients, and expression of α-SMA or FN was not found in tubular epithelial cells. (3)Statistics assay showed the tubular NF-κB p65 protein expression was correlated with all of the following factors: NF-κB p50 protein (r=0.792) and NF-κB p65 mRNA (r=0.763), tubular MCP-1 (r=0.825) and OPN (r=0.869) expression, interstitial α-SMA (r=0.327) and FN (r=0.432) expression, proteinuria(r=0.710), estimated glomerular filtration rate (eGFR) (r=-0.728), and urinary NAG (r= 0.930), P<0.01 respectively. Conclusion Tubular inflammation may play a role in the pathogenesis and progression of DN.