Research on the evaluation index system of hospital culture construction led by Party building and the mediating effect / 中华医院管理杂志

Objective:To establish an evaluation index system of hospital culture construction led by Party building in public hospitals, and to explore the relationships among Party building, hospital culture and patient satisfaction, and explain the mediating effect of hospital culture between Party building and patient satisfaction.Methods:Literature review and two rounds of Delphi method were used to create an evaluation index system of hospital culture construction led by Party building in public hospitals. On such basis, a questionnaire was designed and 429 staff from 33 public hospitals in Shanghai were surveyed through April and June 2021. Cronbach α coefficient method and exploratory factor analysis were used to test the reliability and validity of the indexes, and the regression analysis method was used to verify the mediating effects. Results:Following two rounds of Delphi survey run by 14 experts, a performance evaluation index system for the hospital culture construction was constructed, comprising 5 level-1, 13 level-2 and 29 level-3 indexes. The Cronbach α coefficients of overall indexes and 5 level-1 indexes fell in the range of 0.860-0.901( P<0.01), and the retest reliability of overall index and 5 level-1 indexes fell between 0.91-0.93( P<0.01). Based on the exploratory factor analysis, all of the characteristic roots of the factors generated by orthogonal rotation were>1, and the total variance explained contribution rate was 56.84%, proving the good validity of the indexes. The effect of Party building on patient satisfaction was significant( β1=0.139, P<0.01), and that on hospital culture effect significant as well( β2=0.168, P<0.01), while that on patient satisfaction was also significant( β3=0.115, δ=0.448, P<0.01)with hospital culture effect introduced as the mediating effect. Conclusions:The evaluation index system of hospital culture construction led by Party building proves highly scientific and effective, and hospital culture plays to some extent a mediating role between Party building and patient satisfaction. This proves that Party building presents a significant transmission effect on patient satisfaction through hospital culture building. The study provides a reference for strengthening Party building and hospital culture construction and improving patient satisfaction in public hospitals.

A point of confusion for embryologists in the identification of viable spermatozoa by the eosin-nigrosin test / 대한생식의학회지

A viable spermatozoon is a prerequisite for fertilization in intracytoplasmic sperm injection (ICSI). Thus, it is crucial to select viable but immotile spermatozoa on the day of ICSI. We report conflicting results in the identification of viable but immotile spermatozoa between the eosin-nigrosin staining and the laser test, which resulted in confusion for embryologists during assisted reproductive technology (ART). Three patients’ semen samples that showed no motile spermatozoa are described in this report. To identify viable spermatozoa, we used both the eosin-nigrosin test and the laser test for each sample, and repeated the semen analysis twice in each patient. Viable but immotile spermatozoa selected by the laser test were used for ICSI. Viable spermatozoa were detected by both the eosin-nigrosin and laser tests in two patients (case 1, 95.00% vs. 24.21% and 92.68% vs. 22.22%; case 2, 41.18% vs. 23.48% and 39.81% vs. 22.52%), indicating consistent results between the two methods. In the third patient, the eosin-nigrosin test yielded viability rates of 20.75% and 19.14%, while the result of the laser test was 0%. Thus, testicular aspiration was performed to collect viable sperm from this patient. Normal fertilization was achieved after the injection of viable but immotile spermatozoa selected from these patients by the laser test, resulting in the birth of two healthy babies. Our study documents a case where the eosin-nigrosin test showed a limitation in identifying viable but immotile spermatozoa for ART, while the laser test may overcome this limitation. Larger samples may be required to corroborate the clinical value of the laser test.

A successful pregnancy using completely immotile but viable frozen-thawed spermatozoa selected by laser / 대한생식의학회지

The aim of this study was to report a successful pregnancy using completely immotile frozen-thawed spermatozoa selected by laser. A single laser shot was used to detect the presence of viable immotile spermatozoa in fresh and frozen-thawed testicular spermatozoa. The viability rate was 55.8% after the laser detection, and cryopreservation was carried out immediately. The thawing test was performed on the day of oocyte pick-up, and no motile sperm were observed after extending the culture for another 4 hours, while a survival rate of 39.8% was detected using the laser. In all, five mature oocytes were injected, resulting in four cases of normal fertilization (80%) on day 1. Further, two high-quality day 3 embryos were transferred, which resulted in a singleton pregnancy. Our study demonstrates that completely immotile spermatozoa are worth cryopreserving for further intracytoplasmic sperm injection, which provides a new insight into male fertility preservation in cases of completely immotile spermatozoa.

Effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles / 中华妇产科杂志

Objective To investigate the effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles. Methods A retrospective analysis was performed in Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region on clinical data of single frozen-thawed blastocyst transfer cycles from January 2008 to December 2013. All cycles were divided into four groups (AA, AB/BA, BB, BC/CB) according to the blastocyst score, then the clinical outcomes were compared between groups. And on this basis, the clinical outcomes were further explored when the group of outcomes with single blastocyst transfer wasn′t ideal, which would diverted to transfer two blastocyst. Results In single frozen blastocyst transfer cycles, the clinical pregnancy rate of each group with the blastocyst scored AA, AB/BA, BB, BC/CB were 61.4%(470/765), 51.2%(330/645), 40.5%(407/1 005), 22.9%(60/262), live births rate in each group were 52.2%(399/765), 41.2%(266/645), 30.4%(306/1 005), 13.7%(36/262), and the abortion rate were 13.6%(64/470), 16.7%(55/330), 21.4%(87/407), 35.0%(21/60), separately. This showed that the clinical pregnancy rate and live births rate decreased significantly with the decline of blastocyst quality (P40%) and live births rate (>30%) could be obtained, however, the clinical pregnancy rate of 22.9% and live births rate of 13.7%could only be acquired when blastocyst scored BC/CB only transferred one embryo, which significant lower than those of each group scored ≥BB grade (P0.05). Conclusions Of single blastocyst transfer in frozen-thawed cycles, the clinical pregnancy rate and liver births rate showed significant upward trend, but the abortion rate showed significant downward trend, with the decline of blastocyst quality. When the blastocyst scored ≥BB grade, the single blastocyst transfer could be considered to be performed.