Cardiovascular surgery in COVID-19: Change and countermeasure / 中国胸心血管外科临床杂志

@#The coronavirus disease 2019 (COVID-19) epidemic has a tremendous impact on the countries around the world since the outbreak in December 2019. From December 2022, with the loosening of domestic epidemic control policies, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rose significantly and reached to its epidemic peak in the majority of the cities in China, which further overwhelmed our medical care system. The cardiac surgery departments in China lack the experience in conducting work under the COVID-19 pandemic. In this paper, we summarize the main topics that might be faced during the pandemic by reviewing the previous related literatures, which included: the cardiac surgery volume trends, the impact of SARS-CoV-2 infection on the prognosis of cardiac surgery, the timing of cardiac surgery and the surgical strategy should be modified, and possible recommendations for the manager or governors during the pandemic, so as to outline a path forward for cardiac surgery for the near future.

Experience on prevention and control management in PICU during the epidemic of novel coronavirus Omicron variant in Shanghai / 中国小儿急救医学

Objective:To summarize the experience of the precise prevention and control strategy of novel coronavirus infection in the pediatric intensive care unit(PICU)during the epidemic of the Omicron variant.Methods:A retrospective analysis was performed on the strategies and management experience of precise prevention and control of novel coronavirus infection in PICU at Pediatric Hospital of Fudan University from March 1 to May 10, 2022.Results:According to the national and Shanghai novel coronavirus infection prevention and control standards, the PICU in our hospital, in accordance with the specialty characteristics of PICU, cooperated with the hospital′s department of infection and medical department to jointly construct a precise ward management strategy for the outbreak of the omicron mutants infection.Precise prevention and control management strategies were formulated from four aspects: the admission process of critically ill children, the division of PICU ward areas and nosocomial infection protection, the reception management system for children′s family members, and the " bubble management" system for PICU staff, and run them for 3 months.During the epidemic, there was no nosocomial infection of novel coronavirus infection in children or medical staff.During the period, a total of 140 critically ill children were admitted, including 87 cases transferred from the general ward in the hospital, 48 cases from the emergency department(non-febrile, 3 cases transferred by the transfer team), four cases from fever clinic, and one case from control ward.Four of the critically ill children had no emergency nucleic acid test report when they were admitted to the PICU.Among the 140 critically ill children, 54 patients received mechanical ventilation, 18 patients received blood purification, and two patients were monitored after liver transplantation.Seventy-eight (55.7%) children had underlying diseases.Conclusion:During the current round of novel coronavirus epidemic in Shanghai, PICU in our hospital formulated the admission and ward management procedures for critically ill children, which ensured the prevention and control of nosocomial infection of novel coronavirus, and at the same time ensured the treatment of critically ill children to the greatest extent.

Management strategy and role of thermal ablation in ground-glass nodules / 中国胸心血管外科临床杂志

@#The majority of incidentally found and screen-detected lung cancer is manifested as ground-glass nodule (GGN), which is more likely to be detected in the young people, women and non-smokers. An appropriate management strategy for GGN can not only reduce the mortality of lung cancer but also minimize overtreatment. Although most of persistent GGNs are finally diagnosed as adenocarcinoma or precursor glandular lesions, the GGN-featured lung cancer is characterized as indolent growth or even non-growth. Therefore, scheduled follow-up might be safe for the special radiologic type under a certain condition. We should design the individualized diagnosis and treatment strategy for each patient. The treatment decision-making depends on various factors, including invasion, dynamic change, efficacy and safety of the treatment, as well as physical and psychic condition of the patients. Different from other types of lung cancer, the indolent feature of GGN-featured lung cancer allows a long time to intervene. Therefore, the determination of proper timing for intervention should be made cautiously. Surgical resection is still the principal treatment for GGN-featured lung cancer. However, there is still no consensus on the optimal surgical approach for GGN-featured lung adenocarcinoma. Currently, sublobar resection without lymphadenectomy has been recommended to the patients with precursor glandular lesions. In light of the GGN-featured lung cancer which generally represents a local lesion, local ablation therapies have been used in those patients, especially in the ones who are inoperable or refuse to undergo surgery. The percutaneous local ablation includes different techniques: radiofrequency ablation, microwave ablation and argon-helium cryoablation. The local ablation is safe, minimally invasive and repeatable. In addition, it offers the advantage to biopsy and treatment synchronously. Percutaneous ablation has the potential to be an alternative of surgery to cure GGN-featured lung cancer based on emerging evidences. The efficacy of transbronchial ablation guided by  ultrasound or electromagnetic navigational system in the treatment of GGN-featured lung cancer has been primarily validated. As a developing technology, it might be a promising approach but needs further exploration. With the advance in ablation technology, we do believe that the interventional therapy will play an equal role as surgery in curative treatment of GGN-featured lung cancer in the future. Personalized treatment considering the condition of patients and the features of the lesion will maximize the benefit of every patient. This article will explore the diagnosis and treatment strategies of GGN on the basis of further understanding of GGN, and introduce the application of ablation therapy in GGN from the perspective of respiratory intervention.

Discussion on management strategies of multi-center pharmaceutical clinical study initiated by investigator / 中华医学科研管理杂志

Objective:Discuss the problems of multi-center pharmaceutical clinical trial which initiated by investigator (IIT), providing references for developing study management strategies.Methods:By analyzing the site recruitment, academic and ethical review, study contract, study training, quality control, influencing factors of subject enrollment, proposed management strategies of multi-center pharmaceutical clinical study which initiated by investigator.Results:While conducting multi-center pharmaceutical clinical study initiated by investigator, the study experiences, study team, hospital equipment, and the internal process of hospitals are the factors which ensure the progress and quality of clinical study. Most of the sites have no clear statement of scientific review, but most of the high-level hospitals do not use the ethical review results of the head hospitals, the ethics must be reviewed repeatedly; Contract also has different requirements due to different management departments. During the preparation and implement of IIT, the investigators should undergo a rigorous training which is a key element to ensure the quality of the study. Research quality and progress restrict each other and are affected by many factors, detailed quality control measures should be developed, training and inspection, and the cooperation of project management and data management, also with discover the data problems of sites and communicate with investigators timely to ensure the improvement measures are implemented.Conclusions:There are many factors have impact on study progress and quality of multi-center pharmaceutical clinical trial of IIT. Before conducting research, protocols should be developed scientifically, and fully assessing its feasibility, screening study sites strictly, shorten the time of ethical review and contract preparation. Study training, inspection, data management, risk management and document management should be implement strictly, and make full use of information platforms and means, improve management efficiency and IIT progress and quality.

A gestão autônoma da medicação e o exercício do cuidado / Autonomous medication management and care exercise / Manejo autónomo de medicamentos y el ejercicio de la atención

Este artigo foi construído em interface com o projeto brasileiro da Estratégia da Gestão Autônoma da Medicação (GAM), especificamente em Vitória (Espírito Santo) em um Centro de Atenção Psicossocial Infanto-Juvenil (CAPSi). Ele enuncia o desdobramento da GAM em sua experiência inédita com Grupo de Intervenção com Familiares (GIFs) de crianças e adolescentes e tem por objetivo narrar a experimentação da GAM no Estado do Espírito Santo, no campo da saúde mental infanto-juvenil. Nesta pesquisa afirmamos uma postura ético-metodológica pautada no método cartográfico e na pesquisa-intervenção, pressupondo a produção de conhecimento indissociável da produção de cuidado. A GAM tem contribuído para a efetivação das políticas públicas de saúde, como um exercício de ampliação de possibilidades de cuidado, disparando processos de autonomia e protagonismo, democratização nos serviços de saúde, criando e sustentando formas de tratamento coletivamente, reconfigurando, assim, as relações entre usuários, familiares, profissionais e pesquisadores.(AU)

This article was built in interface with the Brazilian Autonomous Medication Management Strategy (GAM) project, specifically in Vitória (Espírito Santo) at a Child and Youth Psychosocial Care Center (CAPSi). It enunciates the unfolding of GAM in its unprecedented experience with Group of Intervention with Family (GIFs) of children and adolescents and aims to narrate the experimentation of GAM in the State of Espírito Santo, in the field of intangible and youth mental health. In this research, we affirm an ethical-methodological stance based on the cartographic method and in research-intervention, assuming the production of knowledge inseparable from the production of care. GAM has contributed to the effectiveness of public health policies, as an exercise in expanding care possibilities, triggering processes of autonomy and protagonism, democratization in health services, creating and sustaining forms of treatment collectively, thus reconfiguring relationships among users, family members, professionals and also researchers. (AU)

Este artículo fue construido en interfaz con el proyecto de Estrategia Autónoma de Gestión de Medicamentos (GAM) de Brasil, específicamente en Vitória (Espírito Santo) en un Centro de Atención Psicosocial Infantil y Juvenil. Enuncia el desenvolvimiento del GAM en su experiencia inédita con el Grupo de Intervención con Familia de niños y adolescentes y tiene como objetivo narrar la experimentación del GAM en el Estado, en el campo de la salud mental juvenil. En esta investigación afirmamos una postura ético-metodológica basada en el método cartográfico y en la investigación-intervención, asumiendo la producción de conocimiento inseparable de la producción de cuidados. El GAM ha contribuido a la efectividad de las políticas públicas de salud, como ejercicio de ampliación de las posibilidades de atención, desencadenando procesos de autonomía, democratización en los servicios de salud, creando y sustentando formas de tratamiento de manera colectiva, reconfigurando así las relaciones entre investigadoresy otros. (AU)

Gestión integrada para la prevención y control del dengue y otras arbovirosis en la Municipalidad de Ambato / Integrated management for the prevention and control of dengue and other arboviruses in the Municipality of Ambato

Las arbovirosis por Dengue (VD), Zika (VZIK) y Chikungunya (VCHIK), transmitidas por vectores del género Aedes, tienen alta prevalencia en países tropicales, especialmente en Ecuador donde se les considera problemas de salud pública. Se realizó un estudio descriptivo para identificar el nivel de cumplimiento de la estrategia de gestión integrada (EGI) para prevención y control de VD y otros arbovirus en Ambato, Tungurahua - Ecuador. Se realizó perfil comunitario a partir de fuentes oficiales y secundarias, se evaluó componentes del ambiente mediante lista de verificación y se evaluó cumplimiento de EGI mediante encuesta al personal del sector salud. Datos consultados señalan que en la provincia existe 36% y 10% de pobreza y pobreza extrema, respectivamente; además adecuado servicio de agua potable, recepción de agua por tubería, gestión de residuos sólidos y servicio de electricidad en ambas zonas, urbana y rural. Se constató que más del 50% de la población rural presenta condiciones óptimas de salud ambiental: aire limpio (90,28%) y agua potable (66,94%); en la población urbana destaca higiene de alimentos (63,89%) y microambiente doméstico (69,44%), con deficiencia en recolección de residuos sólidos (33,89%). La EGI tuvo un nivel de cumplimiento de 100% en parroquias urbanas en componentes laboratorio, atención al paciente, promoción y comunicación, mientras que en parroquias rurales, salud ambiental tuvo 63% e investigación y capacitación menor nivel (47,78%); siendo necesario mejorar sistemas de desechos sólidos en la población urbana y promover el conocimiento y capacitación epidemiológica en la rural, para reducir el riesgo de transmisión por arbovirus(AU)

Dengue (DV), Zika (ZIKV) and Chikungunya (CHIKV) arboviruses, transmitted by vectors of the Aedes genus, have a high prevalence in tropical countries, especially in Ecuador where they are considered public health problems. A descriptive study was carried out to identify the level of compliance with the integrated management strategy (EGI) for prevention and control of DV and other arboviruses in Ambato, Tungurahua - Ecuador. A community profile was made from official and secondary sources, components of the environment were evaluated by means of a checklist and compliance with EGI was evaluated by means of a survey of health sector personnel. Consulted data indicate that in the province there is 36% and 10% of poverty and extreme poverty, respectively; In addition, adequate drinking water service, receiving water through pipes, solid waste management and electricity service in both urban and rural areas. It was found that more than 50% of the rural population presents optimal environmental health conditions: clean air (90.28%) and drinking water (66.94%); In the urban population, food hygiene (63.89%) and domestic microenvironment (69.44%) stand out, with a deficiency in solid waste collection (33.89%). The EGI had a compliance level of 100% in urban parishes in laboratory, patient care, promotion and communication components, while in rural parishes, environmental health had 63% and research and training lower level (47.78%); being necessary to improve solid waste systems in the urban population and promote epidemiological knowledge and training in rural areas, to reduce the risk of transmission by arbovirus(AU)

Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury / 南方医科大学学报

OBJECTIVE@#To investigate the effects of restrictive fluid management in patients with severe traumatic brain injury (sTBI).@*METHODS@#Between January, 2019 and June, 2020, we randomly assigned 51 postoperative patients (stay in the ICU of no less than 7 days) with sTBI into treatment group (@*RESULTS@#The cumulative fluid balance of the two groups were positive on day 1 and negative on days 3 and 7 after ICU admission; at the same time points, the patients in the treatment group had significantly greater negative fluid balance than those in the control group (@*CONCLUSIONS@#Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI.

Gestión para la protección medioambiental en la Universidad de Ciencias Médicas de Santiago de Cuba / Management for the environmental protection in the University of Medical Sciences in Santiago de Cuba

El papel de la universidad en la conservación del medioambiente y la protección de sus recursos naturales se expresa mediante la integración de la dimensión ambiental en el sistema educativo y se dirige a la adquisición de conocimientos, al perfeccionamiento de capacidades y a la formación de valores éticos que favorezcan un comportamiento social y profesional coherente con el desarrollo sostenible. En tal sentido, en la Universidad de Ciencias Médicas de Santiago de Cuba se evaluó el cuidado del medioambiente aplicando la metodología establecida por el Ministerio de Ciencia, Tecnología y Medioambiente para la obtención del reconocimiento nacional al respecto, con lo cual se evidenció un avance en la gestión de la Universidad, aunque aún existen aspectos pendientes que se han incluido en la "Estrategia de gestión ambiental" de la institución para avanzar en el desempeño de la protección medioambiental.

The role of the university in the conservation of the environment and the protection of its natural resources is expressed by means of the environmental dimension integration in the educational system and it is directed to the acquisition of knowledge, to the improvement of capacities and the training of ethical values that favor a social and professional behavior coherent with the sustainable development. In such a sense, in the University of Medical Sciences of Santiago de Cuba the care of environment was evaluated implementing the methodology established by the Ministry of Science, Technology and environment in order to obtain the national recognition in this respect, with which an advance in the management of the University was evidenced, although there are some unfinished aspects that have been included in the "Strategy of Environmental Management" of the institution to advance in the environmental protection performance.

Management strategies for diagnosis and treatment process of stroke patients during an outbreak of SARS-CoV-2 / 西安交通大学学报(医学版)

SARS-CoV-2 is highly infectious and poses a serious threat to human health. In addition to typical respiratory manifestations, some patients have neurological symptoms or other cerebrovascular disease risk factors, which may easily lead to stroke and endanger life. During the outbreak of Coronavirus disease 2019 (COVID-19), the relevant diagnosis and treatment process strategies were formulated for general outpatient department of neurology, emergency department of neurology/green channel of stroke, intervention operation of suspected/confirmed patients, and management of neurological ward, so as to provide guidance for rapid screening and treatment of stroke patients, and avoid the occurrence of nosocomial infection.

Management strategy of oral mucosal diseases during the epidemic of Corona Virus Disease 2019 / 口腔疾病防治

Corona Virus Disease 2019 (COVID-19) has broke out in 29 countries and regions in the world in a short period since December 2019. Various measures of prevention and control have been taken all over China. At present, the epidemic situation shows a positive trend, however, there are still a few new comfirmed cases in some area of China. So the job and thinking of epidemic prevention still cannot be relaxed. As an important specialty of stomatology, the risk of cross infection is high in oral medicine. Establishing an effective system of pre- inspection and triage and adopting strict measures of prevention and control are essential. According to the prevention and control situation of COVID- 19, the characteristics of hospital infection, pre examination, protective measures, the home management strategies of oral mucosal diseases during the epidemic period and the differential diagnosis between COVID-19 and common oral muco- sal diseases with fever were summarized and recommended in this paper.

Perioperative management strategy of severe traumatic brain injury during the outbreak of COVID-19 / 中华创伤杂志(英文版)

Since December 2019, a pneumonia caused by a new coronavirus, i.e. COVID-19 occurred in Wuhan, Hubei Province, China. Although the epidemic in China has been bought under control, the global COVID-19 situation is still grim. Severe traumatic brain injury (TBI), as one of critical conditions in the department of neurosurgery, requires an early and effective treatment, especially surgery. There were currently no reliable guidelines on how to perform perioperative protection in TBI patients with suspected or confirmed coronavirus infection. According to the corresponding treatment regulations and guidelines issued by the authorities, we summarized the management strategy of TBI patients in perioperative period during the COVID-19 outbreak based on medical and nursing practice, in order to provide a reference for clinicians.

Operating room management strategy for orthopedic patients in Third Hospital of Hebei Medical University during epidemic of corona virus disease 2019 / 中华创伤杂志

In December 2019, the corona virus disease 2019 (COVID-19) broke out in Wuhan, Hubei Province. Although the number of newly confirmed COVID-19 cases in provinces outside of Hubei Province has declined continuously since February 4, the epidemic of COVID-19 remains serious. As companies resume work, it is still inevitable that some high-energy orthopedic trauma patients and elderly patients with low-energy fractures will need surgical treatment. The operating room, as a place for close contact between doctors, patients and nurses, increases the risk of infection and transmission. Based on the current needs of orthopedic trauma patients and the situation of the country's resistance to the epidemic of COVID-19, the authors expound the operating room management, preparation of medical materials, transfer of patients needing surgery, intraoperative protection and post-operative end disinfection in Third Hospital of Hebei Medical University so as to provide reference for prevention and control management of the operating room during the epidemic period.

Study on nursing emergency management strategy of general hospitals in non-epidemic areas under the outbreak of coronavirus disease 2019 / 上海交通大学学报（医学版）

Objective: To understand the implementation of the emergency management plan of nursing in the general hospitals in non-epidemic areas under the outbreak of coronavirus disease 2019 and propose strategies. Methods: Nine experts were interviewed by the method of focus group interviews method and the data were collected and analyzed by the method of Colaizzi data analysis method. Results: The important themes of nursing emergency management included the deployment and training of human resources, the development and implementation of material management system, and ward visiting system, the training and reserve of specialist nurses, as well as the psychological assistance and humanistic care. Conclusion: The emergency management of nursing in the general hospitals in non-epidemic areas is a systematic project. Nursing managers should further complete the construction of team and system for nursing emergency management, and improve the emergency nursing abilities and the mental health of nurses.

Eficacia de una estrategia de manejo cognitivo de los síntomas de enfermedad coronaria en la mujer / Efficacy of a cognitive management strategy for coronary heart disease symptoms in women

Las mujeres que experimentan síntomas de enfermedad coronaria muestran respuestas como negación, subvaloración y atribución de los síntomas a un origen no cardiaco. Este fenómeno se ha traducido en demora para consultar, disminución de la efectividad de los tratamientos, aparición de complicaciones e incremento de la mortalidad. La presente investigación tuvo como objetivo determinar la eficacia de una estrategia de manejo cognitivo de los síntomas de enfermedad coronaria para mejorar las acciones de respuesta y los niveles de autoeficacia general en un grupo de mujeres participantes de un programa de rehabilitación cardiaca en dos instituciones de salud de la ciudad de Bogotá D.C. Este estudio se desarrolló a partir de un diseño tipo ensayo clínico controlado no aleatorizado. El grupo control recibió el manejo habitual del programa de rehabilitación cardiaca, mientras que el grupo experimental recibió la estrategia de manejo de enfermería elaborada a partir del Modelo Conceptual del Manejo del Síntoma de Dodd y colaboradores y de la Teoría de Rango Medio de Autoeficacia propuesta por Bárbara Resnick. Esta intervención se realizó en cuatro sesiones con un encuentro semanal. Las acciones de respuesta y los niveles de autoeficacia fueron evaluados al inicio, dos y cinco semanas después de finalizar la intervención. El análisis de resultados mostró una correlación positiva en el grupo experimental entre las acciones de respuesta y los niveles de autoeficacia general luego de la aplicación de la estrategia de manejo. Este hallazgo se mantiene en la medición intermedia y final. Con respecto al desenlace secundario, se demostró que la estrategia de manejo diseñada e implementada no fue más eficaz que la intervención convencional sobre el puntaje de autoeficacia general obtenido durante las mediciones preliminar, intermedia y posterior. Lo anterior comprueba la importancia de incluir elementos cognitivos y enfoque de género dentro de los programas de rehabilitación cardíaca.

The women that experience symptoms of coronary heart disease show responses such as denial, underestimation and, even, attributes the symptoms to a non-cardiac origin. This phenomenon has derived in a delay at the time of medical consultation, decrease in treatment effectiveness, medical complications and increase of mortality rate. This study aims to determinate the effectiveness of a cognitive management strategy in coronary heart disease, in order to improve response actions and general self-efficacy levels in a group of women who participated in a cardiac rehabilitation program at two health institutions in Bogotá (Colombia). This study was developed with a design type non-randomized controlled clinical trial of research. The control group received usual management within the cardiac rehabilitation program, while the experimental group received the nursing management strategy made from Dodd's et al. Conceptual Management Symptom Model and Resnick's middle range theory of self-efficacy. This intervention was carried out in four sessions scheduled during four weekends. Response actions and auto-efficacy levels were assessed in three moments: at baseline, two and five weeks after intervention was completed. Research results and analysis showed a positive correlation between response actions and self-efficacy actions after intervention with the management strategy in experimental group. This finding remained even in intermediate and final measurements. In relation to the secondary outcome, the study showed that the designed and implemented management strategy was not more effective compared to the conventional intervention in terms of general self-efficacy scores during preliminary, intermediate and final measurements. This confirms the importance to include items related to cognition and gender approach within rehabilitation cardiac rehabilitation programs.

Application risk and management strategy of infusion pumps / 医疗卫生装备

Objective To analyze the risk factors of the infusion pump to provide evidence-based basis for its safety management and monitoring.Methods Totally 1 000 pieces of questionnaires were issued for 100 infusion pumps from 9 grade-A tertiary hospitals in Beijing.The abnormalities and the correlation between the indexes were analyzed for the infusion pump,the indexes were compared on their effects on the abnormalities.Results Statistical analysis on data samples showed that the main factors included the manufacturer of infusion pump and pipeline,service time of infusion pump,compatibility between infusion pump and pipeline as well as the user department.Conclusion The management facility has to pose emphases on safety and utilization management as well as standardized application of the infusion pipeline so as to reduce adverse events efficiently.

Effect of low tidal volume lung protective ventilation strategy on the outcome of elderly patients with poor pulmonary function after abdominal operation / 临床麻醉学杂志

Objective To observe the effect of low tidal volume lung protective ventilation management strategy on postoperative outcome of elderly patients with poor pulmonary function after abdominal surgery.Methods Eighty patients of poor pulmonary function undergoing open gastrointestinal surgery,male 64 cases,female 16 cases,aged over 65 years old,ASA physical status Ⅱ or Ⅲ,NYHA cardiac function Ⅱ or Ⅲ grade,expected operation time 2-4 h were screened.The patients were randomly divided into 2 groups: protective ventilation management group (group P) and conventional mechanical ventilation group (group C),40 cases in each group.Multi-mode anesthetic management was performed in both groups.The respiratory parameters were adjusted according to the group after tracheal intubation,and the respiratory rate was adjusted to maintain PETCO2 35-45 mm Hg.The blood gas evaluated postoperative oxygen and postoperative spontaneous breathing recovery time,recovery time,extubation time,PACU time,gastrointestinal function recovery time,ambulation time,hospital stay and cost of hospitalization were recorded.The occurrence of major complications were observed at 30 days after surgery.Results PaO2 of group C was significantly decreased at 1 and 3 days after surgery than that before operation (P<0.05),PaCO2 of group C was significantly higher at 1 and 3 days after surgery than that of group P (P<0.05);PACU residence time of group P was (76.63±29.72) min,significantly shorter than that of group C [(93.80±42.90) min] (P<0.05);The difference spontaneous breathing recovery time,awake time,extubation time,exhaust time,ambulation time,postoperative hospitalization time and hospitalization expenses of two group was not statistically significant.Within 30 d after operation,2 cases (5%) of respiratory failure patients,3 cases (7.5%) of pneumonia in group P;5 cases (12.5%)of respiratory failure patients,3 cases (7.5%) of pneumonia,postoperative hemorrhage in 1 cases (2.5%) and 1 cases (2.5%) delirium in group C,there was no significant difference of the main complications in 30 d after operation between two groups.Conclusion Under the condition of this research,low tidal volume lung protective ventilation management strategy can improve elderly patients with poor pulmonary function after abdominal surgery postoperative oxygen and help to reduce the occurrence of postoperative adverse reactions.

Discussions on the business strategy against total reimbursement control of medical insurance for large public hospitals / 中华医院管理杂志

To address such challenges as the rapid rise in health care costs,insufficient constraints on supply-side behavior by medical insurance,and rising risk exposure of the insurance foundation,the Ministry of Human Resources and Social Security has proposed a payment mode reform featuring total reimbursement control.Such a total control policy will affect significantly the business operation of urban public hospitals.To adapt to the impacts so incurred,a three-level transformation strategy is recommended as follows.A development strategy calling for a new growth model,greater role of hospital-health alliances for greater service coverage; a business management strategy to ensure quality of care and safety,clinical pathways in place and optimize service processes; an administrative strategy to enhance cost control,strengthen information technology,and transform the management functions.

Risk factors and management strategy of obstructive sleep apnea and hypopnea syndrom in children / 中华实用儿科临床杂志

Childhood obstructive sleep apnea and hypopnea syndrom (OSAHS) has complex causes,which can lead to cardiovascular diseases,neurological complications such as cognitive impairment,and metabolic syndrome.It has affected children's physical and mental health.Childhood OSAHS should emphasize the early identification of the risk factors,it's necessary to undergo polysomnography and intervene timely.The diagnosis and treatment of OSAHS should be combined with clinical characteristics,and should not only rely on undergo polysomnography report results.Tonsil and adenoidectomy is still the first line treatment,nasal inhaled hormone and leukotriene receptor antagonist are effective for mild OSAHS children.

Analysis on running problems in medical insurance real-time settlement in outpatient department / 中华医院管理杂志

Analyze the problems of medical insurance real-time settlement in outpatient department.Explore the situation of stringent management of health medical insurance agencies,accuracy of the information,significant increasing costs that medical insurance agencies refused to pay and severe environment to doctors.And management strategy such as regulating doctors' behavior strictly,upgrading hospital information systems,increasing hospital staff to excavate the hospital potential and publicizing the new policy of medical insurance comprehensively.

Conflict management strategies of staff nurses in Macau / 中国实用护理杂志

Objective To identify the conflict management strategies of staff nurses in Macau. Methods The Thomas -Kilmann Conflict Mode Instrument (TKI)was employed in the study to investigate the conflict management strategies of a convenience sample of 140 staff nurses who were pursuing a Bachelor of Science in Nursing (Supplementary) Programme in Macau. Results The most commonly used strategy by staff nurses in Macau for conflict management was accommodation, followed by avoidance, then compromise. In contrast, the least often used strategy was competition. Conclusions Chinese culture as well as nursing education background should be fully considered when developing the training plan of conflict man -agement strategies for staff nurses in Macau.