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Objective:To study the effect of blood volume feedback control system on improving intradialytic-hypotension (IDH) in maintenance hemodialysis (MHD) patients.Methods:It was a prospective cohort study. Thirty MHD patients with recurrent IDH in the Dialysis Center of the First Affiliated Hospital of Zhejiang University School of Medicine from March 2021 to March 2022 were selected. A self-control study was conducted in MHD patients. The patients were treated with routine hemodialysis in both baseline phase (A1) and reversal phase (A2), while with hemodialysis under the blood volume feedback control system in intervention phase (B). Each phase lasted for 4 weeks (12 hemodialysis sessions). The average occurrences of IDH and IDH-related adverse events (IDH-RAE, stopping dehydration for more than 10 minutes or getting off the hemodialysis machine 10 minutes earlier due to IDH) of each patient between phase A1, B, and A2 were calculated and compared. In a total of 1 080 dialysis records, a logistic regression analysis model was established with age, sex and intervention as independent variables and with the occurrence of IDH-RAE as the outcome.Results:A total of 30 eligible patients were included in the study, including 14 males (46.7%) and 16 females (53.3%), aged 63.0 (56.5, 72.5) years old, with a median dialysis age of 84.0 (37.2, 120.0) months. The average times of IDH in 30 MHD patients decreased from 1.17 (0.83, 1.67) in stage A1 (before intervention) to 0.33 (0.25, 0.58) in stage B (after intervention) ( P<0.05). The frequency of IDH-RAE decreased significantly from 0.29 (0.19, 0.47) in stage A1 to 0.17 (0,0.25) in stage B ( P<0.05). Logistic regression analysis results indicated that the use of blood volume feedback control system reduced the risk of IDH-RAE by 53% ( OR=0.47, 95% CI 0.34-0.64, P<0.001). Conclusions:The application of blood volume feedback control system can effectively reduce the occurrences of IDH and the risk of IDH-RAE in MHD patients.
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In the process of continuous renal replacement therapy (CRRT), various factors such as the temperature of replacement fluid, the flow of fluid and the circulation of blood in cardiopulmonary bypass, lead to the temperature of the blood injected back into the body is often lower than normal. It leads to the decrease of body temperature and the occurrence of hypothermia, which can be life-threatening in severe cases. In clinical practice, medical staff mostly reduces the occurrence of hypothermia in patients with CRRT by means of the heating device of the machine, the heating of the liquid temperature box for cardiopulmonary bypass, and the application of heating blankets, but the effect is not ideal. Therefore, medical staff of the department of critical care medicine of the Second Affiliated Hospital of Anhui Medical University designed a heating device and temperature control system for CRRT dialysis fluid bag, and obtained the National Invention Patent of China (ZL 2021 1 0334906.7). The device includes a heating and thermal insulation device and a temperature control system, wherein the heating and thermal insulation device is composed of the body of the heating dialysis fluid bag and the temperature control structure, which solves the problems of safe and efficient liquid heating and thermal insulation during the CRRT process. The temperature control system can display the dynamic state of the patient's body temperature, adjust the temperature of the dialysis fluid bag in time, and monitor the temperature of the blood transfusion in real time through the cooperation of the five modules of data collection, data handle, data analysis, regulation and display. This design is applied to CRRT, which can achieve precise control of body temperature of critically ill patients, and has certain clinical significance.
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The proton treatment control system is the supporting software of the proton therapy device, which specifically coordinates and controls the status and work of each subsystem. In this study, the software architecture and hardware implementation of the proton treatment control system was developed and built a foundation for the overall debugging. Using C# programming language and WPF programming techniques, TCP network communication protocol specified by the proton treatment technical document and MVVM pattern in Windows system, the logic design and implementation of each level were studied. Meanwhile, the communication interface between the subsystems under TCP communication protocol was agreed. The logic design and research of the setup field and treatment field were carried out. And the User Interface was designed and developed using the above technology. The program realizes the communication and interaction between the proton treatment control system and each subsystem, so as to control and monitor the whole treatment process. The proton treatment control system provides a software basis for the remote overall debugging and on-line monitor and control of proton treatment device.
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Protones , Interfaz Usuario-Computador , Programas Informáticos , Computadores , LógicaRESUMEN
Objective:To explore the application and effect of multi-level quality control system (referred to as “quality control”) in health management center setting.Methods:The health management center of Hanzhong Central Hospital constructed a multi-level quality control system of “hospital-department-unit” and “department-unit-quality-controller” in August 2019. A total of 83 619 people who underwent physical examination in the Health Management Center of Hanzhong Central Hospital from August 2018 to July 2020 were selected as the subjects. 32 009 people who underwent physical examination from August 2018 to July 2019 were selected as the control group, and 51 610 people who underwent physical examination from August 2019 to July 2020 were selected as the experimental group. The timely notification of important abnormal results and the follow-up of the “four-high” population (hypertension, hyperglycemia, hyperlipidemia, and hyperuricemia) were observed. Two thousand satisfaction questionnaires and two thousand physical examination reports were collected from the institutions who had received both physical examination in the Health Management Center of Hanzhong Central Hospital for two consecutive years. The physical examination items of the above clients were basically the same. The satisfaction rate of the two groups of physical examination and the qualification rate of the physical examination reports were measured respectively.Results:The results showed that the timely notification rate of important abnormal results (99.4% vs 96.6%), follow-up rate of “four-high” population (hypertension 95.1% vs 91.2%, hyperglycemia 95.3% vs 91.6%, hyperlipidemia 94.6% vs 92.3%, hyperuricemia 92.7% vs 86.4%), satisfaction rate of physical examination (physical examination environment 94.0% vs 91.3%, service attitude 96.4% vs 91.9%, waiting time 97.6% vs 95.4%, physical examination process 98.3% vs 96.8%, professional level of medical staff 97.2% vs 95.1%), and qualified rate of physical examination report (accuracy of input information 99.5% vs 98.1%, accuracy of main examination conclusion 99.4% vs 97.3%, normative sorting 99.8% vs 98.8%, rationality of health advice 99.2% vs 96.8%) in the experimental group were significantly higher than those in the control group (all P<0.05). Conclusion:The establishment of a multi-level quality control system in health examination service can improve the timely notification rate of important abnormal results, the follow-up rate of the “four-high” population, the satisfaction of physical examinees, and the qualified rate of physical examination reports.
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Peking Union Medical College Hospital has carried out the practical exploration of a new system of medical risk prevention and control based on the integration of medical and law, broken the traditional practice of legal counsel only handling medical disputes after the event, explored the pre-management and control mode of medical risks. The hospital established a whole process medical risk management mode in which legal counsel, medical administrators and clinical medical staff cooperated and participated, further standardized the medical behavior, legal concept and legal practice awareness of medical personnel, realized standardized management and formed a long-term mechanism. It could not only effectively integrate the fragmented clinical legal service needs and extensively enhance the sense of occupational security of clinical medical staff, but also effectively improve the operation quality of medical safety indicators and promote the high-quality development of the hospital.
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Sudden cardiac death (SCD) is one of the most common causes of death for patients with cardiovascular diseases. General practitioners are the providers of primary medical and health service, it its worthwhile to discuss their role positioning in the prevention and control system of SCD. In this study, SWOT analysis was used to explore the strength, weakness, opportunity and threats of the involvement of general practitioners in SCD prevention and control system, to clarify the roles of general practitioners and to provide suggestions for the improvement and development of SCD prevention and control system in China.
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Objective To image the veins around the foramen of monro (FM), to build the 3D model of them, to construct venous network in this area and to explore the spatial positional correlation between FM and veins around it. Methods Totally 60 healthy subjects were selected to get the original images on 3. 0 T MR and procesed the original images by minimum intensity projections (mIP) and Materialise’ s interactive medical image control system (Mimics), built the 3D model of the veins around FM, observed and analyzed the morphology of FM and the veins around it on original and processed images. Results The displaying rate of FM was 65% (78 sides), the displaying rate of internal cerebellar veins (ICV) was 100% (120 sides), the diameter was (2. 13±0. 30) mm. The displaying rate of anterior septal vein (ASV) was 100% (120 sides), the diameter was(0. 69±0. 19)mm. The displaying rate of superior thalamostriate vein (STV) was 98. 3% (118 sides), the diameter was (1. 47± 0. 38) mm. The displaying rate of superior choroidal vein (SCV) was 82. 5% (99 sides), the diameter was(0. 40±0. 18)mm. According to the relationship between the converging point of the tributaries of ICV and the location of FM, FMs were classified into 5 types:ⅠA, 24. 2% (29 sides), ASV converged into ICV at the venous angle and closed to the posterior edge of FM; ⅠB, 13. 3% (16 sides), ASV converged into ICV away from the venous angle and the posterior edge of FM; ⅡA, 45% (54 sides), ASV converged into ICV at the false venous angle and closed to the posterior edge of FM; ⅡB, 15. 8% (19 sides), ASV converged into ICV away form the false venous angle and the posterior edge of FM. Ⅲ, 1. 7% (2 sides), STV was absent. Conclusion FM and the veins around it are visible on the susceptibility weighted imaging(SWI). It can be constructed by Mimics that the 3D model of ICV, its tributaries, FM and the converging points of the major veins. The classification of FMs is meaningful to the option of surgical approaches through FM.
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The pilot work of organ donation after citizen's death has been implemented in China for 10 years. The number of organ donations was significantly increased from 34 cases in 2010 to more than 6 300 cases in 2018, accounting for over 15% of the global quantity of organ donations. China has established an organ donation and transplantation system that follows the international ethical standards, and conforms to our own social development stage and cultural tradition. Organ donation is a novel discipline created by multi-disciplinary integration in the new era of China, the process of which was reviewed from the perspectives of legal supervision, workflow, management mode, training and education mode, quality management and control system, organ donation in the epidemic of noval coronavirus pneumonia and application of innovative technologies, etc.
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The construction of county and district medical community is an important measure for high-quality medical resources to "double sink and improve". In this study, we have initially constructed a medical equipment quality control system for members of the regional medical community. The current situation of lack of professional medical equipment management personnel and quality control equipment in primary medical institutions has been alleviated, the quality control level of medical equipment in primary medical institutions has been improved, and a new management model for quality control of primary medical equipment has been explored.
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Equipos y Suministros de Hospitales/normas , Administración de Materiales de Hospital/organización & administración , Control de CalidadRESUMEN
The critical period for the prevention and control of novel coronavirus pneumonia (NCP) in China, in response to requirements for accelerating the modernization of the disease prevention and control system, we analyzed and summarized the current situation, existing problems, and deficiencies in China′s modernization of disease prevention and control system. In addition, we put forward the contents and countermeasures for the modernization of the disease prevention and control system. The modernization of the disease prevention and control system should be built around governance modernization, talent modernization, equipment modernization, scientific research modernization, and modernization of the regulatory system. The countermeasures and suggestions need to reposition the disease prevention and control system, rationalize the management system and operating mechanism, strengthen the modernization of talents and equipment, strengthen scientific research on disease prevention and control, and further improve the disease prevention and control legal system.
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Objective To evaluate the advantages of reconstructing by mimics software before operation a three-dimensional model of talar posterior process fracture which is to be used in the treatment of talar posterior process fracture through the posteromedial malleolar approach.Methods From May 2015 to February 2019,7 patients with talar posterior process fracture were treated at Department of Orthopaedic Trauma,Jishuitan Hospital.They were 5 men and 2 women,aged from 20 to 70 years (mean,39 years).They underwent routine CT examination preoperatively.Their posterior process of talus was reconstructed by Mimics software based on their CT scanning data before operation to determine the size,number and displacement of fracture fragments.Their fractures of posterior process of talus were treated by open reduction and screw fixation in prone position through the posterior ankle approach.The American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot scoring system was used to evaluate functional recovery.Results The operation time for this group ranged from 70 min to 105 min,averaging 87.1 min.Early after operation,the wounds healed well with no injury to nerves or tendons.All patients were followed up for 4 to 24 months (average,12 months).Follow-up by X-ray examination after 10 to 16 weeks revealed fracture union with no complications like screw breakage,nonunion,malunion or traumatic arthritis.Their AOFAS ankle-hindfoot scores at the final follow-up ranged from 80 to 98 points.Conclusion Preoperative three-dimensional reconstruction of talar posterior process fracture based on CT images using Mimics software can accurately determine the entry point and direction of screw insertion,yielding advantages of clear exposure,easy reduction and convenient screwing in the treatment of talar posterior process fracture through the posteromedial malleolar approach.
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Objective:To independently develop a power control system of ultrasonic scalpel so as to reduce the energy consumption and maintain the normal temperature of ultrasonic scalpel.Methods:In this paper, the model of equivalent circuit of ultrasonic transducer nearby syntony was built up, and the hardware control system of ultrasonic scalpel based on digital signal processing (DSP) was designed.Results:Through testing the circuit and work performance of power control system, the series of parameters such as effective value and so on which were produced by this system could adjust frequency of power source in time and attain anticipative functional indicator, and it took the ultrasonic scalpel to work in syntonic situation.Conclusion:The tested indicators of power control system of ultrasonic scalpel based on the kernel design of DSP can attain anticipative requirement, and can take this system to work in syntonic situation.
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Stroke is one of the main causes of mortality, long-term physical and cognitive impairment in China. In order to meet the challenge, Stroke Prevention and Treatment Project of the National Health Commission(SPTPC) was established in April 2011 in the Ministry of Health. In 2016, SPTPC issued a work plan of stroke center hospital. In order to shorten the time of pre-hospital, the SPTPC established the stroke center network, stroke map and stroke green channel to create "the three 1-hour gold rescue circle" to form a hierarchical stroke diagnosis and treatment system. The current construction of the Chinese Stroke Center is divided into two levels and four layers. As of December 31, 2018, SPTPC has certified a total of 310 advanced stroke centers, including 30 demonstration advanced stroke centers and 280 advanced stroke centers, and 127 stroke prevention centers, including 85 demonstration stroke prevention centers and 42 stroke prevention centers. The median time from admission to intravenous thrombolysis (DNT) at the advanced stroke center was decreased by 13.2% (53 min vs. 46 min) in the fourth quarter of 2018 as compared with that in the first quarter of 2017.The national thrombolytic rate of acute ischemic stroke was increased 3.24 times (1.78% vs. 0.42%) in 2017 compared that in 2010. In the next step, SPTPC will vigorously promote the construction of stroke centers and graded diagnosis and treatment mechanisms, consolidate quality control and standardization, increase the scope of influence of mobile stroke and remote diagnosis and treatment, and further improve the construction of stroke center systems with Chinese characteristics.
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Objective To construct the schistosomiasis diagnostic reference laboratory in Jiangsu Province, and to examine the role and diagnostic efficiency of the reference laboratory. Methods A schistosomiasis diagnostic reference laboratory was built in Jiangsu Province according to the requirements of the construction of the national schistosomiasis diagnostic reference laboratory in China. Inter-laboratory comparisons were conducted and the diagnostic capability of grassroots laboratories was evaluated in Jiangsu Province. Results The organization structure, environmental conditions, administration and quality systems of the schistosomiasis diagnostic reference laboratory in Jiangsu Province all met the requirements for construction of the national schistosomiasis diagnostic reference laboratory in China, and the schistosomiasis diagnostic reference laboratory in Jiangsu Province was issued a certificate of a province-level schistosomiasis diagnostic reference laboratory. During the 6 inter-laboratory comparisons performed by national schistosomiasis diagnostic reference centers of China, the qualitative and quantitative results of each detection item were all in agreement with the reference samples (Kappa = 1), and the diagnostic capability was identified excellent. The results of indirect hemagglutination assay of 426 serum samples from 4 grassroots laboratories were re-examined, and the mean coincidence rate was 94.13% (range, 92.08% to 96.25%) with the grassroots laboratories, with a mean Kappa value of 0.85 (range, 0.83 to 0.86) and a mean missing rate of 10.19% (range, 0 to 17.65%). Conclusions The schistosomiasis diagnostic reference laboratory has been successfully established and effectively operated in Jiangsu Province, which plays an active role in improving the capability of schistosomiasis diagnostic equality in the province.
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Objective To construct the schistosomiasis diagnostic reference laboratory in Jiangsu Province, and to examine the role and diagnostic efficiency of the reference laboratory. Methods A schistosomiasis diagnostic reference laboratory was built in Jiangsu Province according to the requirements of the construction of the national schistosomiasis diagnostic reference laboratory in China. Inter-laboratory comparisons were conducted and the diagnostic capability of grassroots laboratories was evaluated in Jiangsu Province. Results The organization structure, environmental conditions, administration and quality systems of the schistosomiasis diagnostic reference laboratory in Jiangsu Province all met the requirements for construction of the national schistosomiasis diagnostic reference laboratory in China, and the schistosomiasis diagnostic reference laboratory in Jiangsu Province was issued a certificate of a province-level schistosomiasis diagnostic reference laboratory. During the 6 inter-laboratory comparisons performed by national schistosomiasis diagnostic reference centers of China, the qualitative and quantitative results of each detection item were all in agreement with the reference samples (Kappa = 1), and the diagnostic capability was identified excellent. The results of indirect hemagglutination assay of 426 serum samples from 4 grassroots laboratories were re-examined, and the mean coincidence rate was 94.13% (range, 92.08% to 96.25%) with the grassroots laboratories, with a mean Kappa value of 0.85 (range, 0.83 to 0.86) and a mean missing rate of 10.19% (range, 0 to 17.65%). Conclusions The schistosomiasis diagnostic reference laboratory has been successfully established and effectively operated in Jiangsu Province, which plays an active role in improving the capability of schistosomiasis diagnostic equality in the province.
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Stroke is one of the main causes of mortality, long-term physical and cognitive impairment in China. In order to meet the challenge, Stroke Prevention and Treatment Project of the National Health Commission (SPTPC) was established in April 2011 in the Ministry of Health. In 2016, SPTPC issued a work plan of stroke center hospital. In order to shorten the time of pre-hospital, the SPTPC established the stroke center network, stroke map and stroke green channel to create "the three 1-hour gold rescue circle" to form a hierarchical stroke diagnosis and treatment system. The current construction of the Chinese Stroke Center is divided into two levels and four layers. As of December 31, 2018, SPTPC has certified a total of 310 advanced stroke centers, including 30 demonstration advanced stroke centers and 280 advanced stroke centers, and 127 stroke prevention centers, including 85 demonstration stroke prevention centers and 42 stroke prevention centers. The median time from admission to intravenous thrombolysis (DNT) at the advanced stroke center was decreased by 13.2％ (53 min vs. 46 min) in the fourth quarter of 2018 as compared with that in the first quarter of 2017.The national thrombolytic rate of acute ischemic stroke was increased 3.24 times (1.78％ vs. 0.42％) in 2017 compared that in 2010. In the next step, SPTPC will vigorously promote the construction of stroke centers and graded diagnosis and treatment mechanisms, consolidate quality control and standardization, increase the scope of influence of mobile stroke and remote diagnosis and treatment, and further improve the construction of stroke center systems with Chinese characteristics.
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Objective To illustrate the basic operational principle of the control software item Part and value ( IPV) of Elekta digital medical linac and specifically explain that the control software monitors and controls the subsystems in a real-time manner by using three types of items and Parts. Methods Firstly, the composition of the control system of Elekta digital medical linac was introduced. Then, the definition and category of the items and Parts of the control software and the basic principle of different types of items were illustrated. Finally, the application of control software items and Parts in real-time monitoring and controlling the operation of subsystems was evaluated by analyzing the motion control of high-power ( HP) phase shifter. Results By analyzing the principle and citing a classical example to specifically illustrate the operational principle and application of control software IPVs, the users, especially the maintenance personnel, could master relevant theoretical knowledge, rapidly and accurately find the operational parameters during daily use and maintenance, besides analyze and resolve the problems based on the control principle of relevant subsystem. Conclusion Users, especially the maintenance personnel who master the working principle of these subprojects and their project sub-items can quickly and accurately check, calibrate the operating parameters via the control software, resolve equipment failure and avoid accidents caused by inappropriate operation in the daily use or maintenance.
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OBJECTIVE:To promote the development of hospital clinical pharmacy.METHODS:The measures which promoted the development of hospital clinical pharmacy after established by Jiangsu quality control system for pharmacy management were introduced.Through collecting clinical pharmacy indexes (the number of clinical pharmacists,the range of clinical pharmacy practice,the number of clinical pharmaceutical practice,the number of therapeutic drug monitoring (TDM),the number of reported ADR,etc.) in Jiangsu Province Pharmacy Management Quality Control Network Reporting System established by Quality Control Center during Jan.2014-Dec.2016,the development of clinical pharmacy in Jiangsu hospital were analyzed.RESULTS:The measures formulated and adopted by Quality Control Center included expanding the scale of clinical pharmacists training,strengthening the training of rational use of antibiotics,formulating provincial rational drug use standard,carrying out pharmaceutical quality control circle activities,etc.The data of clinical pharmacy indexes were collected from 61 hospitals.The results showed that,compared with Jan.2014,the number of clinical pharmacists in sample hospitals increased from 4.72 to 5.86 in Dec.2016;the number of involved special departments increased slightly;clinical pharmacy practice (weekly rounds number,medication history writing,case analysis,medication guidance,drug counseling) increased significantly;the number of beds managed by clinical pharmacists reached 289 beds;the types of TDM increased from 7.38 to 7.87,the number of yearly monitoring was 1 293;the number of monthly reported ADR increased from 14.71 to 19.34,but the number of consultation,new/severe ADR decreased slightly.CONCLUSIONS:Both service ability and service level of clinical pharmacy in 61 hospitals in Jiangsu have been improved by the establishment of the provincial quality control system for pharmacy management.
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The hospital is one of the main subjects for application of Chinese herbal pieces (CHP) which is the prescription drug for Chinese medicine clinical prevention and treatment of disease. The quality of CHP in hospital has a direct impact on clinical effect and is related to the health of the patients. But presently the market of CHP is chaotic with the prominent issue. The cultivation, the production and processing, the storage management and operation of CHP are not standardized. Simultaneously, the supply method of CHP is cut off from the right of the hospital to know the source and production process of CHP. The hospital is restricted to the supply enterprises of CHP. This situation makes a great obstacle to the quality control of CHP in hospital. The quality control system of CHP in hospital is composed of the source and the quality management of CHP. The quality control system of CHP includes the measures such as the purchasing management, acceptance of storage, storage and maintenance, and personnel capacity improvement. The prescription-based processing of Chinese materia medica should play an important role in this system. The whole process traceability system and the guarantee function of the market supervision system of Chinese medicinal materials should also be taken effect. In this way, the dominant position of hospital in the quality control system of CHP is strengthened.
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OBJECTIVE:To refine the quality standard of pharmacy intravenous admixture service(PIVAS),and provide refer-ence for improving the work quality of PIVAS. METHODS:Through establishing quality management organization and developing quality standard rules,quality control system for PIVAS in our hospital was constructed and total quality management was conduct-ed. Numbers of quality problems before(Jul. 2013-Jun. 2014)and after(Jul. 2014-Jun. 2015)its implementation were compared, and the effects were evaluated. RESULTS:117 management systems and 14 link quality standards and rules were made,including staff behavior standards,quality standards for drug management,supervision and inspection of quality standards,etc. Numbers of quality problems dropped from 358 to 177 after the implementation,the ratio of dispensing errors accounted for the total dispensing declined from 0.35? to 0.17?(P<0.05). CONCLUSIONS:The construction of quality control system and the implementation of quality control standards and rules in PIVAS of our hospital has improved the quality of PIVAS work.