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Based on the ideas of management systemization, system standardization, process specialisation, post accountability, duty formalization, form informatization, information digitization and digital intelligence, the smart, mobile and paperless bedside billing service was developed which incorporated both functional and financial prospects. The innovation was realized by Internet+ bedside billing and an integrated information platform, so that the inter-hospital billing system could be connected to the medical insurance system, electrical receive system and commercial insurance system. This saved manpower and equipment deployment, and improved service quality. The bedside intelligent mobile billing system of a hospital was launched in January 2021, and the average discharge billing time of inpatients in 2020 and 2021 was 44.36 min and 30.59 min, respectively, and the online billing fee time was significantly shorter than offline billing in 2021, and the differences were all significant( P<0.01).
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Early warning of infectious disease outbreak is key to controlling epidemics. Public general hospitals can effectively play their " outpost" role in the early warning and response of infectious diseases, which is directly related to the success of epidemic prevention and control. The authors summarized the current construction and main functions of infectious disease early warning systems at national level, regional level and public general hospitals, analyzed the problems existing in such construction, and put forward targeted suggestions. As found by the authors, some public general hospitals in China have initially built an early warning system for infectious diseases, achieving early recognition, early warning and reporting of infectious diseases to some extent. However, these systems were challenged by such shortcomings as insufficient intelligence, lack of data information exchange, immature practice and application, and lack of attention to the monitoring and early warning of endemic infectious diseases. It is suggested to improve the policy and system support in the future, to expand the types of infectious diseases for monitoring and early warning, to enlarge the sources of monitoring data and to strength hospital informationization construction.
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Objective:To explore the factors influencing patient safety behavior of nursing students during clinical practice.Methods:A cross-sectional study was used, in which a total of 214 participants completed the online survey related to the undergraduate nursing students ′ clinical teaching satisfaction scale, safety attitude questionnaire and nurse safety behavior questionnaire. Results:The mean scores of clinical teaching satisfaction, safety attitude and nurse safety behavior were (3.83±0.81), (3.70±0.65) and (3.93±0.79) respectively. There were positive correlations between clinical teaching satisfaction, safety attitude with the nurse safety behavior ( r=0.82, 0.75, P<0.01). The results also showed that the same shifts with their clinical instructors, clinical teaching satisfaction and safety attitude could affect safety behavior of nursing students ( F=67.81, R2=0.753, ΔR2= 0.742, P=0.00), which accounted for 74.20% of total variation. Conclusions:The same shift arrangement for both clinical instructors and nursing students, enhancement of the demonstration and guidance from clinical instructors, as well as strengthening the cultivating patient safety attitude would be beneficial to promoting the safety behavior of nursing students during clinical practice.
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Objective:To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX).Methods:The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX.Results:A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 ( P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism( P<0.05). Conclusion:The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.
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Objective@#To test the reliability and validity of the Chinese version of the Handoff Clinical Examination Exercise (Handoff CEX).@*Methods@#The Chinese version of the Handoff CEX was composed of two parts, one to assess the nurse providing the handoff and another to assess the nurse receiving the handoff. A total of 80 handoffs was evaluated to test the reliability and validity of the Chinese version of the Handoff CEX.@*Results@#A total of 320 evaluations of handoff was obtained. The Cronbach α coefficient was 0.85 for the handoff provider, and that was 0.80 for the handoff recipient. Weighted kappa scores for provider evaluations ranged from 0.31-0.52, and that for recipient evaluations ranged from 0.35-0.55. The correlation coefficients between each factor ranged from 0.23 to 0.62, and that between each factor and the total scale ranged from 0.33 to 0.64 (P<0.05). Experienced nurses (>5 years) received significantly higher mean scores than inexperienced nurses(≤5 years) in all domains except organizational efficiency and professionalism(P<0.05).@*Conclusion@#The Chinese version of the Handoff CEX is a reliable and valid tool to assess the nursing handoff, which is useful for educators, supervisors and clinical nurses to provide training, ongoing assessment and feedback to improve the quality of handoff.
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Objective@#To identify the impeding and promoting factors of role definition in nursing handoff, in order to increase the quality of nursing handoff.@*Methods@#Two nursing managers, 22 head nurses and four nurses were recruited by purpose sampling. Data were collected by using focus group study, and analyzed using content analysis.@*Results@#According to the framework of role transition theory, the factors could be classified as individual factors (37 items, 23.72%), organizational factors (105 items, 67.31%), effectiveness of role definition (11 items, 7.05%), and problems of role definition (3 items, 1.92%).@*Conclusions@#Role definition in nursing handoff helping the coming nurse check the performance of the last shift and transfer the nursing responsibility, contributes to the improvement of nursing quality, but there are still many factors affecting the role definition in nursing handoff.
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Objective To study the effect of contra lateral support technology on the contra lateral postural displacement of long-term bed ridden patients and patients of inability to perform voluntary movements in clinical practice. Methods 100 eligible patients were divided into control group and experimental group according to the admission sequence. 50 patients in the control group use traditional triangle mat to turn over for every 2 hours,and 50 patients in the experimental group use combined mat to turn over at the same frequency. Postural displacement on the patient′s skin and the displacement time were observed for 24 hours and recorded for 6 times. Results The incidence rate of postural displacement, abnormal skin and the mean time of displacement of the control group were 28.67%(86/300),5.00%(15/300),(99.0 ± 18.5)min,and that of the experimental group were 65.33%(196/300),9.00% (27/300),(78.2 ± 31.6)min.The differences between both groups were statistically significant(χ2=80.958, 3.687, t=4.014, all P<0.05). Conclusions With the patient′s muscle strength increasing, the ratio of postural displacement after turning over gradually increases,and the mean time for displacement gradually decreases, increasing the damage on the skin by shear force and the risk of stress injury due to invalid position. However, the contra lateral support technology could reduce the occurrence of postural displacement to a large extent,thus decreasing risk of stress injury.
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Objective To observe the differences of retinal vessel oxygen saturation between diabetic and healthy subjects.Methods Seventy-one diabetic patients and 91 healthy persons were included diabetes group and control group respectively.Oxygen saturation was measured in retinal blood vessels in two groups using retinal Oxymap.The oxygen saturation in retinal arteries and veins about 1.5-3.0 disc-diameter from center of optic disc was analyzed by instrumental software.Results Among 71 cases of diabetics,there was no significant difference in retinal oxygen saturation between male and female,among different ages and duration of disorder (all P ＞ 0.05).The retinal average arteriolar oxygen saturation in diabetes group was higher than that in control group (P =0.00).The diabetes group had the higher arteriolar oxygen saturation in all the quadrants,while only the superior temporal and inferior temporal showed significant difference statistically (all P ＜0.05).The retinal average venous oxygen saturation in diabetes group showed an upward trend although with no significance (P ＞0.05).Venous oxygen saturation in the diabetes group were higher in retinal superior temporal and inferior temporal quadrant and lower in retinal inferior nasal quadrant,there were significant statistical differences (all P ＜ 0.05).The retinal arterio-venous oxygen saturation differences in diabetes group was higher than that in control group,there was significant statistical difference (P =0.00).Conclusion There is significant difference in retinal vessel oxygen saturation between diabetics and healthy subjects.There are different degrees of changes in retinal oxygen saturation among different quadrants,indicating uneven distribution of retinal oxygen metabolism in each quadrant.
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The antitumor activities of artemisinin and its derivatives has become a hot topic in recent years.Artemisinin and its derivatives have been reported to exert antitumor effects mainly by blocking the cell cycle, promoting tumor cell apoptosis, inhibiting angiogenesis and so on.Also, their influence on signaling pathways has attracted considerable interest of many scholars.Currently, in order to discover some compounds with better therapeutic potentials, many studies dedicated to the synthesis and development of new artemisinin derivatives.In addition, the effects of artemisinin and its derivatives on multi-drug resistantace in tumor cells also become a trend of the future research.In this paper, we review the research advances in the antitumor activities of artemisinin and its derivatives during the past five years to provide a reference for future study .
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Objective To investigate the current working status and explore the relationship among job stress, job burnout and organizational commitment in ICU nurses. Methods By using cluster random sampling method, 233 nurses from 5 general hospitals were selected to accept investigation by Commitment Questionnaire and Nurses' general situation questionnaire. Results The job stress and job burnout were both significant negatively correlated with organizational commitment (r=-0.33, P<0.01;r=-0.22, P < 0.01).The management issues and interpersonal relationships and decreased personal accomplishment both had significant impact on affective commitment and continuance commitment of ICU nurses (r=0.539, P < 0.01; r=0.387, P < 0.01). The management issues and interpersonal relationships, professional and career issues and emotional exhaustion had significant predictive power on normative commitment(r=0.458,P < 0.01). Conclusion It generally was in a higher level of job stress in ICU nurses, which indicates that hospital mangers should try to eliminate the causes ,assist them to reduce job stress and relieve the job burnout.
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Objective To investigate the application effects of new-type glove constraint in intensive care unit. Methods A total of 113 eligible patients were randomly divided into two groups by random digits table method, of which 59 patients used the traditional restraint for body constraint in the control group while 54 patients applied the new-type glove constraint in the treatment group. The skin conditions of restraint position, tube coming off and the satisfaction of patients and relatives were compared between two groups. Results The incidence of skin abnormality at restraint position was 0 in the treatment group and 13.6%(8/59) in the control group. The difference had statistical significance (χ2=7.880, P<0.01). The satisfaction of patients and relatives was 33.3%(18/54) in the treatment group and 5.1%(3/59) in the control group, and the difference had statistical significance (χ2=16.619, P<0.01). Conclusions The use of new-type glove constraint may give a maximum activity space to patients;reduce patient′s psychological adverse impacts;and decrease the skin and body damages. It is worthy of clinical promotion and application.
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<p><b>OBJECTIVE</b>To analyze the correlation between the genotype and phenotype of 18q deletion syndrome with chromosome microarray analysis (CMA).</p><p><b>METHODS</b>Eight cases with 18q deletion syndrome were selected, including two affected fetuses and six children patients. DNA was extracted and hybridized with Affymetrix CytoScan TM 750K arrays following the manufacturer's standard protocol. The data was analyzed with a special software package.</p><p><b>RESULTS</b>CMA analysis identified pathogenic copy number variations (CNVs) on 18q in all cases, which ranged from 6.612 Mb to 22.973 Mb. NFATC1, GALR1, MBP, SALL3 and TSHZ1 are likely to be causative genes for congenital heart disease, psychological, growth retardation, and cleft palate.</p><p><b>CONCLUSION</b>CMA can precisely locate the breakpoints of 18q and facilitate definition of the genotype-phenotype correlations, which is useful for prognosis.</p>
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Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Deleção Cromossômica , Transtornos Cromossômicos , Genética , Cromossomos Humanos Par 18 , Genética , Variações do Número de Cópias de DNA , Análise em MicrossériesRESUMO
<p><b>OBJECTIVE</b>To explore the genetic etiology of fetuses with multicystic dysplastic kidney (MCDK) by chromosome microarray analysis (CMA).</p><p><b>METHODS</b>Seventy-two fetuses with MCDK were analyzed with conventional cytogenetic technique, among which 30 fetuses with a normal karyotype were subjected to CMA analysis with Affymetrix CytoScan HD arrays by following the manufacturer's protocol. The data was analyzed with ChAS software.</p><p><b>RESULTS</b>Conventional cytogenetic technique has revealed three fetuses (4.2%) with identifiable chromosomal aberrations. CMA analysis has detected pathogenic CNVs in 5 fetuses (16.7%), which included two well-known microdeletion or microduplication syndromes, i.e., 17q12 microdeletion syndrome and Williams-Beuren syndrome (WBS) and three submicroscopic imbalances at 4q35.2, 22q13.33, and 1p33. PEX26, FKBP6, TUBGCP6, ALG12, and CYP4A11 are likely the causative genes.</p><p><b>CONCLUSION</b>CMA can identify the submicroscopic imbalances unidentifiable by conventional cytogenetic technique, and therefore has a significant role in prenatal diagnosis and genetic counseling. The detection rate of pathogenic CNVs in fetuses with MCDK was 16.7% by CMA. 17q12 microdeletion syndrome and WBS are associated with MCDK. Mutations of PEX26, FKBP6, TUBGCP6, ALG12, and CYP4A11 genes may be the causes for MCDK.</p>
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Adulto , Feminino , Humanos , Masculino , Gravidez , Adulto Jovem , Cromossomos , Genética , Feto , Análise em Microsséries , Métodos , Rim Displásico Multicístico , Genética , Diagnóstico Pré-Natal , MétodosRESUMO
Objective To explore the scanning technology of head-neck-coronaryone-stop-shopCT angiography using 256-slice iCT and complete image quality analysis.Methods 106 consecutive patients underwent 256-slice iCT head-neck-coronaryone-stop-shop CT angiography.According to the average heart rate,patients were divided into three groups,the 1ow heart rate group with the average heart rate ranged from 40 to 60,medium heart rate group with heart rate from 60 to 80 beats per minute and high heart rate group with heart rate more than 80 beats per minute.The volume rendering (VR),maximum intensity projection (MIP), multi-planar reformation (MPR)and curved planar reconstruction (CPR)were employed for three-dimensional reconstruction after the original image reached to the iCT post-processing workstation.The image quality of head-neck artery and coronary artery were assessed by two senior radiologists individually .Results The image quality scores in the three groups show statistic significance (F=14.886 , P =0.000).The difference between low heart rate group and medium heart rate group show statistic significance (P =0.031).The difference between low heart rate group and high heart rate group was statistical significant (P = 0.026 ).There was no statistic difference between medium heart rate group and high heart group.The excellent rates of coronary artery image quality reached to 100%,96.6%,92.6% in low,medium and high heart rate group respectively.The rates of excellent about head-neck vascular im-age quality in the three groups reached to 100%.Conclusion 256-slice iCT head-neck-coronaryone-stop-shopCT angiography can obtain satisfactory image.The image quality does not decrease in patients with high heat rate.
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Objective To evaluate efficiencies of 4 kinds of γ‐interferon release assay(IGRA) detection kits in diagnosis of pul‐monary tuberculosis .Methods 4 kinds of IGRA reagents produced by Oxford Immunotec Ltd (Oxford) in British ,Shanghai Fuxing Changzheng Medical Science Co .,Ltd(Fuxing) ,Cellectis in Australia(Cellectis) and Haikou VTI Biological Institute(VTI) ,respec‐tively ,were used to determine release levels of peripheral bloodγ‐interferon which had antigenicity of Mycobacterium tuberculosis in 86 cases of patients with tuberculosis and 80 cases of healthy individuals ,and diagnostic efficiencies were evaluated .Results Among the 4 kinds of IGRA reagents ,including Oxford ,Fuxing ,Cellectis and VTI ,the sensitivity was 93 .02% ,88 .37% ,90 .70% and 91 .86% ,respectively ;the specificity was 92 .50% ,75 .00% ,82 .50% and 87 .50% ,respectively ;the positive predictive value was 93 .02% ,79 .17% ,84 .78% and 88 .76% ,respectively ;the negative predictive value was 92 .50% ,85 .71% ,89 .19% and 90 .91% ;the diagnostic accordance rate was 92 .77% ,81 .93% ,86 .75% and 89 .76% ,respectively ;the area under receiver operating charac‐teristic(ROC) curve was 0 .975 ,0 .892 ,0 .958 and 0 .963 .Conclusion There are no significant differences among Oxford ,Fuxing , Cellectis and VTI reagents ,and reagents could be selected according to clinical requirements .
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Objective To summarize the experience in nursing the patients with chronic severe hepatitis complicated with hypoglycemia. Method Five chronic severe hepatitis patients with hypoglycemia were cared and by monitoring blood glucose, observing the state of disease, correcting low blood sugar and safety control, providing an appropriate nutritional support, arranging the speed of infusion in a proper order and offering related disease knowledge. Results After the treatment, the blood sugar was 3.3~4.9 mmol/L, with a median of 4.2 mmol/L. One patient died of liver and kidney failure, one gave up the treatment because of deterioration and the rest three got better. The hospital stay was 42~120 d with an average of 88.0 d. Conclusion Relevant nursing intervention for the hypoglycemia of chronic severe hepatitis can promptly correct low blood sugar , maintain normal level of blood sugar and avoid serious complications.
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Objective To evaluate the effects ofYiqi Yangyin Huoxue Formula on clinical endpoints of diabetic nephropathy patients.Methods Totally 95 patients who were involved into the six-month DN clinical RCT for observation in 2008 were retrospectively collected and screened. There are 47 cases in the trial group, who were chronically treated by integrated traditional Chinese and Western medicine therapy which mainly adoptingYiqi Yangyin Huoxue Formula. There were 48 cases in the control group, who were chronically treated with Western medicine. Follow-up visits were conducted in 2011, 2012, 2013, and 2014 respectively. Long-term incidence rate of renal function progress/deaths were compared in the two groups.Results Five cases died in the trial group, among which one case died of renal failure. Eight cases died in the control group, among which five died of renal failure and multiple organ failure. The incidence of endpoints entering end-stage renal disease and renal function progress was much lower than that of control group. Conclusion Integrated traditional Chinese and Western medicine therapy dominated byYiqi Yangyin Huoxue Formula has good clinical efficacy of kidney protection, and can slow the progress of DN patients entering end-stage renal disease, and better than single Western medicine intervention.
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Objective The study aimed to explore the relationship between organizational commit ment,leader-member exchange and nurses' organizational citizenship behavior based on an empirical study.Methods A total of 264 nurses recruited from four general hospitals were investigated with the Organizational Commitment Scale,Leader-Member Exchange Scale,and Organizational Citizenship Behavior Scale.Results Affective organizational commitment and leader-member exchange correlated with every factor of organizational citizenship behavior.Both affective organizational commitment and leader-member exchange predicted the variance of identification with organization 0.29,altruism toward colleagues 0.06,interpersonal harmony 0.09,protecting organizational resources 0.12,and conscientiousness 0.28.Conclusions Affective organizational commitment and leader-member exchange had a positive influence on nurses' organizational citizenship behavior,thus,hospital managers should strengthen nurses' affective organizational commitment and leader-member exchange to promote their organizational citizenship behaviors.
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The clinical manifestation of acute invasive fungal sinusitis was associated with facial pain,altered sense of smell, blindness and headache. Physical examinations show that dark brown nasal secretions with bone resorption in paranasal sinus. Radiographi parameters showed uneven density in paranasal sinus and intraorbital extension. Fungus smears and pathological examination can make a definitive diagnosis.
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Humanos , Doença Aguda , Dor Facial , Fungos , Cefaleia , Micoses , Patologia , Seios Paranasais , Sinusite , Microbiologia , PatologiaRESUMO
<p><b>OBJECTIVE</b>To explore the clinical significance of ten-eleven-translocation methylcytosine dioxygenase 2 (TET2) mRNA expression levels in adult acute myeloid leukemia patients with normal cytogenetics (CN-AML).</p><p><b>METHODS</b>Expression levels of TET2 mRNA were measured by real-time PCR in 157 adult CN-AML, and its clinical impact in CN-AML was evaluated as well.</p><p><b>RESULTS</b>TET2 gene expression levels from bone marrow mononuclear cells (BMMNCs) [7.29(3.41-9.99)] and CD34+ cells [6.02(5.64-6.54)] in CN-AML were significantly lower than those [BMMNCs: 8.13(6.68-9.04), P=0.026; CD34+ cells: 6.48(5.97-7.12), P=0.034] in healthy control. And TET2 mRNA level at diagnosis [7.32(6.11-8.41)] was obviously lower than that at complete remission [8.39(7.76-8.79), P<0.01]. CN-AML patients with lower levels of TET2 mRNA showed worse survival rate [(32.7±5.9)%] at 18-month than those with higher levels [(48.6±6.9)%, P=0.041]. In multivariate analysis, lower level of TET2 mRNA was an independent prognostic factor for OS [hazard ratio(HR)2.032, 95% confidence interval (CI)1.272-3.247, P=0.003] and event-free survival [HR 1.532, 95% CI 1.014-2.314, P=0.043].</p><p><b>CONCLUSION</b>The level of TET2 mRNA is significantly lower in patients with CN-AML and it is an independent negative prognostic factor. TET2 could be an important factor for the molecular-based risk stratification in CN-AML.</p>