【摘要】 目的 探討如何通過流程優化應對體檢高峰期。 方法 通過體檢高峰期流程優化前后（2008年與2010年）的管理成效對比，評估高峰期流程控制的有效性。 結果 體檢高峰期流程優化后，平均候檢人數由8人下降至3人、平均侯檢時間由11.9 min下降至4.2 min，平均體檢時間由175 min下降至130 min。體檢者對體檢環境、服務態度和服務質量的滿意度均高于優化前，差異有統計學意義（Plt;0.05）。 結論 通過流程優化與控制有效地緩解了高峰期體檢人員等候時間過長現象，極大地提高了體檢者滿意度，保障了健康體檢工作質量。【Abstract】 Objective To explore how to cope with the peak flow of physical examination through the process optimization. Methods Evaluate the utility of the process control at physical examination peak flow, by contrasting the management effect before and after the physical examination peak flow optimization (2008 and 2010). Results After the process optimization in peak flow, the average number of people waiting to be checked is down to 3 from 8, the consumers′ satisfaction with the medical environment, service attitude and the service quality is higher than before optimization, the difference was significant (Plt;0.05). Conclusion Through the process optimization and control effectively relieve the time for waiting to be examined, greatly enhance the satisfaction of people who take physical examinations and ensure the quality of physical examination.
目的 探討團體體檢據實結算的方法，提高體檢中心接檢人員的工作效率和質量。 方法 采用六西格瑪法, 并通過其定義、測量、分析、改進、控制5個步驟，研究并改進團體據實結算的方法，同時對比分析方法改進前后，“清理分檢未完”的單次工作量、單次制表時間、單次核實時間以及缺陷發生率。 結果 方法改進后，“清理分檢未完”的單次工作量變化無統計學意義（P＞0.05）；單次制表時間由（4.23 ± 0.43）h縮短至（0.06 ± 0.01）h、單次核實時間由（3.18 ± 0.46） h縮短至（1.07 ± 0.01）h、缺陷率從4.83%降至0.69%（P＜0.01）,達到了預期目標。 結論 運用六西格瑪法可以發現流程中存在的關鍵問題,從而提出有針對性的改進措施,提高工作效率和質量。
Objective Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.
目的 總結分析急診觀察室患者流行病學特點及臨床療效，為臨床急診治療提供指導。 方法 以2007年1月－2010年12月收治的247 312例急診觀察室患者為研究對象，按年齡、性別、地域分布、疾病種類、發病時間、好轉率、收入院百分率、死亡率等因素進行流行病學分析。 結果 各年度患者人數呈增加趨勢，2010年減緩；城鎮患者占91.5%；20～40歲患者占45.9%，40～60歲患者占27.2%，＞60歲占21.3%；疾病種類分布中呼吸系統占42.4%，心血管疾病患者數量呈升高趨勢，以老年人為主，中毒患者呈下降趨勢。全年6、7、8月份因發熱、上呼吸道感染患者較多，總數增加明顯，其次11、12、1月份因慢性支氣管炎急發患者較多，總數也有升高趨勢；白天工作時間患者數量占66.2%；平均每天就診人次為169.4人次，節假雙休日平均每天就診人次為191.1人次（P＜0.01）；各年度好轉率呈升高趨勢，收入院百分率無顯著變化，死亡率無顯著區別。 結論 近年急診觀察室患者以呼吸系統疾病為主，好轉率呈升高趨勢，但心血管疾病數量呈升高且有年輕化趨勢，值得重視。
ObjectiveTo study the effect and mechanism of lipopolysaccharide (LPS) on osteoclasts formation and its bone resorption function.MethodsBone marrow-derived macrophages (BMMs) were extracted from the marrow of femur and tibia of 4-week-old male C57BL/6 mice. Flow cytometry was used to detect BMMs. The effect of different concentrations of LPS (0, 100, 200, 500, 1 000, 2 000 ng/mL) on BMMs activity was examined by cell counting kit 8 (CCK-8) activity test. In order to investigate the effect of LPS on osteoclastogenesis, BMMs were divided into macrophage colony-stimulating factor (M-CSF) group, M-CSF+receptor activator of nuclear factor κB ligand (RANKL) group, M-CSF+RANKL+50 ng/mL LPS group, M-CSF+RANKL+100 ng/mL LPS group. After the completion of culture, tartrate resistant acid phosphatase (TRAP) staining was used to observe the formation of osteoclasts. In order to investigate the effect of LPS on the expression of Connexin43, BMMs were divided into the control group (M-CSF+RANKL) and the LPS group (M-CSF+RANKL+100 ng/mL LPS); and the control group (M-CSF+RANKL), 50 ng/mL LPS group (M-CSF+RANKL+50 ng/mL LPS), and 100 ng/mL LPS group (M-CSF+RANKL+100 ng/mL LPS). The expressions of Connexin43 mRNA and protein were detected by Western blot and real-time fluorescent quantitative PCR, respectively. In order to investigate the effect of LPS on osteoclast bone resorption, BMMs were divided into M-CSF group, M-CSF+RANKL group, M-CSF+RANKL+50 ng/mL LPS group, and M-CSF+RANKL+100 ng/mL LPS group. Bone absorption test was used to detect the ratio of bone resorption area.ResultsThe flow cytometry test confirmed that the cultured cells were BMMs, and CCK-8 activity test proved that the 100 ng/mL LPS could promote the proliferation of BMMs, showing significant differences when compared with the 0, 200, 500, 1 000, and 2 000 ng/mL LPS (P<0.05). TRAP staining showed no osteoclast formation in M-CSF group. Compared with M-CSF+RANKL group, the osteoclasts in M-CSF+RANKL+50 ng/mL LPS group and M-CSF+RANKL+100 ng/mL LPS group were larger with more nuclei, while the osteoclasts in M-CSF+RANKL+100 ng/mL LPS group were more obvious, and the differences in the ratio of osteoclast area between groups were statistically significant (P<0.05). Western blot result showed that the relative expression of Connexin43 protein in LPS group was significantly higher than that in control group (P<0.05). Real-time fluorescent quantitative PCR showed that the relative expression of Connexin43 mRNA in control group, 50 ng/mL LPS group, and 100 ng/mL LPS group increased gradually, and the differences between groups were statistically significant (P<0.05). Bone resorption test showed that osteoclast bone resorption did not form in M-CSF group, but the ratio of bone resorption area increased gradually in M-CSF+RANKL group, M-CSF+RANKL+50 ng/mL LPS group, and M-CSF+RANKL+100 ng/mL LPS group, and the differences between groups were statistically significant (P<0.05).ConclusionLPS at concentration of 100 ng/mL can promote the expression of Connexin43, resulting in increased osteoclastogenesis and enhanced osteoclastic bone resorption.
In recent years, immune checkpoint inhibitors have begun to be used in targeted cancer therapy. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events. Neuromuscular disease is more common among adverse events involving the nervous system. With the increasing use of immune checkpoint inhibitors, the early recognition and treatment of neuromuscular immune-related adverse events are very important. In this review, we are focused on the epidemiology, pathogenesis, clinical manifestations, evaluation, diagnosis, and treatment of neuromuscular diseases (including peripheral neuropathy, myasthenia gravis, and myositis) caused by immune checkpoint inhibitors, aiming to provide a theoretical basis for improving the diagnosis and treatment ability of users of immune checkpoint inhibitors for such neuromuscular diseases and reducing the disability rate and mortality rate caused by immune checkpoint inhibitors.
目的：探討婦科癌癥患者疼痛的護理措施。方法：60例婦科癌癥患者隨機分為常規護理、特殊護理，觀察疼痛治療效果。結果：特殊護理患者疼痛緩解明顯。結論：護理干預能改善患者疼痛。
Objective To evaluate the clinical efficacy and safety of domestic sparfloxacin in the treatment of acute bacterial infections. Methods A multicenter randomized controlled clinical trial was conducted. 117 patients were treated with domestic sparfloxacin 200-300 mg qd for 5-14 days and 114 patients were treated with domestic lomefloxacin 300 mg bid for 5-14 days. Results The cure rates and the efficacy rates in each group were 84.62%, 74.56% and 94.87%, 92.98%, respectively. The bacterial clearance rates were 94.28% and 92.02%, respectively. Adverse drug reactions rates were 7.69% and 11.40%, most of them were mild. There were no significant differences of above results between the two groups (Pgt;0.05). Conclusions The results suggest that sparfloxacin with wide antibacterial spectrum, satisfactory activity, is an effective and safe antibacterial agent in treatment of mild to moderate acute bacterial infections.
Objective To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Methods Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients’ age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70° (mean, 40.1°). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm × 1.3 cm to 4.0 cm × 2.0 cm. Results After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.
Objective To evaluate the effects of delicacy management applied in branch health management sub-center. Methods From July 2013 to December 2015, integrated delicacy management was applied throughout the whole process of the preparation for the establishment and the running of the branch health management sub-center. The strengths and weaknesses of the management, the management of the details and the control of the emphasis were analyzed. And the medical visits and incomes after the application of delicacy management were also analyzed. Results From July 2013 to December 2015, the monthly average medical visits were 1 870.17±609.93, 2 842.50±1 247.60 and 3 717.92±1 257.98, while the monthly average incomes were (2 136.0±585.1) thousand yuan, (3 620.5±1 559.9) thousand yuan and (4 921.1±1 837.2) thousand yuan, which increased significantly. Conclusion The application of delicacy management in the branch health management sub-center could ensure the quality of service, promote the steady growth of performance, and improve the understanding of the surrounding population of health management, thus we can improve the economic and social benefits of the health management sub-center.