目的 探讨通过优化病案首页质控体系提高误入DRG低权重组病例转出率的效果。方法 采用PDCA循环法,通过实施分层级编码培训、基于AI赋能的专项质控模式及智能化反馈机制构建等系统性地改进措施优化质控体系。通过对比分析质控系统优化前后(2022年1—7月和2023年1—7月)DRG低权重组病例的病案首页质控过程、“经质控低权重病例入组率”和“误入低权重组病例转出率”等指标,评估质控体系优化的实施效果。结果 质控体系优化后,低权重组病例转出率由3.27%提升至4.15%(P=0.018),经质控低权重病例入组率由16.98%降至14.96%(P<0.001)。结论 AI赋能的专项质控、分层级编码培训与智能化反馈机制三项措施并举可以系统优化质控体系,进而提升DRG低权重组病例转出率。
Objective To investigate the effect of optimizing the medical record front page quality control system on improving the transfer-out rate of cases mistakenly assigned to low-weight DRG groups.Methods The Plan-Do-Check-Act(PDCA)cycle methodology was employed.Systemic improvements were implemented to optimize the medical record front page quality control system,including hierarchical coding training,innovation of a specialized quality control model based on AI empowerment,and establishment of an intelligent feedback mechanism.The implementation effectiveness was evaluated by comparative analysis of the following indicators before(January-July 2022)and after(January-July 2023)optimization:the medical record quality control process for low-weight DRG cases,the rate of low-weight cases assigned to groups after quality control,and the transfer-out rate of cases mistakenly entering low-weight groups.Results After optimizing the medical record front page quality control system,the transfer-out rate of cases from low-weight groups increased from 3.27% to 4.15%(P=0.018),while the rate of low-weight cases assigned to groups after quality control decreased from 16.98% to 14.96%(P<0.001).Conclusions Implementing a three-pronged approach—AI-powered specialized quality control,hierarchical coding training,and an intelligent feedback mechanism—can systematically optimize the medical record front page quality control system,thereby improving the transfer-out rate of cases mistakenly assigned to low-weight DRG groups.
目的 观察超声引导下针刺蝶腭神经节治疗过敏性鼻炎的临床疗效。方法 将80例过敏性鼻炎患者随机分成干预组(40例)和对照组(40例),干预组采用超声引导针刺蝶腭神经节,对照组采用常规方法针刺蝶腭穴,每周2次,持续4周。结果 治疗4周后,干预组和对照组均显示出良好疗效。干预组的总有效率为92.50%,对照组的总有效率为82.50%,差异有统计学意义(P<0.05);干预组在鼻症状总分(TNSS)、非鼻症状总分(TNNSS)、视觉模拟量表(VAS)和鼻结膜炎生活质量问卷(RQLQ)等指标上的改善均优于对照组(P<0.05)。结论 超声引导下针刺蝶腭神经节治疗过敏性鼻炎能有效改善患者的临床症状。
Objective To investigate the main clinical effect of acupuncture of pterygopalatine ganglion on patients with allergic rhinitis under the guidance of ultrasound.Methods A total of 80 patients with allergic rhinitis were randomly divided into intervention group and control group.The intervention group was treated with ultrasound guided acupuncture of the sphenopalatineganglion,the control group was treated with conventional acupuncture at sphenopalatine point.The clinical efficacy was determined after the course of treatment.Results The total effective rate was 92.50% in the intervention group and 82.50% in the control group.The improvement of total nasal symptom score,total non-nasal symptom score,VAS and Arhinoconjunctivitis Quality of Life Questionnaire scores in the treatment group was significantly better the control group Conclusions Ultrasound-guided acupuncture of the sphenopalatine ganglion can improves clinical symptoms of patients with allergic rhinitis.
目的 探讨医院药房外包代煎代送服务的质量管理。方法 成立中药代煎质量控制管理小组,研究给出完善质量控制体系的策略,涉及建立标准化操作流程、加强人员培训、优化信息化管理系统以及健全监督评估机制。结果 通过对中药库房的采购、入库验收、在库管理、调剂环节的审方、调剂、煎药质量管理以及物流、发药人员全流程管理,提高了患者的满意度,更多的患者选择了中药代煎服务。结论 实施有效的质量控制措施可提高代煎代送服务的质量,为医院药房提升服务质量给予理论依据与实践指导。
Objective To explore quality management of outsourced decoction preparation and delivery services in hospital pharmacies.Methods A quality control management team for traditional Chinese medicine(TCM)decoction preparation was established to develop strategies for improving the quality control system.These strategies involved establishing standardized operating procedures,strengthening personnel training,optimizing the information management system,and improving the supervision and evaluation mechanism.Results Through comprehensive process management,covering procurement,warehouse acceptance,inventory management,prescription review in the dispensing stage,dispensing itself,quality control of decoction preparation,logistics,and management of dispensing personnel,patient satisfaction was enhanced,leading more patients to opt for the TCM decoction service.Conclusions Implementing effective quality control measures can improve the quality of decoction preparation and delivery services,providing a theoretical basis and practical guidance for hospital pharmacies to enhance their service quality.
目的 剖析中医药治疗儿童哮喘的随机对照试验(RCT)结局指标,为中医药治疗该病临床试验的核心指标集构建提供初步依据。方法 检索中国知网(CNKI)、万方(WanFang)、维普网(VIP)、中国生物医学文献数据库(SinoMed)、PubMed、Cochrane Library、EmBase、Web of Science。时间跨度为建库至2024年7月1日。此次检索全面覆盖了中医药疗法治疗儿童哮喘的临床随机对照研究,由两名研究者根据纳排标准独立完成文献筛选和资料提取,提取文献基本特征和结局指标。结果 初步检索出2 449篇文献,最终纳入165个RCT,包括205个结局指标,分为症状/体征、中医症状/证候、理化检查、生活质量评价、远期预后、安全性指标六域。结论 中医药治疗儿童哮喘尚存在中医证候诊断和疗效标准不完善、主要和次要结局指标界限不清等问题,应当构建统一规范且广为认可的核心指标集,以促进儿童哮喘核心指标集的完善。
Objective To analyze the outcome indicators of randomised controlled trials(RCTs)of traditional Chinese medicine(TCM)for the treatment of childhood asthma,and to provide a preliminary basis for the construction of a core set of indicators for clinical trials of TCM for the treatment of this disease.Methods A database search was conducted on China Knowledge Network(CNKI),WanFang,VIP,SinoMed,PubMed,Cochrane Library,EmBase,and Web of Science,covering the period from the establishment of the database to 1 July 2024.The search comprehensively covered clinical randomised controlled studies of TCM therapies in the treatment of childhood asthma,and was completed independently by two investigators who screened the literature and extracted information according to the criteria,and extracted the basic characteristics of the literature and outcome indicators.Results Initially,2 449 literatures were retrieved,and 165 RCTs were finally included,including 205 outcome indicators,which were classified into six domains:symptoms/signs,TCM symptoms/evidence,physical and chemical examination,quality of life evaluation,long-term prognosis,and safety indicators.Conclusions Currently,there are problems such as imperfect diagnostic and efficacy criteria for TCM evidence,and unclear boundaries between primary and secondary outcome indicators in the treatment of childhood asthma with TCM.A unified,standardised and widely recognised core indicator set should be constructed to promote the improvement of the core indicator set for childhood asthma.
目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组(n=53)与对照组(n=53)。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表(WHOQOL-100)及癌因性疲乏程度(PFS),最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表(VAS)评分、术后住院时间均优于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05);干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组(P<0.05);观察组护理满意度高于对照组(P<0.05)。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。
Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection.Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group(n=53)and a control group(n=53)using a random number table method.All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care.The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared.Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale(VAS)score and postoperative hospital stay compared to the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(P<0.05).After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group.The PFS score decreased,and the observation group was lower than the control group(P<0.05).The nursing satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction.
目的 分析共同照护模式联合回授法健康教育在2型糖尿病患者中的应用效果。方法 将2023年1月—2023年12月广州市第一人民医院收治 的114例2型糖尿病患者作为此次研究对象,分为研究组(n=57)和对照组(n=57),对照组患者给予常规护理结合健康教育,研究组患者给予共同照护模式联合回授法健康教育,评估两组在培训前及培训后1、3个月的血糖控制情况及糖尿病患者自我管理行为量表(SDSCA)等指标。结果 培训1、3个月后,两组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白均低于培训前,且研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于对照组(P<0.05)。培训1、3个月后,两组患者的糖尿病患者SDSCA评分高于培训前,且研究组各项评分高于对照组(P<0.05)。重复测量方差分析表明随着时间的推移,患者的血糖控制状况随着不同护理培训策略而得到改善。结论 使用共同照护模式联合回授法健康教育对2型糖尿病患者可以更显著改善血糖控制水平、提高自我管理效能。
Objective To analyze the effect of co-care mode and feedback health education on patients with type 2 diabetes.Methods From January 2023 to December 2023,114 patients with type 2 diabetes admitted to Guangzhou First People's Hospital were divided into two groups:experimental group(n=57)and control group(n=57).Patients in control group were given routine nursing combined with health education.Patients in study group were given co-care and feedback health education. Before intervention and 1,3 months after intervention,patients' blood glucose control and diabetic self-management behavior scale(SDSCA)were evaluated.Results After 1 and 3 months of intervention,the fasting blood glucose,2-hour blood glucose and HbA1c of the two groups were significantly lower than those before intervention,and the fasting blood glucose,2-hour blood glucose and HbA1c of the experimental group were significantly lower than those of the control group(P<0.05).After 1 month and 3 months of intervention,the SDSCA scores of diabetic patients in both groups were higher than those before intervention,and the scores of study group were higher than those of control group(P<0.05).Repeated measures analysis of variance indicating that glycemic control improved significantly over time with different nursing training strategies.Conclusions Co-care mode and feedback health education can significantly improve blood glucose control and self-management efficiency in patients with type 2 diabetes.
传统的结肠镜检查质量评估方式具有主观性强、费时费力等缺点。近年来,人工智能(AI)技术在结肠镜检查质量控制方面展现出客观性、即时性、全面性等优势,具有广阔的应用前景。文章全面探讨了AI在结肠镜检查质量控制中的多个应用场景,包括评估肠道准备质量、记录退镜时间、息肉识别和分类、预测早期结直肠癌浸润深度等方面,并通过具体的研究案例和数据分析了AI技术的有效性和优势。AI技术有望在提升结肠镜检查质量、促进结直肠癌的早诊早治方面发挥更加重要的作用,但面对技术、伦理及法规等多方面的挑战,未来需要持续努力,不断优化算法,加强跨学科合作,推动AI技术在医疗领域的健康、快速发展。
Traditional colonoscopy quality assessment methods have strong subjectivity and are time-consuming.In recent years,artificial intelligence technology has shown objectivity,timeliness,and comprehensiveness in colonoscopy quality control,with broad application prospects.This article comprehensively explores multiple application scenarios of AI in colonoscopy quality control,encompassing assessments of bowel preparation quality,recording of withdrawal times,polyp identification and classification,and prediction of early colorectal cancer invasion depth.Through specific research cases and data analysis,the effectiveness and advantages of AI technology are elucidated.AI technology is expected to play an increasingly significant role in enhancing the quality of colonoscopy and promoting early diagnosis and treatment of colorectal cancer.However,facing challenges from technology,ethics,regulations,and other aspects,continued efforts are needed in the future to continuously optimize algorithms,strengthen interdisciplinary collaboration,and promote the healthy and rapid development of AI technology in the medical field.
目的 统计洛阳市涧西区各作业场的职业病危害因素,分析职业病发生的主要原因,并探讨具体防控策略。方法 收集洛阳市涧西区内2021年1月—2022年12月期间针对各作业场的职业病危害因素监测信息,录入Excel 2010进行数据统计;随机抽取辖区内200名重点职业从业人员,开展回顾性分析,结合职业健康检查结果,将确认存在职业病的115名从业人员列为病例组,其余未发生职业病的85名从业人员列为对照组,比较2组一般资料、临床资料,经统计学单因素、Logistic多因素回归分析归纳可导致职业病发生的影响因素,结合分析结果,探讨具体防控措施。结果 针对辖区内15家厂矿企业,2021年共设立584个监测点,共测得68处锰及其化合物危害、48处矽尘危害、4处苯及其苯系物危害、12处噪声危害,超标率为22.60%(132/584);2022年共设立1 575个监测点,共测得158处粉尘危害、154处锰及其化合物危害、10处矽尘危害、13处噪声危害,超标率为21.27%(335/1 575);单因素分析结果显示,2组从业人员的年龄、工作年限、职业类型、体检频率、体检结果等比较差异均存在统计学意义;Logistic多因素回归分析显示,年龄≥50岁,工作年限≥10年,从事制造业、采矿业,未规律体检,血常规异常,免疫力差,X线胸片异常,双耳高频听力阈值≥40 dB均是发生职业病的重要原因(均P<0.05)。结论 洛阳市涧西区的职业危害因素以粉尘、锰及其化合物为主,高龄、工作年限长的制造业、采矿业人员发生职业病的风险相对较高,优化职业病防治措施并规范上述重点人群的职业健康体检能实现对职业病的有效防控。
Objective To analyze the occupational disease hazards in various workplaces in Jianxi District,Luoyang City,and to analyze the main causes of occupational disease occurrence,explore specific prevention and control strategies.Methods Monitoring information on occupational disease hazards in various workplaces within the jurisdiction from January 2021 to December 2022 was collected,Excel 2010 was used for data statistics.Two hundred key occupational employees within the jurisdiction were selected randomly for retrospective analysis.Based on the results of occupational health examinations,115 employees confirmed to have occupational diseases were included in the case group,while 85 employees who did not have occupational diseases were included in the control group.General and clinical data of the two groups were compared,and the influencing factors that could lead to the occurrence of occupational diseases were summarized through statistical single factor and multivariate logistic regression analysis. Combined with the analysis results,specific prevention and control measures were discussed.Results For 15 factories and mining enterprises within the jurisdiction,a total of 584 monitoring sites were established in 2021,and a total of 68 manganese and its compound hazards,48 silica dust hazards,4 benzene and its benzene series hazards,and 12 noise hazards were measured,which the exceeding rate was 22.60%(132/584).In 2022,a total of 1 575 monitoring sites were established,with a total of 158 dust hazards,154 manganese and its compounds hazards,10 silica dust hazards,and 13 noise hazards detected,which the exceeding rate was 21.27%(335/1 575).The results of statistical univariate analysis showed that there were certain differences in the age,years of work,occupational type,frequency of physical examinations,and results of physical examinations between the two groups of employees.Multivariate logistic regression analysis showed that age≥50 years old,working experience≥10 years,engaged in manufacturing and mining industries,irregular physical examinations,abnormal blood routine,immune differences,chest X-ray abnormalities,and binaural high-frequency hearing threshold≥40 dB were all important reasons for the occurrence of occupational diseases.Conclusions The occupational hazards in this jurisdiction are mainly dust,manganese,and their compounds.The risk of occupational diseases among elderly manufacturing and mining workers with long working years is relatively high.Optimizing occupational disease prevention and control measures and standardizing occupational health examinations for the above-mentioned key populations can achieve effective prevention and control of occupational diseases.
目的 探索机械通气患者发生呼吸机相关性肺炎(VAP)的危险因素,为医疗机构降低VAP的发生率提供参考依据。方法 采用回顾性病例对照的方法,收集2020年1月—2021年4月入住重症医学科(ICU)接受机械通气>48 h、年龄>18岁的患者资料。根据诊断标准确定20例VAP患者作为病例组,在同期住院患者筛选性别、年龄与病例匹配的20例未发生VAP患者为对照组,并对两组间各项临床指标进行统计分析。结果 两组患者在接受机械通气前入院诊断情况、是否手术和合并慢性阻塞性肺炎、APACHEⅡ评分、置管地点比较差异均无统计学意义(P>0.05);机械通气时白细胞、C反应蛋白、降钙素原比较差异无统计学意义(P>0.05)。与对照组相比,病例组住院总日数、住ICU天数、机械通气时间、吸痰护理次数、抗生素使用天数明显增加(均P<0.05)。其中ICU中VAP以耐碳青霉烯类鲍曼不动杆菌(占比70%)感染为主;环境卫生学监测发现,患者周围环境、护士站及使用后的消毒物品均检出鲍曼不动杆菌,说明医务人员手卫生依从性差及环境消毒不彻底也是导致院内VAP发生的原因之一。病例组住院总费用中位数为145 207元,对照组为60 745.48元,VAP造成的平均经济损失为84 461.52元/例。病例组各项医疗费用均高于对照组,比较差异有统计学意义(P<0.05)。结论 机械通气期间不适当的诊治、环境消毒不到位、手卫生依从性差可能是造成医疗机构VAP发生的主要原因。
Objective To explore the risk factors of ventilator-associated pneumonia(VAP)in patients with mechanical ventilation,and provide a reference basis for medical institutions to reduce the occurrence of VAP.Methods A retrospective case-control method was used to collect data of patients who hospitalized in intensive care unit(ICU)from January 2020 to April 2021,received mechanical ventilation > 48 h and were >18 years old.According to the diagnostic criteria,20 patients with VAP infection were enrolled as the case group.During the same period,20 non-infected patients who matched sex,age with case group patients were enrolled as the control group,and the clinical indicators between the two groups were statistically analyzed.Results There were no significant differences between the two groups in terms of admission diagnosis,surgery and chronic obstructive pulmonary disease,APACHEII score and place of intubation before mechanical ventilation(P>0.05).There were no significant differences in white blood cell,C-reactive protein and procalctionin,CRP and PCT during the mechanical ventilation period(P>0.05).Compared with the control group,the length of stay in hospital,the length of stay in ICU,the time of mechanical ventilation,number of sputum suction nursing,and the days of antibiotic use increased significantly(all P<0.05).Among them,Acinetobacter baumannii resistant to carbapenem in ICU(accounting for 70%)was the main cause of VAP infection.The environmental hygiene monitoring found that Acinetobacter baumannii was detected in the patient’s surrounding environment,the nurse station and the disinfected items after use,indicating that the low hand hygiene compliance of medical staff and the incomplete disinfection of the environment were also the causes of VAP infection in the hospital.The median of total cost of hospitalization in the case group was 145 207 yuan,while that in the control group was 60 745.48 yuan.The average economic loss caused by VAP infection was 84 461.52 yuan each case.The medical expenses of the case group were higher than those of the control group,with a statistically significant difference(P<0.05).Conclusions Improper diagnosis and treatment during the mechanical ventilation period,poor environmental disinfection,low hand hygiene compliance of medical staff are probably the main reasons for the occurrence of VAP in this institution.
目的 探讨福辛普利钠与多沙唑嗪联合对肾性高血压的治疗效果,并分析治疗后患者血压控制情况及相关活性因子变化。方法 前瞻性选取天津市北辰区北辰医院2020年10月—2023年10月收治的98例肾性高血压患者,以随机数字表法作为分组方式,分为观察组(n=49)与对照组(n=49)。对照组患者采取福辛普利钠治疗,观察组在对照组基础上增加多沙唑嗪治疗。对比两组的血压控制效果,治疗前后一氧化氮(NO)、内皮素(ET)、血管紧张素Ⅱ(AngⅡ)相关生物活性因子水平变化,肾功能变化,不良反应发生情况。结果 观察组总有效率89.79%,高于对照组的73.47%(χ2=4.356,P=0.037);治疗后两组AngⅡ、ET水平均降低,且观察组[(13.62±2.24)ng/mL、(68.62±6.66)ng/L]低于对照组[(16.25±4.32)ng/mL、(74.26±9.35)ng/L],对比差异有统计学意义(t1=3.783,t2=3.439,P<0.001);NO水平升高,观察组[(54.26±3.42)μmol/L]高于对照组[(50.51±2.37)μmol/L],对比差异有统计学意义(t=6.309,P<0.001);治疗后两组血肌酐(Scr)、尿素氮(BUN)、胱抑素C(CysC)水平均降低,且观察组[(404.36±92.12)μmoI/ L、(13.34±4.31)mmol / L、(2.19±0.24)mg / L]低于对照组[(443.49±80.19)μmoI / L、(15.07±4.23)mmol / L、(2.87±0.38)mg / L],对比有统计学意义(t1=2.243,P1=0.027;t2=2.005,P2=0.048;t3=10.591,P3<0.001);两组不良反应发生率对比差异无统计学意义(10.20% vs 8.16%,P>0.05)。结论 对肾性高血压患者,采取福辛普利钠与多沙唑嗪联合治疗可提升其血压控制效果,改善血管内皮功能,降低血管紧张素Ⅱ表达水平,改善肾功能,且不增加不良反应。
Objective To explore the therapeutic effect of the combination of fosinopril sodium and doxazosin on renal hypertension,and to analyze the blood pressure control and changes in related active factors in patients after treatment.Methods A prospective study was conducted on 98 patients with renal hypertension admitted to Beichen Hospital from October 2020 to October 2023.Random number table method was used as the grouping method,and they were divided into an observation group(n=49)and a control group(n=49).The control group patients were treated with fosinopril sodium,while the observation group was treated with doxazosin additionally.The blood pressure control effect,changes in levels of NO,ET,Ang II related bioactive factors,renal function changes before and after treatment,and their adverse reactions were compared.Results The total response rate in the observation group was 89.79%,which was higher than 73.47% in the control group(χ2=4.356,P=0.037).Ang Ⅱ and ET levels in both groups decreased after treatment,the observation group[(13.62±2.24)ng/mL,(68.62±6.66)ng/L] was lower than the control group[(16.25±4.32)ng/mL,(74.26±9.35)ng/L],the difference was statistically significant(t1=3.783,t2=3.439,P<0.001).Elevated NO levels in the observation group[(54.26±3.42)μmol/L] was higher than the control group[(50.51±2.37)μmol/L],the difference was statistically significant(t=6.309,P<0.001).Blood Scr,BUN,and CysC levels were decreased in both treatment groups,and those in observation group[(404.36±92.12)μmoI/L,(13.34±4.31)mmol/L,(2.19±0.24)mg/L] were lower than the control group[(443.49±80.19)μmoI/L,(15.07±4.23)mmol/L,(2.87±0.38)mg/L],the differences were statistically significant(t1=2.243,P1=0.027;t2=2.005,P2=0.048;t3=10.591,P3<0.001;P<0.05).There was no difference in the incidence of adverse effects between the two groups(10.20% vs 8.16%,P>0.05).Conclusions The combination treatment of fosinopril sodium and doxazosin can improve the blood pressure control effect,improve endothelial function,reduce the expression level of angiotensin II,and improve renal function in patients with renal hypertension,with high safety.