Research on the Application and Effectiveness of the DRG Model on Perioperative Medical Management of Cholecystectomy

Objective:This study aimed to explore the application and effectiveness of the DRG model in the perioperative management of cholecystectomy.By comparing the DRG model with traditional management methods,this study focused on evaluating the potential impact of the DRG model in improving surgical efficiency and reducing complication rates and medical costs.Methods:The random envelope method was used to divide patients scheduled for cholecystectomy from January 2021 to October 2023 into two groups:one group underwent surgery under the DRG model(experimental group),and the other group underwent the traditional management model(control group).Data including basic information,surgery-related data,length of stay,complication records,and medical expenses were collected.Data analysis was carried out using a t-test and chi-square(χ2)test.Results:Results showed that the DRG model shortened the average length of stay,decreased the incidence of complications,reduced medical expenses,and increased patient satisfaction.These results demonstrate the effectiveness of the DRG model in the perioperative management of cholecystectomy,especially in improving surgical efficiency,reducing medical costs,and improving patient satisfaction.Conclusion:The DRG model in the perioperative management of cholecystectomy can significantly improve medical service quality and efficiency and enhance patient satisfaction as compared to traditional treatment methods.

Discussion on the Management of Safe Medication in the Treatment of Internal Diseases of Traditional Chinese Medicine

Objective:To discuss the management of safe medication in the treatment of internal diseases in traditional Chinese medicine.Methods:124 patients with medical diseases were divided into experimental group and control group by random number table method,with 62 cases in each group.The experimental group implemented safe medication management,and the control group implemented routine medication management,all of which were treated for 4 consecutive weeks.The comparison of the improvement of the quality of life,the compliance rate of safe medication and the adverse drug reactions of the two groups after clinical treatment were compared.Results:After 8 weeks of treatment,there was a significant difference in clinical efficacy between the two groups of patients.In terms of quality-of-life scores,the scores of the experimental group were better than those of the control group.The living ability,condition,physical strength and other conditions of patients were significantly different.The t-values were 15.3427,14.0275,and 7.7113,respectively,and P<0.01 was statistically significant.The compliance rates of patients in the experimental group and observation group were 95.16%and 70.96%,respectively,with significant differences(P<0.05).In terms of the incidence of adverse drug events,the experimental group was 3.22%,which was significantly lower than the observation group's 8.06%(P<0.05).Conclusion:The implementation of safe medication management in the clinical treatment ofTCM internal diseases can improve the quality of life of patients to a certain extent,increase their safe medication compliance rate,and reduce the incidence of adverse medication events.The clinical application value is extremely high,and it can be widely promoted and applied.

The Application Value of Sanitary Wipes and Medical Alcohol+Gauze Disinfection Method in the Management and Use of Medical Equipment

Objective:To analyze the effect of sanitary wipes and medical alcohol+gauze disinfection methods on the management and use of medical equipment in hospitals.Methods:From February 2023 to August 2023,80 anorectal surgery medical instruments and equipment were randomly sampled as observation samples,and they were grouped using the random number table method(40 instruments in each group).One group was managed with sanitary wipes and medical alcohol+gauze disinfection method(observation group),and the other group was managed with medical alcohol+gauze disinfection method(control group).The degree of contamination on the surface of instruments and equipment and the staff satisfaction of both groups was noted and compared.Results:After cleaning and disinfection,the relative luminescence luminosity(RLU)value of the surface contamination of the sample instruments and equipment decreased significantly(P<0.05);and after cleaning and disinfection,the relative luminescence luminosity(RLU)of the observation group’s instruments and equipment decreased significantly,and the value was lower than that of the control group,(P<0.05);the results of the nursing job satisfaction questionnaire showed that the scores of each survey item in the observation group were higher than those in the control group,(P<0.05).Conclusion:Integrating sanitary wipes and medical alcohol+gauze disinfection method into the management and use of medical equipment not only improves the disinfection of medical instruments but also improves the job satisfaction of nursing staff.Therefore,this method should be popularized.

Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union

Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of injury.We aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be appropriate.Methods:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive seasons.Players were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,respectively.Symptom,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer vs.shorter).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or improving.Results:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and HIA3.Cognitive and balance performance were not associated with longer return and did not affect median days absence.Conclusion:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP times.This may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

Advancements in medical treatment for pancreatic neuroendocrine tumors:A beacon of hope

This editorial highlights the remarkable advancements in medical treatment strategies for pancreatic neuroendocrine tumors(pan-NETs),emphasizing tailored approaches for specific subtypes.Cytoreductive surgery and somatostatin analogs(SSAs)play pivotal roles in managing tumors,while palliative options such as molecular targeted therapy,peptide receptor radionuclide therapy,and chemotherapy are reserved for SSA-refractory patients.Gastrinomas,insul-inomas,glucagonomas,carcinoid tumors and VIPomas necessitate distinct thera-peutic strategies.Understanding the genetic basis of pan-NETs and exploring immunotherapies could lead to promising avenues for future research.This review underscores the evolving landscape of pan-NET treatment,offering renewed hope and improved outcomes for patients facing this complex disease.

Effect of medical care linkage-continuous management mode in patients with posterior circulation cerebral infarction undergoing endovascular interventional therapy

BACKGROUND Acute cerebral infarction is a severe type of ischemic stroke that can be divided into anterior circulation cerebral infarction and posterior circulation cerebral infarction(PCCI).PCCI affects the structure of the posterior circulation brain,because posterior part of the brain,which has more complex anatomical structures and more prone to posterior circulation vascular variation.Therefore,improving the prognosis of PCCI patients is necessary.AIM To explore the effect of medical care linkage-continuous management mode(MCLMM)on endovascular interventional therapy(EIT)for PCCI.METHODS Sixty-nine patients with PCCI who received EIT and conventional nursing intervention were selected as the control group,and 78 patients with PCCI who received EIT and MCLMM intervention were selected as the observation group.The incidence of postoperative complications,compliance and disease selfmanagement behavior after six months of intervention,modified Rankin scale(mRS)and Barthel index(BI)scores in the acute phase and after one year of intervention,and recurrence within one year were compared between the two groups.RESULTS The total incidence rate of postoperative complications in the observation group(7.69%)was lower than that in the control group(18.84%)(P<0.05).The scores for medical compliance behavior(regular medication,appropriate diet,and rehabilitation cooperation rates)and disease self-management behavior(self-will,disease knowledge,and self-care ability)in the observation group were higher than those in the control group(P<0.05).After one year of intervention,in the observation group,the mRS score was significantly lower,and the BI score was significantly higher than those in the control group(P<0.05).The recurrence rate within one year in the observation group(3.85%)was significantly lower than that in the control group(13.04%)(P<0.05).CONCLUSION MCLMM can reduce the incidence of complications after EIT for PCCI,improve patient compliance behavior and disease self-management ability,and promote the recovery of neurological function.

Investigation and Analysis of Rural Medical Waste Management

Objective: The aim is to understand the status of rural medical waste management and problems and to make recommendations. Methods: The questionnaire survey, interviews and comparative analysis are used. Results: Compared with urban medical waste management, rural medical waste management is weaker in classification, unified recycle, disposals, protect measures of related personnel, regulations and policies of awareness. Conclusion: It is recommended to improve policies and regulations of rural medical waste management, strengthen rural infrastructures and facilities, improve supervision and innovates means of supervision.

Implementation of Medical Behavior Management System in Operating Rooms

Objective:To strengthen personnel management for a clean operating room and ensure an automatic,intelligent,and scientific workflow.Methods:The medical behavior management system has been implemented to monitor and manage medical personnel entering and exiting the operating room,so as to meet the standard requirements of the operating room.Results:The flow of personnel has been controlled effectively,the flow in and out of the operating room has been optimized,the management level of the operating room has improved,and the cost has been cut down.Conclusion:With the advent of the information age and the continuous improvement of the management system,the management of operating rooms has become more reasonable and humanized;the management mode,working environment,and the overall quality of nursing work in operating rooms have improved.

Anorexia nervosa:Outpatient treatment and medical management

Anorexia nervosa(AN)is a disabling,costly and potentially deadly illness.Treatment failure and relapse are common after completing treatment,and a substantial proportion of patients develop severe and enduring AN.The time from AN debut to the treatment initiation is normally unreasonably long.Over the past 20 years there has been empirical support for the efficacy of several treatments for AN.Moreover,outpatient treatment with family-based therapy or individual psychotherapy is associated with good outcomes for a substantial proportion of patients.Early intervention improves outcomes and should be a priority for all patients.Outpatient treatment is usually the best format for early intervention,and it has been demonstrated that even patients with severe or extreme AN can be treated as outpatients if they are medically stable.Inpatient care is more disruptive,more costly,and usually has a longer waiting list than does outpatient care.The decision as to whether to proceed with outpatient treatment or to transfer the patient for inpatient therapy may be difficult.The core aim of this opinion review is to provide the knowledge base needed for performing safe outpatient treatment of AN.The scientific essentials for outpatient treatment are described,including how to assess and manage the medical risks of AN and how to decide when transition to inpatient care is indicated.The following aspects are discussed:early intervention,outpatient treatment of AN,including outpatient psychotherapy for severe and extreme AN,how to determine when outpatient treatment is safe,and when transfer to inpatient healthcare is indicated.Emerging treatments,ethical issues and outstanding research questions are also addressed.

The Application of Block Chain Technology in Medical Management

With the gradual development of social economy,the social function of medical institutions is becoming more and more important.Strengthening the efficiency and quality of medical management can alleviate the contradiction between doctors and patients and improve the level of medical service.Promoting the sustainable development of medical institutions plays a key role.Under the background of the development of science and technology,the theoretical research and practical application of block chain technology are becoming more and more mature,which can not only store and transmit information effectively,but also strengthen the security of information storage.The effective combination of block chain technology and medical management can create a new operation mode and train of thought for medical management and promote the overall improvement of medical management quality and efficiency.It is very helpful to optimize the social service function in medical field.This paper mainly expounds and probes into the concept characteristics of block chain technology,its concrete application in medical management,application effect control strategy and so on.It aims to further strengthen the depth and breadth of application of block chain technology in medical management,provide strong power support for the improvement of medical management service level and promote the sustainable development of medical and health industry.

Analysis of Health Workers’ Perceptions on Medical Waste Management in Tanzanian Hospitals

This paper presents the perceptions of health workers (HWs) on medical waste management (MWM) issues in Tanzanian hospitals. The perceived total waste generation rates were lower than the actual measurements. Administrators perceived lower rates than implementers. The results indicated three categories of medical waste which are given due attention, that is, sharps waste, pathological and infectious waste. Other wastes like radioactive, chemical, pharmaceutical, pressurized containers receive very little attention. Container colour coding and labelling was negligible, while improvised containers are still in use. Medical waste is transported within hospitals manually, with little efforts on mechanized transportation. Poor waste storage was observed, while the prominent medical waste treatment technologies are medium temperature incinerators. Off-site transportation of medical waste is practiced, where the waste is finally dumped or buried. The hospitals are currently utilizing public-private partnership schemes for MWM in only one aspect of off-site transportation. Three main problems which require high attention include: Weaknesses in hospital management, poor MWM infrastructure, and lack of skills and knowledge on MWM among HWs. Knowledge and awareness among HWs on health hazards associated with poor MWM is low (with exception of cholera, HIV and typhoid). Few PPE types are supplied and used in the hospitals, leading to poor diseases prevention. There is also low knowledge among HWs on administrative issues related to MWM in Tanzanian hospitals.

Medical management of pituitary adenomas:a study of ultrastructural changes and receptor expressions

Objective The aim of this study is to analyze the ultrastructural changes and dopamine 2 receptor (D2R) expression levels of pituitary adenomas to clarify the mechanism of medical management. Methods 9 patients with prolactinomas and 4 with nonfunctioning pituitary adenomas(NFPAs) were treated with bromocriptine preoperatively. Ultrastructure changes of tumor cells were observed through electron microscopy.

Radiological findings in non-surgical recurrent hepatocellular carcinoma:From locoregional treatments to immunotherapy

Since hepatocellular carcinoma(HCC)represents an important cause of mortality and morbidity all over the world.Currently,it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence.Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices,there is still no consensus about the treatment of recurrent HCC(RHCC).Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control,especially in the advanced stage of liver disease.Different medical treatments are now approved,and others are under investigation.On this basis,radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC.This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

Retinoblastoma: concerning its initiation and treatment

·Retinoblastoma (RB) is the most common intraocular cancer of infancy and childhood. This cancer is initiated by mutation on , the tumor suppressor gene that is responsible for the regulation of both cell cycle and gnome stability in retinal cells. Patients with a constitutional mutation on can be inherited. RB occurs approximately 1 in every 15 000-20 000 live births. The worldwide mortality for this cancer is about 5%-11%. However, this rate rises to about 40%-70% in developing countries due to a delay in diagnosis. A wide variety of options are available for the treatment, but often a combination of therapies is adopted to optimize individualized care. ·

北京清华长庚医院医管分工协同运营管理模式的探索与实践

介绍北京清华长庚医院探索医管分工协同的运营管理模式,实施临床业务管理与医院运营管理分工协同治理,建立职业化的医院管理人力资源体系,以及取得的成效。

Medical therapy for nephrolithiasis:State of the art

The prevalence of nephrolithiasis is increasing worldwide.Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition.Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance.Insights into occupational exposures and antibiotic use may help uncover individual risk factors.Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.

Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors

BACKGROUND Gastrointestinal tumors have a high incidence rate.The application value of the cooperative nursing care system of medical care has received widespread attention in recent years.However,there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education.AIM To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients.METHODS A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group(n=51)and a combined group(n=51)according to the nursing plan.The routine group adopted routine nursing,and the joint group adopted the medical care cooperative responsibility system nursing management combined with selfefficacy education.The self-efficacy scores,coping style scores,self-experience burden scores,and postoperative complication rates of the two groups before and after intervention were counted.RESULTS After intervention,the daily life behavior management,cognitive symptom management,and disease management scores of the two groups were higher than those before the intervention,and those of the combined group were higher than those of the conventional group(all P=0.000).After the intervention,the positive response scores of the two groups were higher than those before the intervention,the negative response scores were lower than those before the intervention,and the combined group was better than the conventional group(all P=0.000).After the intervention,the two groups’emotional,economic,and physical factor scores were lower than those before the intervention,and the combined group was lower than the conventional group(all P=0.000).The incidence of infection in the combined group(1.96%)was lower than that in the conventional group(15.69%)(P=0.036).CONCLUSION Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients,change the response to disease,and reduce the risk of postoperative infection.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Control of modifiable risk factors and major adverse cardiovascular events in people with peripheral artery disease and diabetes

BACKGROUND People with diabetes and peripheral artery disease(PAD)have a high risk of major adverse cardiovascular events(MACE).Prior research suggests that medical therapies aimed to control modifiable risk factors are poorly implemented in patients with PAD.AIM To examine the association between the control of modifiable risk factors,estimated by the novel PAD-medical score,and the incidence of MACE in people with PAD and diabetes.METHODS Participants were recruited from out-patient clinics if they had a diagnosis of both PAD and diabetes.Control of reversible risk factors was assessed by a new composite measure,the PAD-medical score.This score takes into account the control of low-density lipoprotein cholesterol,blood pressure,blood glucose,smoking and prescription of an anti-platelet.Participants were followed to record incidence of myocardial infarction,stroke and cardiovascular death(MACE).The association of PAD-medical score with MACE was assessed using Cox proportional hazard analyses adjusting for age,sex and prior history of ischemic heart disease and stroke.RESULTS Between 2002 and 2020,a total of 424 participants with carotid artery disease(n=63),aortic or peripheral aneurysm(n=121)or lower limb ischemia(n=240)were prospectively recruited,and followed for a median duration(inter-quartile range)of 2.0(0.2–4.4)years.Only 33(7.8%)participants had the optimal PAD-medical score of five,with 318(75%)scoring at least three out of five.There were 89(21.0%)participants that had at least one MACE during the follow-up period.A one-unit higher PAD-medical score was associated with lower risk of MACE(HR=0.79,95%CI:0.63-0.98)after adjusting for other risk factors.CONCLUSION The PAD-medical score provides a simple way to assess the control of modifiable risk factors targeted by medical management aimed to reduce the incidence of MACE.

Defining metabolic activity of nephrolithiasis--Appropriate evaluation and follow-up of stone formers

Considering the variation in metabolic evaluation and medical management of kidney stone disease,this consensus review was created to discuss the metabolic activity of nephrolithiasis,define the difference between single and recurrent stone formers,and develop a schema for metabolic and radiologic follow-up.A systematic review of the literature was performed to identify studies of metabolic evaluation and follow-up of patients with nephrolithiasis.Both single and recurrent stone formers share many similarities in metabolic profiles.The study group determined that based on an assessment of risk for stone recurrence and metabolic activity,single and recurrent stone formers should be evaluated comprehensively,including two 24 h urine studies on a random diet.Targeted medication and dietary recommendations are effective for many patients in reducing the risk of stone recurrence.Follow-up of those with stone disease should be obtained depending on the level of metabolic activity of the patient,the risk of chronic kidney disease and the risk of osteoporosis/osteopenia.A standard scheme includes a baseline metabolic profile,a repeat study 3e6 months after initiation of treatment,and then yearly when stable,with abdominal imaging obtained every 1-2 years.