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The purpose of minimally invasive thyroid surgery is to perform refined surgery through an intelligent operating system, achieving minimal physical and psychological trauma for patients, thereby improving their quality of life. At present, the commonly used minimally invasive surgical methods are laparoscopic surgery and robotic surgery, both by creating tunnels from a distance to the thyroid gland, requiring high technical requirements for surgical instruments and robotic surgeons. Regardless of the type of minimally invasive surgery, in the early stages of implementation, doctors have a process of exposure, understanding, proficient mastery, and innovative expansion of the system, instruments, operating methods, and surgical thinking. In this process, it is inevitable to encounter some erroneous operations, which are the main causes of medical safety adverse events, including complications, and bring a failed medical experience to patients. At the same time, mistakes can also cause psychological burden for robotic surgeons and have an impact on the development of new technologies. The occurrence of errors also depends on the open surgical experience and clinical adaptability of robotic surgeons, and experienced robotic surgeons can significantly reduce errors. With the innovation of medical technology and the urgent demand of patients for efficacy and beauty, errors should not be a factor hindering the development of minimally invasive thyroid surgery. This article will analyze the erroneous operations of robot surgeons, formulates countermeasures, and provides reference for the safe implementation of robot surgery, thereby promoting the development of intelligent precision minimally invasive surgery, and further benefiting patients with minimally invasive needs.
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Objective:To explore the discharge readiness and influencing factors of patients with multimorbidity, and to formulate corresponding strategies to guide clinical work.Methods:In a cross-sectional study, 183 patients were surveyed by convenience sample method for Department of General Practice, the Third Hospital of Peking University February in to December 2022. Multiple linear regression was used to analyze the factors affecting discharge readiness.Results:All 183 coexisting patients, 95 males, 88 females, mean age (67.34 ± 10.36) years old. Mean discharge readiness was (109.83 ± 18.40). 54.9% of the factors for patients with multiple chronic diseases came from the perception of self-care disorder, hospitalization, stay, and preparation for discharge ( R2=0.549, P<0.05). Conclusions:The discharge readiness of patients with multiple chronic diseases in general medicine is at a high level, and clinical nursing staff should give early intervention to the patients who perceive self-care barriers, need to stay with them, have multiple hospitalization, and are not ready for discharge, so as to ensure that the patients are in a good state of discharge readiness.
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Objective To reduce the amount of public hospital arrears,strengthen debt management,improve the over-all operational efficiency of the hospital,promote fine management of the hospital,and boost high-quality development of the hos-pital.Methods We analyzed relevant data collected from 3 000 inpatients,including 486 with outstanding debts,treated at a tertiary public hospital in Chongqing between 2019 and 2023.Single factor analysis and binary logistic regression analysis were performed to identify the causes of medical arrears,and subsequently propose effective debt management strategies.Results Uni-variate analysis revealed that factors such as medical insurance status,department,gender,age,and cause of arrears significantly influenced the occurrence of medical arrears(P<0.05).The analysis based on the binary logistic model exhibited a good fit with the observed values,with the value of each classification factor's significance less than 0.05.The incidence of arrears was higher among self-funded patients compared to those with medical insurance.The surgical department had the highest rate of arrears,ne-cessitating specialized training for better debt management.The patients aged between 41 and 60 had the highest arrear rate,indi-cating the need for professionally trained nurses to pay close attention to this age group.The primary reasons for arrears included deliberate evasion,disputes,questionable sources(green passage),unforeseen public events,and economic difficulties.Conclusion To effectively manage medical arrears,hospitals should enhance their debt management systems,delineate depart-mental responsibilities and management processes,and implement stringent controls at key points from admission to discharge.
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Objective To investigate the current situation of achievement transformation in tertiary medical hospitals in Shanghai and propose countermeasures for the existing problems to enhance the effectiveness of achievement transformation.Methods A questionnaire survey was done on the transformation and management of scientific research achievements in 47 terti-ary hospitals in Shanghai.Meanwhile,interviews were carried out among the managers and researchers from these hospitals.Re-sults In the past three years,the rate of transformation achievements in the hospitals was only 2.8%.In the achievement trans-formation existed such problems as weak awareness of scientific researchers,low patent quality,lack of full-time managers,and inflexible management mode.It was also believed that there is a need to improve main responsibilities,achievement management,system establishment,personnel training,resource sharing,department coordination and other related aspects.Conclusion The rate of achievement transformation in tertiary medical institutions in Shanghai is at a lower level.There are numerous problems and difficulties in the transformation.Therefore,urgent efficient countermeasures are needed to promote the transformation of a-chievement.
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Objective The purpose of this article is to analyze the problem with the first page of inpatient medical re-cords in the Department of Bone and Soft Tissue Oncology of a certain hospital,in order to provide guidance for improving the quality of the first page of inpatient medical records.Methods A retrospective analysis was conducted on 2 979 inpatient medi-cal records from the Department of Bone and Soft Tissue Oncology of a certain hospital from April 1,2022 to August 31,2023.Excel was used to statistically analyze and record the occurrence of problems on the first submission of inpatient medical records.Results A total of 1 258 inpatient medical records had issues with the first submission of 2 979 inpatient medical records,with an incidence rate of 42.23%.A total of 2 149 defects were found on the homepage of 1 258 problematic medical records,among which 28.71%,22.57%,16.66%,13.49%,and 10.89%were other diagnostic errors,main diagnostic errors,pathological diagnostic errors,other surgical or operational errors,and main surgical or operational errors,respectively.Conclusion There are many pre quality inspection issues on the first page of inpatient medical records in the Department of Bone and Soft Tissue On-cology of a certain hospital,which should be taken seriously.The incidence rate can be reduced by strengthening training for clin-ical physicians,providing targeted guidance for coding personnel on filling out problems on the first page,improving pre submis-sion logic quality control in the Information Department,and strengthening performance evaluation.
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An efficient vacuum suction system is a necessary prerequisite for the smooth operation of the oral diagnosis and treatment.During the use of the dental units,there is often a situation of vacuum suction weakness,resulting in the inability to discharge the mixture of blood,saliva,dental tissue and other mixtures in time,which affects the doctor's treatment field and increases the risk of aspiration pneumonia and cross-infection in patients.The working principle,pipeline system,filters and other aspects of the vacuum suction system that may affect the suction efficiency was analyzed.The causes and solutions of vacuum suction weakness were discussed,and operation suggestions were proposed to ensure the safe and effective use of equipment and ensure the safety of diagnosis and treatment.
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Prescription indication reviews are the problematic points in reviewing prescriptions of Chinese patent medi-cines.However,there is no commonly recognized review standard.This article conducted a statistical analysis of the prescriptions reviewed by pharmacists from July to December 2022 in the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.Combined with work experience,we analyzed the results and reasons for unqualified indication reviews,combed out the difficulties of the indications review in Chinese patent medicines,and proposed feasible strategies to provide support for the stand-ardization and standardized development in reviewing prescriptions of Chinese patent medicines.
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The scientific article analyses modern terrorist threats in the territory of Ukraine, associated with the active use of financial assets, the latest technologies and innovative financial instruments, in particular cryptocurrencies. The positive experience of legislative initiatives and advanced practices of several foreign countries in combatting the legalisation of funds by illegal means and the financing of terrorism is highlighted. The problems of implementation of state policy in this sphere are revealed. Based on this, ways of improving the system of fighting terrorism in Ukraine on the international and national levels have been determined. It was concluded that the basis of the state policy in the field of combatting terrorism during the period of martial law and in the post-war period in Ukraine should be the development of the Strategy for Combatting Terrorism in Ukraine, which should take into account both the best world practices and the modern realities of waging war in the conditions of supporting terrorism with financial infusions.
El artículo científico analiza las amenazas terroristas modernas en el territorio de Ucrania, asociadas al uso activo de activos financieros, las últimas tecnologías e instrumentos financieros innovadores, en particular las criptodivisas. Se destaca la experiencia positiva de las iniciativas legislativas y las prácticas avanzadas de varios países extranjeros en la lucha contra la legalización de fondos por medios ilegales y la financiación del terrorismo. Se ponen de manifiesto los problemas de aplicación de la política estatal en este ámbito. Se concluye que la base de la política estatal en el ámbito de la lucha contra el terrorismo durante el período de la ley marcial y en el período de posguerra en Ucrania debe ser el desarrollo de la Estrategia de Lucha contra el Terrorismo en Ucrania, que debe tener en cuenta tanto las mejores prácticas mundiales y las realidades modernas de hacer la guerra en las condiciones de apoyo al terrorismo con infusiones financieras.
O artigo científico analisa as ameaças terroristas modernas no território da Ucrânia, associadas ao uso ativo de ativos financeiros, às tecnologias mais recentes e aos instrumentos financeiros inovadores, em especial as criptomoedas. A experiência positiva de iniciativas legislativas e práticas avançadas de vários países estrangeiros no combate à legalização de fundos por meios ilegais e ao financiamento do terrorismo é destacada. Os problemas de implementação da política estatal nessa esfera são revelados. Com base nisso, foram determinadas formas de aprimorar o sistema de combate ao terrorismo na Ucrânia em nível internacional e nacional. Concluiu-se que a base da política do Estado no campo do combate ao terrorismo durante o período da lei marcial e no período pós-guerra na Ucrânia deve ser o desenvolvimento da Estratégia de Combate ao Terrorismo na Ucrânia, que deve levar em conta tanto as melhores práticas mundiais quanto as realidades modernas de guerra nas condições de apoio ao terrorismo com infusões financeiras.
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HumansABSTRACT
OBJECTIVE To provide reference for better implementation of the priority review system for generic drugs of encouraged generic drug catalogues. METHODS Based on literature research, practical status of the priority review system for generic drugs in two batches of encouraged generic drug catalogues in China was analyzed, and the problems existing in the application of the system were compared to propose corresponding solutions. RESULTS & CONCLUSIONS China has issued two batches of encouraged generic drug catalogues, and there were 49 varieties of generic drugs included in the catalogues. In the implementation of the priority review system for generic drugs of encouraged generic drug catalogues, there were some problems in legislation, incentive system for the first generic drug, post-marketing re-evaluation system, and cross-departmental coordination and linkage mechanism. It is suggested to strengthen legislation, improve the “first generic market exclusivity period” system, perfect the post-marketing re-evaluation system and form a normalized cross-departmental coordination mechanism so as to ensure the safety, effectiveness and accessibility of generic drugs in China.
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With the rapid development of life science, laboratory animals play an important role in many fields, such as biomedicine. In recent years, the national reforms “to delegate power, streamline administration and optimize government services” continues deepen, the laboratory animals administrative departments have paid more attention to interim and post-event supervision, in which the safety management of laboratory animals is the key and challenging point in the supervision process. In this paper, the information regarding licenses for laboratory animals in Jiangsu, facility areas, animal production and usage, employees, and other information the past three years were introduced. Combined with legal administrative management in recent years, the potential safety risks in the production and use of laboratory animals were analyzed, such as risks in management systems, employees, facility operation, animal quality control, accidental injury and zoonosis, animal transportation, and waste disposal. Additionally, the current construction, daily management services, and the list of interim and post-event supervision of the laboratory animal safety management system were introduced. Based on this discussion, we proposed relevant safety management countermeasures and suggestions and provided support for further improvements to laboratory animal safety management.
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Prions are infectious conformations of certain naturally occurring proteins.These misfolded proteins can struc-turally alter healthy protein,creating misfolded copies that repeat the process and form protein aggregates that lead to neuronal cell death.Although years can pass from initial prion infection to clinical presentation of symp-toms,onset of symptoms is typically followed by rapid neurological decline resulting in death.Prion diseases have been characterized in animals ranging from sheep and cattle to cervids and humans,with notable cross-species infections such as the variant Creutzfeldt-Jakob disease.Thus,prions present a health risk with the potential to disrupt major food sources as well affect human health through animal to human and human to human trans-mission events.While human to human prion transmission is rare and the immediate risks for a prion-facilitated pandemic are low,prions are a class of pathogens for which we are underprepared.In addition,prions,and prion disease-like approaches,have also been discussed in the context of biological weapons and toxins,adding another layer of complexity surrounding biosecurity and biodefense.These threats underscore the need for increased scrutiny and research on prions.Here,pharmaceutical and nonpharmaceutical prion-specific interventions are discussed.Recent advances in prion therapeutic development are also briefly highlighted,and a set of policy rec-ommendations are given that aims to provide high level suggestions for the prevention and mitigation of prion diseases.
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Over the past decade, remarkable progress has been made in prevention and control of endemic diseases in China through implementation of the 12th and the 13th Five-Year National Plans for Prevention and Control of Endemic Diseases and the Three-Year Action Plan for Special Prevention and Control of Endemic Diseases. Based on the latest monitoring data of endemic diseases and the evaluation results of the control and elimination of endemic diseases of the 13th Five-Year Plan, this paper analyzed current main problems in prevention and control of endemic diseases in China, focusing on implementation of prevention and control measures for iodine deficiency disorders, endemic fluorosis, and endemic arsenicosis, as well as the treatment and management of patients. Accordingly, corresponding countermeasures and suggestions are put forward from three aspects, including prevention and control mechanism, implementation of prevention and control measures, and scientific research, so as to provide scientific basis for the country and various regions to consolidate the achievements of prevention and control of endemic diseases and accurately implement the prevention and control measures of endemic diseases.
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Objective:In order to put forward relevant measures and suggestions to improve the quality of the Investigator-Initiated Trials of oncology in medical institutions.Methods:Through literature research, comparative study, combined with the implementation and management of investigator initiated trials, the current status and challenges of the administration of these trials were analyzed.Results:Investigator-Initiated Trials of oncology become increasingly important. However, its quality is poor compared with Industry-Sponsored Trials due to insufficient funds and lack of effective supervision. Besides, four main challenges as follows were identified: lack of clinical research professionals, the quality concerns of ethical review in some institutions, insufficient funding for clinical research, and imperfect quality management system.Conclusions:Based on the actual needs of IITs of oncology, medical institutions should strengthen the talent cultivation, establish electronic information management platform, increase project support, strengthen scientific research supervision and deepen the awareness of risk prevention to improve the quality of investigator initiated trials.
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【Objective】 To explore the quality of platelet-rich plasma(PRP) and adverse events during PRP collection and the countermeasures, so as to provide reference for the development of PRP therapy. 【Methods】 A total of 412 patients who underwent PRP treatment from November 2020 to October 2022 were statistically analyzed in terms of the general data, PRP quality and adverse events during collection, and the countermeasures were formulated. 【Results】 PRP was collected from 409 patients with a volume of (48.391±6.262) mL, with platelet concentration at (1 125.548±366.036)×109/L. There were 33 adverse events occurred in 412 patients, with an incidence of 8.01% (33/412), among which 10 was regarding to collection and 23 were adverse reaction to blood donation. The reasons include mental factors, hyperlipidemia, hypovolemia, abnormal red blood cell morphology and venous puncture injury. 【Conclusion】 Countermeasures against the relative risk factors of adverse events during PRP collection, such as exclusion of hyperlipidemia, relieving mental stress, providing adequate communication and water to patients with low body weight, lowering the collection and transfusion flow rate to patients with poor vascular status and providing calcium gluconate to patients with low calcium response should be taken.
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@#Abstract: Objective , To analyze the current status and existing problems of occupational health talents in China and put Methods forward development measures and suggestions. The occupational health supervision and management law enforcement officers at the city and county levels in China and occupational health professionals in local occupational disease prevention and control technical support institutions at all levels were selected as the survey subjects using comprehensive survey. The Questionnaire on the Construction Status of Occupational Health Personnel Team in China was used to investigate Results , theallocation. ByDecember2020 therewere17900occupationalhealthsupervisionandlawenforcementofficersin , , cities counties and districts and each occupational health supervision and law enforcement officer in China needed to , , supervise and manage 261 enterprises. Among them there are 689 enterprises in Jiangsu Province and 67 enterprises in - - ShanxiProvince.There are 45 200 full time and part time occupationalhealth professionals in occupationaldisease prevention , and control technical support institutions affiliated to local health systems at all levels. Among them there are 4 900 , occupationaldiseasepreventionhospitalsatalllevels 20700diseasecontrolcentersatalllevelsand 19600generalhospitals , - - at all levels. On the distribution of disciplines and specialties there are 22 400 health related majors and 3 200 non health Conclusion , majors. Thereisalackofpersonnelinoccupationalhealthsupervisionandlawenforcement unevengeographical , , distribution few occupational health professionals and imperfect discipline system of occupational health system. There is an , , urgent need to strengthen the construction of occupational health personnel team optimize the structure of the team improve , , the personnel training mechanism innovate personnel training methods and improve the comprehensive quality and ability of occupationalhealthpersonnel.
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@#Practice in military medical radiation license management in the new era of military reform have surfaced problems in military radiation protection, involving radiation protection management regulation, occupational health monitoring for radiation workers, inspection of radiation equipment and site protection, implementation of the “Three Synchronizations System” for construction, renovation, and extension projects of radiation facilities, as well as quality control for radiation protection and diagnosis and treatment. Efforts should be focused on radiation protection training, self-management of medical radiation institutions, supervision and regulation from medical radiation license management institutions, and joint coordination of relevant departments. Under new regulations and standards, creatively conducting medical radiation license management and running the army in accordance with the law in the new era of military reform are of great significance for standardizing military radiation protection and ensuring the healthy development of military medical radiation services.
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While the COVID-19 epidemic required the ability to confront infection prevention practices, its education for medical students remained inadequate. Herein, we have developed an infection practice simulation course for medical students, based on the simulation education method. The course is a compulsory part of the medical school curriculum. Features of the course include adoption of small group education by tutorial method, medical interviews of simulated patients, scenario simulation, supervised discussions and presentations between medical students, efficient point learning using worksheets, achievement assessment using OSCE, course direction by an infectious disease specialist, and university-wide educational participation from all clinical department doctors. The course was designed so that students could be guided to think carefully and be aware of their interactions. In addition, it was expected that participation in the course would have a lifelong educational effect on the medical doctors.
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Objective:To analyze the perioperative clinical characteristics of patients with oral cancer underwent radical resection and flap reconstrution and the nursing managements.Methods:From January 2020 to December 2020, 658 patients with oral cancer underwent radical resection and flap reconstrution in the Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University were retrospectively analyzed. All patients were divided into the elderly group (≥60 years) and the younger group (< 60 years), including 279 cases in the elderly group and 379 cases in the younger group. The perioperative clinical data of the patients were collected, and the perioperative general situation, postoperative complications and influencing factors of complications were analyzed.Results:There were differences between the two groups in the aspects of sex ( χ2 = 12.38, P<0.001), preoperative BMI ( t = 2.43, P = 0.015), smoking history ( χ2 = 18.34, P<0.001), preoperative anesthesia grade ( χ2 = 25.61, P = 0.001), preoperative coexisting disease ( χ2 = 46.97, P<0.001), whether oral floor or tongue cancer ( χ2 = 16.68, P<0.001), whether free flap ( χ2 = 6.81, P = 0.003), operation time ( t = 2.19, P = 0.029), preoperative test index hemoglobin ( t = 4.96, P<0.001), albumin ( t = 5.44, P<0.001), D-dimer( Z = -13.52, P<0.001), calcium levels ( t = 4.07, P<0.001) and postoperative complications ( χ2 = 14.55, P<0.001). Multivariate analysis of postoperative complications showed that the age ( OR = 1.021, 95% CI = 1.005-1.037, P = 0.011), preoperative D-dimer ( OR = 1.219, 95% CI = 1.026-1.447, P = 0.024) and the preoperative coexisting disease ( OR = 1.642, 95% CI = 1.108-2.432, P = 0.013) were the risk factors for the postoperative complications. Multivariate analysis of discharge with tube showed that the age ( OR = 1.017, 95% CI = 1.003-1.031, P = 0.017), preoperative BMI ( OR = 0.917, 95% CI = 0.873-0.963, P = 0.001), whether oral floor or tongue cancer ( OR = 2.135, 95% CI = 1.475-3.091, P<0.001), and operation time ( OR = 1.220, 95% CI = 1.120-1.328, P<0.001) were the related factors for the discharge with tube. Conclusion:In view of the above risk factors, it is beneficial for the physical and mental recovery of patients to pay attention to preoperative evaluation, make adequate preoperative preparation, postoperative nursing and observation, improve swallowing function training, prepare for discharge, pay attention to continuous nursing, and establish a tertiary hospital-community-family rehabilitation system.
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Objective: To analyze the risk factors of blood-borne occupational exposure among medical staff and explore the relevant intervention measures. Methods: In June 2020, the data of blood-borne occupational exposure and related factors reported by medical staff in a grade Ⅲ, Grade A general hospital from 2011 to 2019 were analyzed by retrospective investigation. Results: Among 431 cases of blood-borne occupational exposure, 69.37% were nurses. It mainly occurred in medical staff with 0-4 years of service, accounting for 63.57%; The main place of occupational exposure was in the ward 47.56%; Sharp instrument injury was the main occupational exposure route 91.65%. Occupational exposure department was mainly surgery department 17.87%; The main source of exposure was hepatitis B virus (HBV) 37.12%, followed by treponema pallidum 20.19%. Statistical analysis results show that: Exposure sites (χ(2)=43.585, P<0.01) , exposure sources (χ(2)=22.693, P<0.01) , treatment methods after exposure (χ(2)=18.866, P<0.01) , Flushing (χ(2)=31.963, P<0.01) and disinfection (χ(2)=14.216, P<0.01) were significantly different. Conclusion: The effective measures to reduce blood-borne occupational exposure are to strengthen occupational protection training of medical staff, standardize operation procedures, strengthen supervision of key groups and departments, improve reporting, monitoring and follow-up systems to realize informatization, and do a good job in risk control.
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Humans , Blood-Borne Pathogens , Medical Staff , Needlestick Injuries , Occupational Exposure/prevention & control , Retrospective Studies , Risk FactorsABSTRACT
【Objective】 To study the yielding rate and distribution of unexpected antibodies in blood transfusion children with thalassemia in Yunnan province, and to explore the blood transfusion strategies. 【Methods】 From January 2016 to December 2021, 298 children with thalassemia, who received blood transfusion treatment in Kunming, Xishuangbanna, Wenshan, Dehong, Yuxi and Baoshan hospitals across Yunnan Province, were selected. The unexpected antibodies of blood plasma were screened by microcolumn gel card. The samples with positive antibodies were identified for alloantibody specificity. 【Results】 Unexpected antibodies were yielded in 67 out of 298(22.48%) transfused children with thalassemia. The positive rates of unexpected antibodies in boys and girls were 16.55%(24/145) and 28.10%(43/153), respectively. The positive rates of unexpected antibodies in Han, Dai, Zhuang, Yi, Bulang, Jinuo and Miao people were 14.06%(18/128), 30.80%(32/104), 35.71%(10/28), 36.36%(8/22), 50.00%(4/8), 60.00%(3/5)and 66.67%(2/3), respectively, with statistically significant differences between each other. The positive rate of unexpected antibodies in ethnic minorities was higher than that in Han. The positive rates of unexpected antibodies in children who received the first transfusion at birth-one year old, 1~3 years old, 3~6 years old and above 6 years old were 12.50%(3/24), 10.14%(7/69), 24.54%(40/163)and 40.48%(17/42), respectively. The positive rates of unexpected antibodies in children with first transfusion after 3 years old were significantly higher than those before 3 years old. The positive rates of unexpected antibodies in children with one transfusion, 1~3, 3~10, 10~20 and more than 20 transfusions were 4.76%(1/21), 12.07%(7/58), 23.71%(23/97), 28.16%(29/103)and 36.84%(7/19), respectively, with statistically significant differences between each other. The number of blood transfusions was positively correlated with the unexpected antibody yielding. The yielding rate of unexpected antibodies in children with α thalassemia, βthalassemia, δ+ βthalassemia and untyped thalassemia was 7.50%(3/40), 17.62%(34/193), 53.70%(29/54)and 9.09%(1/11), respectively(P<0.05). The yielding rate of unexpected antibodies in transfused children with δ+ βthalassemia was the highest. And 57 unexpected antibodies of Rh blood group system were yielded, 6 anti-M antibodies, 2 anti-N antibodies and 2 undetermined. 【Conclusion】 The positive rate of unexpected antibodies in transfused children with thalassemia in Yunnan province is high. Routine antibody screening should be carried out for transfusion children with thalassemia, and blood units, compatible with ABO, Rh and MNS typing results, should be selected to ensure the safety and effectiveness of clinical blood use.