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At present， there is no consensus on the diagnosis， treatment， and management of pulmonary nodules with integrated traditional Chinese and Western Medicine in China. To establish the clinical management strategy of pulmonary nodules with integrated medicine， a consensus was formed after full discussion by the experts from the Cancer Committee of Chinese Association of Integrative Medicine and the Cancer Committee of Beijing Association of Chinese Medicine according to the guidelines for pulmonary nodules issued in recent years and the clinical practice of multiple hospitals in the treatment of cancers with integrated Chinese and Western medicine. This consensus involves the existing clinical management guidelines of pulmonary nodules and the intervention methods of traditional Chinese medicine （TCM）. Considering the therapeutic positioning and value of TCM， this consensus standardizes the whole-process management of pulmonary nodules with integrated traditional Chinese and Western medicine， which will help more patients.
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Objective:In the context of China′s increasing standardized management requirements of clinical research, this article aims to explore the management methods of investigator-initiated trials in the new period, to provide possible reference for other medical institutions dedicated to clinical research.Methods:According to the requirements set forth by the＂Administrative Measures for Investigator-Initiated Trials in Medical and Health Institutions (Trial)", combined with the hospital management practice, experiences regarding the research management system construction and implementation, management system construction and its implementation effects are summarized and analyzed.Results:By exploring and summarizing the connotation of high-quality clinical research under the New Policy, tailored clinical research management system in our hospital was developed and implemented. And the hospital′s clinical research capability and level have been greatly improved, which enhancing the hospital academic influence, as well as its competence for serving the development of national and regional clinical research.Conclusions:Along with the rapid progress of clinical research, hospitals need to assure the compliance of national laws and regulations, and develop appropriate and applicable institutional management measures to empower the conduct of high quality clinical research.
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Objective:The study aims to analyze the problems faced in the clinical research and management of stem cells, explore the construction of the entire process of stem cells clinical research, and promote the healthy and orderly development of the clinical research of stem cells.Methods:By consulting the literature and retrieval of relevant policies and regulations, this study analyzed the problems faced by the supervision and management department, medical institutions and researchers, this study and discussed the countermeasures for strengthening the management of the entire process of clinical research of stem cells in medical institutions.Results:There were imperfect internal system and poor management process, insufficient quality control of cell products, low quality of project management, and insufficient clinical research consciousness of stem cell clinical research management in medical institutions.Conclusions:Combined with the current management measures, guidance principles and medical institutions, we should improve the internal system of medical institutions, promote the centralized management and informatization construction of projects, strengthen cell quality control in the hospital, cultivate talent echelons and improve academic and ethical review capabilities, actively explore the management model that is suitable for the entire process of stem cell clinical research for medical institutions in China.
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The global efforts aimed at preventing and controlling HIV infections have made remarkable progress. With the continuous accumulation of clinical evidence and the development of antiviral drugs, the treatment of HIV/AIDS has entered an era of chronic disease management. However, it has also brought about many challenges. Currently, some areas in prevention, control and management of HIV infection need to be further improved, and the long-term management model currently in use need to be further refined in China. The comprehensive whole-course management mode for HIV/AIDS, which is proved as effective and efficient means, should be widely recognized and vigorously promoted in order to provide reference and assistance for the clinical management of HIV infection in China.
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Based on the teaching concept of constructivism, this study aims to promote independent inquiry-based learning and clinical thinking among students and establish the guiding ideology of "full participation, process control, in-depth discussion, and expansion of thinking". A blending learning model was adopted with offline inquiry-based group learning and in-class defense and comment, as well as online teacher-student interaction and supervision to promote learning. Case-problem-based learning (CPBL) of pathophysiology was carried out among the medical students in the class of 2017, and process management was strengthened to effectively manage the two key links of data retrieval and group discussion. The analysis of 176 teaching evaluations collected at the end of the semester show that in terms of the overall evaluation of CPBL teaching, 162 students (92.05%) had high evaluation on teaching objectives, organization, cases, and personal gains and held a very or relatively favorable attitude. There were more negative feedbacks on "appropriate time allocation"; 21 students (11.93%) held a relatively or very disapproving attitude, and 149 students (84.66%) "felt very tired". In terms of teaching effect evaluation, 150 students (85.23%) strongly or relatively agreed that CPBL teaching may help to understand professional knowledge, stimulate learning enthusiasm and initiative, improve problem solving ability, emphasize clinical practice to cultivate clinical thinking, supervise and promote learning, and enhance team cooperation and teacher-student communication. In terms of the evaluation of teachers, 167 students (94.89%) thought that teachers were rigorous, responsible, and enthusiastic in teaching, attached importance to process management, and did well in effective guidance and thinking inspiration (strongly or relatively agree). The above results suggest that the CPBL teaching reform of pathophysiology based on process management can effectively promote in-depth inquiry-based independent learning and the cultivation of clinical thinking and improve teaching effectiveness, but further improvement is needed for teaching arrangement and time allocation.
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Objective:To assess the application effect of "internet + mobile medicine" on the process management of standardized residency training of obstetrics and gynecology.Methods:A total of 43 teachers including 14 administrators and 29 instructors who were not directly responsible for management, and 41 residents who participated in the standardized training in our base were enrolled as research objects. The data of process management were sorted by internet technology, and combined with personal wishes and casting lots, the residents were divided into two groups: the control group ( n=21) adopted traditional way while the observation group ( n=20) used mobile medicine for process management. By conducting multi-dimensional questionnaire and data comparison, we analyzed the evaluation of teachers and residents, the scores of different stage of residents, and the satisfaction of cervical cancer postoperative patients to medical care under different process management mode. SPSS 22.0 software was used for t test and chi-square test. Results:The application of "internet + mobile medicine" in standardized residency training obtained positive evaluation both by teachers and residents, and the ratio of considering "necessary" to reform the traditional residency training management mode in residents [95.1%(39/41)] and administrators [92.9%(13/14)] were both higher than that in instructors [62.1%(18/29)]. And 78.6%(11/14) of the administrators believed that cloud data management took less time. After 6 months of process management by different modes, the clinical diagnosis and treatment ability and skill operation ability scores of observation group were higher than those of control group [(93.6±5.6) vs. (89.4±5.7); (89.6±8.8) vs. (84.0±8.7)]. The "overall medical satisfaction rate" of cervical cancer patients was relatively high in both groups [100%(30/30) vs. 93.3%(28/30)], and the "very satisfied rate" of patients in the mobile medical group was higher than that in the traditional group [86.7%(26/30) vs. 63.3%(19/30)].Conclusion:The application of "internet + mobile medicine" is conducive to strengthening the process management and optimizing the quality of standardized residency training management of obstetrics and gynecology.
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Objective:To explore the application effect of the intelligent ward combined with DMAIC in improving the procedure and shortening the time of operation, so as to provide a reasonable basis for optimizing and improving the operation process.Methods:This was a prospective study. A total of 240 patients with gynecological surgery hospitalized in Shengjing Hospital of China Medical University from August to November 2021 were selected as the research object. From August to September 2021, the routine management mode of staff in the operating room and ward was adopted as the control group, with a total of 120 cases. From October to November 2021, the intelligent ward combined with DMAIC mode of staff in the operating room and ward was adopted as the observation group, with a total of 120 cases. The time of receiving operation notice, preoperative preparation time, preparation time of transfer personnel, waiting time after the arrival of transfer personnel and the total time of receiving operation were compared between the two groups.Results:The time of receiving operation notice was (1.42 ± 0.61) min in the observation group, which was less than that in the control group (3.53 ± 1.12) min, the difference was statistically significant ( t=18.14, P<0.05). The preoperative preparation time was (8.43 ± 1.80) min in the observation group,which was less than that in the control group (11.36 ± 2.01) min, the difference was statistically significant ( t=11.89, P<0.05). There was no significant difference in the preparation time of transfer personnel between the two groups ( P>0.05). The waiting time after the arrival of transfer personnel was 2.33(1.75, 2.93) min in the observation group, which was less than that in the control group 5.19(3.46, 8.42) min, the difference was statistically significant ( t=-10.06, P<0.05). The total time of receiving operation was (23.90 ± 4.94) min in the observation group, which was less than that in the control group (28.84 ± 4.75) min, the difference was statistically significant ( t=7.90, P<0.05). Conclusions:The intelligent ward combined with DMAIC improves the operation receiving process of the ward, shortens the total time for receiving the operation, and effectively improves the work quality and efficiency of the medical staff.
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Objective:To explore the effect of whole-process management mode based on "Internet + nursing service" in the management of children with concealed penis.Methods:This study adopted a quasi-experimental research method. A total of 383 children with concealed penis who were hospitalized in the Third Department of Urology of Hunan Provincial People′s Hospital from January 2018 to August 2021 were convenient selected. According to the sequence of admission, 195 children admitted from January 2018 to May 2020 were set as the control group, and 188 children admitted from June 2020 to August 2021 were set as the observation group. The control group was received conventional treatment and nursing, but the observation group was received whole-process management mode based on "Internet + nursing service". The length of hospitalization, incidence of complications after discharge, anxiety of the children′s parents and satisfaction of the doctors, the specialist & nurse sharing and the children′s parents were compared between the two groups.Results:Finally, 186 and 193 children were included in the observation group and the control group, respectively After the intervention, in the observation group, the length of hospitalization, anxiety score of the children′s parents, difference of anxiety score of the children′s parents, satisfaction content of the doctors, satisfaction effect of the doctors, satisfaction content of the specialist & nurse sharing, satisfaction effect of the specialist & nurse sharing, satisfaction content of the children′s parents and satisfaction effect of the children′s parents were (4.30 ± 1.35) d, (35.08 ± 3.17) points, (19.14 ± 4.35) points,(4.57 ± 0.54) points, (4.71 ± 0.49) points, (4.75 ± 0.50) points, (5.00 ± 0.00) points, (4.60 ± 0.49) points, (4.65 ± 0.49) points; in the control group, the scores were (5.50 ± 1.41) d, (44.79 ± 3.30) points, (9.22 ± 3.67) points, (3.71 ± 0.49) points, (4.00 ± 0.58) points, (3.50 ± 0.58) points, (3.25 ± 0.50) points, (3.54 ± 0.59) points, (3.64 ± 0.67) points. The differences between the two groups were statistically significant ( t values were -23.94-29.19, all P<0.05). The complication rates of the observation group and the control group were not statistically significant ( χ2=0.64, P>0.05). Conclusions:The whole-process management mode based on "Internet + nursing service" is beneficial to shorten the length of hospitalization, relieve the degree to anxiety of the children′s parents, improve the satisfaction of the doctors, the specialist & nurse sharing and the children′s parents, and accelerate the rehabilitation of children, which is worthy of clinical promotion.
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Currently, the number of clinical research projects continues to grow. Both sponsors and researchers hope to accelerate medical ethical review efficiency, and the regulatory agencies strengthen the control over the ethical review quality. The ethics committee (EC) offices of medical institutions are relatively insufficient in terms of human resource allocation and archiving space. Combined with the development goals of the EC and the requirements of the homogeneity construction of ethical review, it was urgent to optimize the ethics review process and accelerate the efficiency of ethics review through informatization construction. Through informatization construction, the process management of ethical review could be strengthened, the work steps could be simplified, the ethical review level could be improved, and the supervision ability and efficacy of EC on clinical research could be strengthened, which may provide continuous quality improvement strategies and specific optimization measures for the operation and management of the EC, so as to effectively protect the safety, the rights and interests of subjects.
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OBJECTIVE@#The national requirements for the fund management of scientific research projects are becoming more stringent, so that it is convenient to carry out scientific research work and can strengthen the regulation of scientific research reagent procurement, so this study explores the standardization of the whole process of the procurement of scientific research reagent supplies in hospitals and new modes of management.@*METHODS@#By exploring the implementation of the centralized procurement management platform, we engage in full process supervision before, during, and after the event.@*RESULTS@#Introduction of centralized procurement management platform for scientific research reagent supplies can normalize the procurement process, ensure the quality of procurement and improve the procurement efficiency on the basis of ensuring the quality of scientific research.@*CONCLUSIONS@#The new model of centralized procurement of full process management based on one-stop service for scientific research reagent supplies is an important part of improving the fine scale management of public hospitals, and it is of great significance in improving the level of scientific research in China and avoiding scientific research corruption.
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Indicators and Reagents , Hospitals, Public , ChinaABSTRACT
Las particularidades de las revistas científicas en la actualidad, en cuanto a procesos, resultados y sujetos actuantes que garantizan su materialización y sostenimiento, hacen de estas un objeto de estudio de innegable complejidad desde el punto de vista organizacional; todo lo cual revela la ineludible necesidad de una adecuada gestión. Sin embargo, esta perspectiva no es muy común en la literatura científica especializada, lo que implica una búsqueda detallada de las aportaciones realizadas hasta el momento. Los objetivos del estudio se orientaron a analizar, desde el punto de vista bibliométrico, la gestión de los procesos en las revistas científicas, con la finalidad de contribuir a revelar las tendencias que han caracterizado su tratamiento en la comunidad científica y con ello sentar las bases para posteriores estudios. Se realizó un análisis sobre la gestión de los procesos en revistas científicas, utilizando la estrategia de búsqueda "título"-"resumen"-"palabras clave" hasta el año 2022, en las bases de datos Scopus, Science Direct, Google Scholar y SciELO. Se emplearon como métodos teóricos el análisis y síntesis, el hermenéutico-dialéctico y el holístico-dialéctico; como métodos empíricos la revisión documental y el análisis bibliométrico. Se evaluaron y contrastaron diferentes indicadores bibliométricos: la productividad de artículos, productividad y colaboración autoral, ocurrencias, co-ocurrencias de palabras clave, entre otros. Se pudo determinar que, si bien el tema de la gestión de los procesos en revistas científicas ha suscitado un creciente interés en la comunidad científica internacional, ha sido poco tratado en la literatura general y desde la perspectiva de la gestión organizacional.
The particularities of scientific journals today, in terms of processes, results and acting subjects that guarantee their materialization and sustainability make them an object of study of undeniable complexity from the organizational point of view, all of which reveals the unavoidable need to proper management. However, this perspective is not very common in specialized scientific literature, which implies a detailed search of the contributions made up to now. The objectives of the study were oriented to analyze, from the bibliometric point of view, the management of processes in scientific journals, in order to help reveal the trends that have characterized their treatment in the scientific community and thereby lay the foundations for further studies. An analysis was carried out on the management of processes in scientific journals, using the search strategy "title"-"abstract"-"key words" until 2022, in Scopus, ScienceDirect, Google Scholar and SciELO databases. Analysis and synthesis, hermeneutic-dialectical and holistic-dialectical methods were used as theoretical methods; as empirical methods, documentary review and bibliometric analysis. Different bibliometric indicators were evaluated and contrasted: article productivity, authorial productivity and collaboration, occurrences, co-occurrences of keywords, among others. It was possible to determine that, although the issue of process management in scientific journals has aroused growing interest in the international scientific community, it has been little discussed in general literature and from the perspective of organizational management.
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La investigación propone mostrar cómo los autores visualizan el proceso de gestión de la Formación Laboral Investigativa o Práctica Laboral Investigativa en la Universidad de Ciencias de la Cultura Física y Deporte Manuel Fajardo. Partiendo de la aprobación del Plan de Estudio E es considerada la disciplina integradora de la carrera, constituye el eje transversal que favorece la dirección científica del proceso docente-educativo e integra por excelencia los contenidos de diferentes materias y los componentes organizacionales del proceso formativo a través de un enfoque interdisciplinario en la solución de problemas profesionales que permite que los estudiantes se identifiquen, se desarrollen con el que hacer y su modo de actuación profesional. Para ello, se propone como objetivo elaborar acciones metodológicas encaminadas a la gestión del proceso de la Formación Laboral Investigativa. En la investigación se sistematizaron antecedentes históricos, referentes teóricos y metodológicos de la muestra objeto de estudio, así como métodos científicos del nivel teórico, empírico y matemático, entre ellos, el análisis de documentos, la observación y la entrevista. Los resultados obtenidos en el diagnóstico, permitieron revelar la necesidad de elaborar la propuesta de acciones metodológicas que contribuirá a la gestión del proceso y a su vez favorecerá al desarrollo y ejecución praxis de los conocimientos y habilidades profesionales adquiridas.
A pesquisa se propõe a mostrar como os autores visualizam o processo de gestão da Formação Laboral Investigativa ou Prática Laboral Investigativa na Universidade Manuel Fajardo de Cultura Física e Ciências do Esporte. Com base na aprovação do Plano de Estudos E, é considerada a disciplina integradora do curso de graduação, constitui o eixo transversal que favorece a direção científica do processo ensino-educacional e integra por excelência os conteúdos das diferentes disciplinas e os componentes organizacionais do processo de formação através de uma abordagem interdisciplinar na solução de problemas profissionais que permite aos alunos identificar-se, desenvolver-se com o que fazem e sua forma de atuar profissionalmente. Para este fim, propõe-se como objetivo elaborar ações metodológicas voltadas para a gestão do processo de Treinamento de Trabalho Investigativo. A pesquisa sistematizou os antecedentes históricos, referências teóricas e metodológicas da amostra em estudo, assim como métodos científicos de nível teórico, empírico e matemático, entre eles, a análise de documentos, observação e entrevista. Os resultados obtidos no diagnóstico revelaram a necessidade de elaborar a proposta de ações metodológicas que contribuirão para a gestão do processo e, por sua vez, favorecerão o desenvolvimento e a implementação prática dos conhecimentos e habilidades profissionais adquiridos.
The research proposes to show how the authors visualize the management process of the Research Labor Training or Research Labor Practice at the Manuel Fajardo University of Physical Culture and Sport Sciences. Starting from the approval of the Study Plan E, it is considered the integrating discipline of the career, it constitutes the transversal axis that favors the scientific direction of the teaching-educational process and integrates par excellence the contents of different subjects and the organizational components of the formative process through an interdisciplinary approach in the solution of professional problems that allows students to identify themselves, develop with what to do and their way of professional performance. For this purpose, it is proposed as an objective to elaborate methodological actions aimed at the management of the Research Labor Training process. In the research, historical background, theoretical and methodological references of the sample under study were systematized, as well as scientific methods of the theoretical, empirical and mathematical level, including document analysis, observation and interview. The results obtained in the diagnosis revealed the need to elaborate the proposal of methodological actions that will contribute to the management of the process and in turn will favor the development and praxis execution of the acquired knowledge and professional skills.
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Contract countersignature can effectively avoid potential risks caused by sub-standard contract signing, yet its time consuming process will inevitably delay the contract signing and related business development. Therefore, it is necessary to ensure the timely signing of hospital contracts on the premise of meeting internal control requirements. In order to improve the efficiency of contract countersigning, a tertiary hospital has explored various approaches to optimize the contract countersigning process since 2019. These approaches included establishing a three-level centralized contract management model, clarifying the review responsibilities of each countersigning department, customizing the countersigning process, managing the contract by risk classification, and establishing a meeting opportunity system of contract countersigning modification opinions. These measures had cut back the time spent in the contract countersigning process from 12.1 working days in 2018 to 4.2 working days in 2021.
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Effective supervision of the clinical research management department can guarantee and improve the quality of the investigator initiated trials(IIT). The authors analyzed relevant clinical research regulations and literature and summarized the current situation of risk-based IIT project process quality management. On such basis, they determined the risk-based IIT project process quality management method in combination with the previous research of the research group.From 2021 to 2022, this method was used to implement process quality management for 353 IIT projects in Shanghai′s tertiary hospitals. More than 3 000 risk points were identified through centralized supervision, and then on-site supervision was carried out to correct the problems found. As proven by the results, the method could find existing problems in time and define the risk level of the project, and also formulate an individualized risk supervision plan accordingly, so as to effectively ensure the data reliability and scientific results. It is suggested that the clinical research management department implement risk based management for the whole process of IIT projects, increase funding and staffing, and implement hierarchical management for the projects by research types, so as to promote the sustainable development of IITs.
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Objective:To build an investigator-initiated clinical research process management indicator system based on the theory of Hazard Analysis and Critical Control Point(HACCP).Methods:A plan was developed according to HACCP principles, and 23 experts were invited to form an expert advisory group. Literature research, panel discussion, and Delphi method were used to collect clinical research process management indicators, and the weight of each indicator was calculated via Analytic Hierarchy Process(AHP).Results:Two rounds of expert consultation were carried out with a high positive coefficient and a high expert authority level, and finally formed 3 primary indicators and 14 secondary indicators. The primary indicators were project establishment, project process management, and project implementation assessment, with weights of 0.142 8, 0.714 4, and 0.142 8, respectively.Conclusions:This study established a clinical research process management system based on HACCP theory from 3 dimensions: project establishment, project process management, and project implementation assessment, carried out precise management of clinical research according to the weights of secondary indicators, focusing on the content of indicators with great weight, and provided an important reference for the management of investigator-initiated clinical research.
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【Objective】 To explore the effect of mobile transfusion closed-loop information system in the whole process management of clinical blood transfusion. 【Methods】 The hospital information system (HIS) of Soochow Hospital affiliated to Nanjing Medical University was integrated with the blood information system (BIS) and personal digital assistant (PDA) to build a closed-loop transfusion management process to ensure the safety of clinical blood use. From May 2021 to April 2022, 1 395 patients who were admitted to our hospital for blood transfusion therapy were studied. Among them, 632 patients from May to October 2021 (before the implementation of closed-loop management) were the control group, and 763 patients from November 2021 to April 2022 (after the implementation of closed-loop management) were the observation group. Before and after the implementation of closed-loop management, we compared the implementation rate of double-checking before blood sample collection, rate of transfusion within 30 min after blood issuing, implementation rate of double-checking of bedside transfusion, situation of patrol every 15 minutes, rate of transfusion completed within 4 h, rate of nursing documentation standardization, so as to evaluate the improvement effect of the whole process of transfusion management. 【Results】 The implementation rate of double-checking before blood sample collection was 99.48%(759/763) in the observation group and 93.99%(594/632) in the control group; the transfusion rate within 30 min after blood issuing was 95.02%(725/763) in the observation group and 91.46%(578/632) in the control group; the implementation rate of double-checking of bedside transfusion was 100%(763/763) in the observation group and 95.73%(605/632) in the control group; the complete rate of patrol every 15-min was 94.36%(720/763) in the observation group and 90.35%(571/632) in the control group; the completion rate of transfusion within 4 h was 95.81%(731/763) in the observation group and 92.25%(583/632) in the control group; the rate of nursing paperwork standardization was 98.03%(748/763) in the observation group and 81.80%(517/632) in the control group, and the difference between the two groups was statistically significant (P<0.05). 【Conclusion】 The mobile transfusion closed-loop information system can realize the whole process management of clinical blood transfusion, effectively improve the standardization of blood transfusion and transfusion documents, and guarantee the safety of clinical blood transfusion.
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Liver transplantation is one of the best approaches for the treatment of hepatocellular carcinoma. The concept of transplant oncology could shed light on the whole process management of hepatocellular carcinoma patients. The success rate of operation and perioperative safety were the major concerns in the past, whereas the focus of treatment is gradually shifting to cancer treatment and improving patient survival and quality of life, with the promotion of neoadjuvant and postoperative adjuvant therapy for hepatocellular carcinoma. The prognosis of different group of patients might be heterogeneous. Therefore, refined stratification should be carried out for heterogeneous patients before and after liver transplantation to achieve the best prognosis. The present study classified patients for three clusters: primary hepatocellular carcinoma patients within the transplant criteria, hepatocellular carcinoma recurrence after liver resection, and patients after down-staging or neoadjuvant therapy. Fine stratified management are essential for the whole process management in the new era of transplant oncology.
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A função de gestor hospitalar é invariavelmente complexa, independentemente da região, de fato que, ainda em certos aspectos, os serviços de saúde são mais desafiadores em alguns países, devido à regulação de leitos, financiamento e tecnologias à disposição. Acrescenta-se à extensa relação de demandas gerenciais, a exigência por conhecimentos específicos na gestão dos recursos humanos e físicos. A influência do modelo fragmentado de organização do trabalho, em que cada profissional realiza parcelas do trabalho sem uma integração com as demais áreas envolvidas, tem sido apontada como uma das razões que dificultam a realização de um trabalho em saúde mais integrador e de melhor qualidade, tanto na perspectiva daqueles que o realizam como para aqueles que dele usufruem. A partir do momento em que profissionais de saúde, que trabalham diretamente com o paciente, ocupam coordenações, na medida em que ascendem na organização, passam a desempenhar mais tarefas administrativas. Como exemplo, é possível perceber que uma enfermeira ou médico que coordenam uma unidade de internamento, realizam mais funções administrativas e quase nenhuma técnica, usando seus conhecimentos técnicos para atuar na chefia. Esses profissionais, ao ocupar determinados cargos, nem sempre entendem das atividades administrativas. Com isso, o hospital perde um bom técnico e pode não ganhar um bom chefe. Este trabalho tem uma descrição reflexiva acerca do processo de gestão hospitalar.(AU)
The role of hospital manager is invariably complex, regardless of the region. In some countries, health services are even more challenging due to the regulation of beds, financing, and technologies available. In addition to the extensive list of managerial demands, there is also the requirement for specific knowledge in the management of human and physical resources. The influence of the fragmented model of work organization, where each professional performs portions of the work without integration with the other involved areas, has been pointed out as one of the reasons hindering the accomplishment of a more integrating and better-quality health work, both from the perspective of those who perform it and of those who use it. From the moment health professionals, who work directly with the patient, occupy managerial positions, as they ascend in the organization, they inevitably start to have more administrative tasks. As an example, it is possible to notice that a nurse or doctor who coordinates an inpatient unit performs more administrative functions and almost no technical ones. They use their technical expertise to act in managerial positions. These professionals, when occupying certain positions, are not always fully trained to understand administrative activities. Thus, the hospital ends up losing a good technician worker and may not always get a good manager in return. This work presents a reflexive description on the hospital management process.(AU)
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Personnel Management , Health Programs and Plans/organization & administration , Administrative Claims, Healthcare , Hospital Administration/trends , Health Personnel/organization & administrationABSTRACT
We retrospectively analyzed the clinical characteristic of one patient with metastatic prostate cancer and the relative literatures were reviewed. A 40-year-old man was admitted and diagnosed as prostate cancer on March 20, 2018(T 4N 1M 1a) with prostate-specific antigen (PSA) at 47.99 ng/ml. The first 68Ga-PSMA PET/CT showed multiple nodular lesions in the bilateral peripheral bands of the prostate, multiple nodular lesions in the right apex, abnormal uptake of nuclides in multiple lymph nodes in the abdominal aortic wandering zone, the abdominal aortic bifurcation zone, and the bilateral iliac artery wandering zone at the level of the lumbar 2-5 vertebral body, and metastasis was considered. The patient was treated with six cycles of drug castration combined with antiandrogenic treatment and pre-operative system chemotherapy(docetaxel). Six months later, the PSA decreased to 0.225ng/ml. Robot-assisted laparoscopic prostatectomy and expanded pelvic lymph node dissection was performed. Postoperative total androgen blocking therapy was maintained, and PSA slowly increased. Ten months after operation, salvage radiotherapy for enlarged lymph nodes was performed in pelvic extension field, prostate tumor bed area and pelvic cavity. PSA remained stable for 7 months postradiotherapy, and then increased. The patient developed castration-resistant prostate cancer and was treated with triptorelin combined with abiraterone. PSA was decreased, and local radiotherapy was performed for new lymph node metastases in the neck. 68Ga-PSMA PET/CT could provide a decision-making basis for accurate clinical staging, therapeutic effect evaluation and distant metastatic lesions location with guiding value for the formulation of individualized treatment plans.
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The development of quality Chinese medicine is an important way to improve the quality of Chinese medicine, and ensure the safety and effectiveness of Chinese medicine. This article systematically elaborates the definition, classification, standard and mana-gement certification strategy of quality Chinese medicine. We present the quality Chinese medicine which is higher quality than that of eligible Chinese medicine based on quality control standards. Quality Chinese medicine is strictly in accordance with management procedures, likely GAP and GMP et al, during the productive process, which quality indicators is higher than that of the current relevant national quality standards, such as Chinese Pharmacopoeia(ChP) et al; its limited indicators such as exogenous pollutants and endogenous toxic substances are lower than that of the current relevant national quality standards, likely ChP et al; meanwhile these Chinese herbal medicine, medicinal pieces, patent medicines, and health products and foods with Chinese medicine raw materials are been certificated by quality Chinese medicine. At the same time, this article systematically expounds the five major management systems of quality Chinese medicine, including technical training management for practitioners, productive process management, standard mana-gement, quality inspection and certification management, and product traceability management. And we put forward strategies to improve the supervision and management system, and promote the standardization and development of quality Chinese medicine by improving the technical management system of quality Chinese medicine, strengthening the quality management system and six sigma(6σ) management in the company. These strategies will provide a reliable basis and effective way to improve the quality of Chinese medicine.