The effectiveness of closed-loop oxygen therapy for adult non-mechanical ventilation patients: a Meta-analysis / 中国实用护理杂志

Objective:To evaluate the effect of closed-loop therapy system in adult non-mechanical ventilation patients in order to provide evidence-based basis for promoting the safety of oxygen therapy.Methods:Randomized controlled trials of closed-oxygen therapy system on the percentage within SpO 2 target, the incidence of hypoxaemia or hyperoxia, oxygen consumption, the mean oxygen therapy days, as well as the length of hospital stay in adult non-mechanical ventilation patients were searched in PubMed, Web of Science, Embase, Cochrane, CNKI, Wanfang, VIP from inception to June 30, 2022. Data extraction, and literature quality evaluation were performed by two researchers independently, RevMan 5.3 was used for meta-analysis. Results:A total of 5 articles including 502 patients were included. The results showed that the closed oxygen therapy system could significantly improve the percentage of time within SpO 2 target of patients ( SMD=1.56, 95% CI 1.22-1.90, Z=9.04, P<0.001) and reduce the percentage of time with hypoxaemia ( SMD=-0.35, 95% CI-0.50--0.19, Z=4.37, P<0.001) or hyperoxia ( SMD=-0.91, 95% CI-1.07--0.75, Z=11.04, P<0.001) of patients. Moreover, the mean oxygen flow rate of closed oxygen therapy ( SMD=-0.64, 95% CI-1.25--0.03, Z=2.07, P<0.05), the mean oxygen therapy days ( SMD=-0.55, 95%, CI-1.06--0.03, Z=2.08, P<0.05), as well as the length of hospital stay ( SMD=-1.68, 95% CI-2.22--1.14, Z=6.11, P<0.001) were lower than those of patients with manual adjustment systems. Conclusion:The closed oxygen therapy system can promote the safety of oxygen use, but it needs clinical application to further explore.

Modulation of motor responses and neural activities with transcranial ultrasound stimulation based on closed-loop control / 生物医学工程学杂志

Closed-loop transcranial ultrasound stimulation technology is based on real-time feedback signals, and has the potential for precise regulation of neural activity. In this paper, firstly the local field potential (LFP) and electromyogram (EMG) signals of mice under different intensities of ultrasound stimulation were recorded, then the mathematical model of ultrasound intensity and mouse LFP peak/EMG mean was established offline based on the data, and the closed-loop control system of LFP peak and EMG mean based on PID neural network control algorithm was simulated and built to realize closed-loop control of LFP peak and EMG mean of mice. In addition, using the generalized minimum variance control algorithm, the closed-loop control of theta oscillation power was realized. There was no significant difference between the LFP peak, EMG mean and theta power under closed-loop ultrasound control and the given value, indicating a significant control effect on the LFP peak, EMG mean and theta power of mice. Transcranial ultrasound stimulation based on closed-loop control algorithms provides a direct tool for precise modulation of electrophysiological signals in mice.

Exploration of centralized closed-loop management mode for gynecological day surgery / 中华医院管理杂志

Day surgery can effectively improve the utilization of medical resources. In October 2015, an obstetrics and gynecology hospital established a gynecological day surgery center to centrally manage gynecological day surgery and continuously optimize the management process. In July 2019, the hospital established an intelligent information platform for gynecological daytime surgery managemen. Based on this platform, the " evaluation-appointment-hospitalization-follow-up-chronic disease management" information management process was implemented, the " pre hospital-in hospital-post hospital" full process medical quality and safety monitoring was carried out to form a centralized closed-loop management mode for gynecological day surgery led by gynecologists. Under this management mode, the number of gynecological day surgeries in the hospital has increased from 2 866 cases in 2019 to 4 065 cases in 2021, providing convenient medical services and personalized chronic disease management services, and ensuring the quality and safety of gynecological day medical care, for reference for promoting the high-quality development of day surgeries in specialized hospitals.

Practical research on fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching / 中华医学教育探索杂志

Objective:To explore the effect of fishbone diagram combined with PDCA(plan, do, check, action) closed-loop management in the teaching of orthopedic interns in operating room.Methods:The 60 interns received by the Department of Orthopedics in our hospital from January 2019 to August 2020 were randomly divided into the conventional group and the observation group in average. The conventional group used traditional methods, and the observation group introduced fishbone diagram combined with PDCA closed-loop management. The theoretical and practical assessment scores and the evaluation of satisfaction with the teaching were compared between the two groups before and after the teaching in the operating room. SPSS 22.0 was used for t-test and Chi-square test. Results:The scores of each theoretical assessment, the total scores of theoretical assessments, and the scores of practical assessments, in the observation group were higher than those of the conventional group ( P<0.05). The satisfaction rates of interest, effectiveness, rationality, and popularization with teaching in the observation group were 100.00%, 100.00%, 96.67%, and 100.00% respectively, which were higher than those (80.00%, 83.33%, 80.00%, and 83.33% respectively) in the conventional group. Conclusion:The application of fishbone diagram combined with PDCA closed-loop management in orthopedic operating room teaching can improve the performance of interns in the assessment, and can also achieve better teaching satisfaction.

Closed-loop management strategies for patients with severe mental disorder complicated with COVID-19 infection / 四川精神卫生

With the fluctuating condition of the COVID-19 epidemic， the current findings remain unclear about the preventive measures and coping strategies for patients with severe mental disorders at the nodes of the transmission chain. Past experience in prevention and control has shown that establishing an effective system for emerging infectious disease prevention and control and establishing transitional wards in specialist mental healthcare institutions play a significant role in reducing the risk of epidemic transmission. However， there is no formulated strategy for the management of patients with severe mental disorders and COVID-19 infection who have recurrent or worsened mental symptoms during the diagnosis and treatment of COVID-19 and are unable to cooperate with the treatment in Fangcang shelter hospitals or infectious wards. Based on the field research in the front line of the epidemic prevention， this paper discusses the management strategies of patients with severe mental disorders and COVID-19 infection in the context of the practical difficulties in managing patients with severe mental disorders and COVID-19 infection， emergency management strategies， protective conditions for front-line psychiatric medical staff and the legal basis for the management of patients with severe mental disorders and COVID-19 infection in emergency situations.

Application of closed-loop blood transfusion information system in the whole process management of blood transfusion / 中国输血杂志

【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.

Design and implementation of single disease data quality management system based on hospital information system / 中华医院管理杂志

Quality management and control of single disease is a means to continuously improve medical quality and safety by building a set of quality control indicators and evaluation systems based on the whole process of disease diagnosis and treatment. In the actual single disease management process, the reporting of each disease involved data from various systems such as electronic medical records, and the data integration was difficult. While the traditional manual reporting method took a lot of time and the data accuracy could not be guaranteed. In the development process of hospital informatization, a hospital has designed a set of intelligent full-closed loop single disease management platform based on the hospital information system, by integrating the existing human and information data resources of the hospital. This platform integrated functions of single disease intranet reporting, in-depth capture of reporting elements, single-disease quality index management, and single-disease real-time intelligent control, in order to promote more refined and intelligent disease management and thus steadily improve medical quality and safety.

Practice of a hemodialysis alliance in the context of closed-loop hospital management / 中华医院管理杂志

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Infusiones controladas por objetivo y sistemas de circuito cerrado. Límites en expansión / Target-controlled infusions and closed-loop systems: expansion limits

Introducción: La administración manual en bolo ha evolucionado desde la infusión volumétrica basada en regímenes farmacológicos estandarizados, hasta los sistemas de infusión controlada por objetivo y los más sofisticados sistemas de circuito cerrado. Objetivo: Describir los principios tecnológicos y aplicaciones clínicas extendidas de la infusión controlada por objetivo y los sistemas de circuito cerrado. Métodos: Se realizó una revisión no sistemática de la literatura, en bases de datos científicas como Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID y el buscador académico Google Scholar, en el mes de septiembre del año 2020. Desarrollo: La disponibilidad y portabilidad de dispositivos electrónicos con capacidad de procesamiento avanzado a precios relativamente accesibles, el perfeccionamiento del aprendizaje automático e inteligencia artificial aplicado a las decisiones médicas, y las iteraciones tecnológicas complejas incorporadas en los sistemas de circuito abierto y cerrado, desarrollados originalmente en el campo de la Anestesiología, han posibilitado su expansión a otras especialidades y entornos clínicos tan disímiles como el tratamiento de la diabetes mellitus, administración de fármacos antineoplásicos, ventilación mecánica, control de las variables hemodinámicas y la terapia antimicrobiana en pacientes críticos. Conclusiones: La infusión controlada por objetivo y los sistemas de circuito cerrado se han convertido en tecnologías maduras, seguras y viables, aplicadas clínicamente en múltiples naciones y escenarios, con un desempeño superior a los sistemas manuales tradicionales(AU)

Introduction: Manual bolus administration has evolved from volumetric infusion based on standardized pharmacological regimens to target-controlled infusion systems and the most sophisticated closed-loop systems. Objective: To describe the technological principles and extended clinical applications of target-controlled infusion and closed-loop systems. Methods: A nonsystematic review of the literature was carried out, during September 2020, in scientific databases such as Cochrane Database of Systematic Reviews, Pubmed/Medline, EMBASE, Scopus, Web of Science, EBSCOhost, Science Direct, OVID and the academic search engine Google Scholar. Development: The availability and portability of electronic devices with advanced processing capacity at relatively affordable prices, the refinement of machine learning and artificial intelligence applied to medical decisions, as well as the complex technological iterations incorporated into open and closed-loop systems, originally developed in the field of anesthesiology, have enabled their expansion to other specialties and clinical settings so diverse as treatment of diabetes mellitus, administration of antineoplastic drugs, mechanical ventilation, control of hemodynamic variables and antimicrobial therapy in critical patients. Conclusions: Target-controlled infusion and closed-loop systems have become mature, safe and viable technologies, applied clinically in multiple nations and settings, with superior performance compared to traditional manual systems(AU)

Application of propofol closed-loop target-controlled infusion for different anesthesia depth combined with nerve block in elderly artificial hip replacement / 中国医师杂志

Objective:To investigate the effect of propofol closed-loop target-controlled infusion system in controlling the bispectral index (BIS) at different levels during artificial hip replacement in the elderly under general anesthesia combined with nerve block on postoperative delirium, postoperative pain and intraoperative circulation control.Methods:From October 2017 to May 2019, 95 elderly patients with elective unilateral artificial hip replacement were selected from Xiangya Hospital of Central South University. They were randomly divided into light anesthesia group (48 cases) and deep anesthesia group (47 cases). Under general anesthesia combined with nerve block, the target BIS value of propofol closed-loop target-controlled infusion in the light anesthesia group was set to 55±5, and the target BIS value of the deep anesthesia group was 45±5. The incidence of postoperative delirium and postoperative pain visual analogue scale (VAS) score were observed. The changes of hemodynamics, intraoperative vasoactive drug use, propofol dosage and intraoperative BIS value at different time points were compared between the two groups.Results:There was no significant difference in the incidence of postoperative delirium and the VAS score of postoperative pain between the two groups ( P>0.05). The average intraoperative BIS and the ratio of intraoperative BIS>50 in the light anesthesia group were higher than those in the deep anesthesia group ( P<0.001), and the intraoperative propofol consumption was lower than the deep anesthesia group ( P<0.001); In the light anesthesia group, the arterial systolic blood pressure level after laryngeal mask implantation and skin incision during the induction period of general anesthesia was higher than that in the deep anesthesia group ( P<0.05), and the number of cases of phenylephrine use in the light anesthesia group was lower than that of the deep anesthesia group ( P<0.05). Conclusions:When using general anesthesia combined with nerve block for the elderly artificial hip replacement, the different control levels of BIS in the closed-loop target-controlled infusion of propofol have no effect on postoperative pain and postoperative delirium, but the intraoperative BIS value controlled at a lower level is related to the suppression of the patient′s hemodynamics and brings more propofol consumption.

Effect of perioperative whole-course closed-loop temperature management system in the prevention of hypothermia in elderly patients with femoral neck fracture / 中华创伤杂志

Objective:To explore the effect of perioperative whole-course closed-loop temperature management system for prevention of hypothermia in elderly patients with femoral neck fracture.Methods:A retrospective case-control study was conducted to analyze the clinical data of 120 elderly patients with femoral neck fracture admitted to Chengdu First People's Hospital from January 2020 to December 2020. There were 48 males and 72 females, aged 60-79 years［（68.3±5.0）years］. All patients underwent total hip arthroplasty. Heat warming with the whole-course closed-loop temperature management system was applied in 40 patients（closed-loop group）, with the medical heating mattress in 40 patients（heat preservation group）, and with the quilt in 40 patients（control group）. The core body temperature of the three groups was recorded 8 minutes after wearing the temperature sensor（T0）, immediately after induction of anesthesia（T1）, 30 minutes after induction of anesthesia（T2）, 60 minutes after induction of anesthesia（T3）, at the end of surgery（T4）, and 20 minutes after entering the postanesthesia care unit（PACU）（T5）. The thrombin time（TT）, prothrombin time（PT）and activated partial thromboplastin time（APTT）were compared among groups before operation and at T4. The incidence of intraoperative hypothermia, incidence of shivering during PACU, incidence of surgical site infection, extubation time（from the day of drug withdrawal to the time of tracheal tube removal）, length of hospital stay（from the day of operation to the time of discharge）and adverse reactions related to the devices were compared among groups.Results:There was no statistically significant difference in core body temperature among three groups at T0（ P>0.05）. The core body temperature in closed-loop group［（36.61±0.28）℃］was higher than that in heat preservation group［（36.45±0.28）℃］and control group［（36.44±0.27）℃］at T1（ P<0.05）, but no statistically significant difference was found in core body temperature between heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group［（36.46±0.28）℃,（36.40±0.30）℃,（36.45±0.37）℃,（36.50±0.27）℃］was higher than that in heat preservation group［（36.32±0.31）℃,（36.24±0.26）℃,（36.28±0.30）℃,（36.24±0.31）℃］and control group［（36.12±0.30）℃,（35.98±0.28）℃,（35.73±0.31）℃,（35.81±0.32）℃］at T2-T5（ P<0.05）, and a higher temperature was found in heat preservation group than control group（ P<0.05）. The core body temperature in closed-loop group was increased at T1 compared to that at T0（ P<0.05）, while there was no statistical difference at T0 and T1 in heat preservation group and control group（ P>0.05）. The core body temperature in closed-loop group showed no significant difference at T2-T5 and T0（ P>0.05）, while the core temperature in heat preservation group and control group was decreased at T2-T5 compared to that at T0（ P<0.05）. The core body temperature in closed-loop group was within the set target temperature range. There was no statistically significant difference in TT, PT and APTT among the three groups before operation（ P>0.05）. At T4, the levels of TT, PT and APTT in closed-loop group［（18.9±1.7）seconds,（11.9±0.7）seconds,（35.5±3.3）seconds］and heat preservation group［（18.8±1.7）seconds,（11.6±0.8）seconds,（32.8±2.7）seconds］were shorter than those in control group［（20.9±1.3）seconds,（13.0±0.8）seconds,（35.7±3.4）seconds］（ P<0.05）. At T4, the levels of APTT in closed-loop group and heat preservation group were longer than those before operation（ P<0.05）. At T4, the levels of TT, PT and APTT in control group were longer than those before operation（ P<0.05）. There was no significant difference in the incidence of intraoperative hypothermia or shivering during PACU between closed-loop group［18%（7/40）, 3%（1/40）］and heat preservation group［33%（13/40）, 8%（3/40）］（ P>0.05）, which were lower than those in control group［75%（30/40）, 33%（13/40）］（ P<0.05）. There was no significant difference in the extubation time between closed-loop group［（12.5±3.6）minutes］and heat preservation group［（13.2±3.9）minutes］（ P>0.05）, which was shorter than that in control group［（16.6±4.0）minutes］（ P<0.05）. The incidence of surgical site infection and length of hospital stay were statistically insignificant among the three groups（ P>0.05）. No adverse reactions such as allergic reaction or pressure ulcers occurred in the three groups. Conclusion:For the elderly patients with femoral neck fracture, the perioperative whole-course closed-loop temperature management system can effectively maintain the core body temperature, improve coagulation function, prevent hypothermia, reduce shivering and shorten the extubation time, without increasing the risk of other adverse events, so the system can be safely used in clinical practice.

Application of intelligent closed-loop mobile nursing management system in quality management of blood transfusion / 中国输血杂志

【Objective】 To explore the effect of intelligent closed-loop mobile nursing management system in quality management of blood transfusion. 【Methods】 The mobile nursing system and the cold chain management system of our hospital were integrated to realize intelligent closed-loop management of blood transfusion. After consulting medical records, 789 blood recipients, admitted to the Department of Hematology of our hospital from January to December 2017 (before the implementation of closed-loop management), were selected as the control group, and 836 blood recipients, admitted during January to December 2018 (after the implementation of closed-loop management), were selected as the observation group. A self-designed blood transfusion standard management checklist was adopted, with the number of standard execution items as the numerator and the total number of checked items as the denominator to obtain the standard implementation rate. The checking rate of blood sample collection, blood transfusion rate within 30 min after blood issuing, the execution rate of double check specification and inspection specification, the completion rate of RBCs transfusion within 4 h and qualified rate of blood transfusion nursing record before and after the implementation of closed-loop management were compared by chi-square test or Fisher's exact probability method to evaluate the efficacy of blood quality management improvement. A total of 8 head nurses from clinical departments (Hematology Department, Cardiac Surgery Department, Operating Room, Comprehensive ICU) involved in blood transfusion were selected for semi-structured interviews. The interviews focused on the effect of intelligent closed-loop mobile nursing information system in quality management of clinical blood use, and the results of the interviews were analyzed. 【Results】 The double check execution rate of blood transfusion, the checking rate of blood sample collection specification, the transfusion rate within 30 min after blood issuing, the execution rate of blood transfusion inspection, the completion rate of RBCs transfusion within 4 h, the qualified rate of blood transfusion nursing record in the observation group and the control group after and before the implication of the intelligent closed-loop mobile nursing management system were 100%(836/836) vs 97.72%(771/789), 99.04%(828/836) vs 97.34%(768/789), 97.97%(819/836) vs 95.06%(750/789), 99.28%(830/836) vs 94.93%(712/789), 99.16%(829/836) vs 97.47%(769/789) and 100%(836/836) vs 89.73%(708/789), respectively, showing significant improvement (P < 0.05). The time spend on the record, summary and feedback of quality control results was significantly shortened. 【Conclusion】 The application of intelligent closed-loop mobile nursing management system in the quality management of clinical blood use can effectively improve the efficiency of blood transfusion, nursing quality and the safety of clinical blood use.

Desarrollo y Simulación de un Algoritmo de Control Automatizado para Insulinoterapia de Urgencias Hiperglucémicas en Diabetes / Development and Simulation of an Automated Control Algorithm for Insulin Therapy of Hyperglycemic Emergencies in Diabetes

Resumen El presente trabajo describe el desarrollo y simulación de un algoritmo para el control automático de la infusión de insulina en el manejo glucémico de pacientes con cetoacidosis diabética (CAD) y estado hiperosmolar hiperglucémico (EHH). Se programó un algoritmo que calcula la insulina necesaria para lograr un descenso glucémico de 50 mg/dL/h hasta llegar a glucemias de 250 mg/dL, para posteriormente mantenerlas en 220 mg/dL hasta la remisión de la patología. La simulación del software se realizó haciendo uso de registros glucémicos de 10 pacientes con CAD manejados en el Hospital Juárez de México. Los resultados de la simulación mostraron una incidencia 6 veces menor de hipoglucemias, así como un 33.7% menos de insulina necesaria dentro del tratamiento, sin diferencias entre los descensos medios de glucosa por hora de las mediciones reales y simuladas. Este software propone un uso innovador de los llamados páncreas artificiales al aplicarlos en urgencias hiperglucémicas, implementando además el uso de la sensibilidad a la insulina como variable para el funcionamiento de los mismos. Los resultados demuestran que el algoritmo podría ser capaz de lograr un manejo glucémico apegado a las guías de tratamiento, generando un menor gasto de insulina y evitando hipoglucemias durante la terapéutica, con una posible aplicación en dispositivos biomédicos autónomos.

Abstract This paper describes the development and simulation of an algorithm for the automatic control of insulin infusion, in the glycemic management of patients with diabetic ketoacidosis (CAD) and hyperglycemic hyperosmolar state (EHH). An algorithm was programmed to calculate the requirement insulin for a glycemic decrease of 50 mg/dL/h until reach 250 mg/dL in blood glucose levels, and thus maintaining it at 220 mg/dL until the pathology remission. The software simulation was performed using glycemic records of 10 patients with CAD managed in the Hospital Juárez de México. The results of the simulation showed a lower incidence of hypoglycemia, as well as a lower insulin requirement within the treatment, without differences in the average glucose decreases per hour between real and simulated measurements. This software proposes an innovative use of the artificial pancreas in hyperglycemic emergencies, and also implementing the use of insulin sensitivity as a variable for their function. The results show that the algorithm could be able to achieve glycemic management attached to the treatment guidelines, generating lower insulin expenditure and avoiding hypoglycemia during therapy, with a possible application in autonomous biomedical devices.

Closed loop small bowel obstruction due to mid urethral sling mesh

Closed loop small bowel obstruction is a surgical emergency, which when left untreated leads to vascular compromise resulting in intestinal ischemia, necrosis and perforation. We report the case of a 61 years old female with past surgical history of hysterectomy and a mid-urethral sling, who presented to the emergency department for abdominal pain and obstipation. She was found on imaging to have a closed loop small bowel obstruction. An exploratory laparotomy revealed an adhesive band encompassing the distal terminal ileum, visceral peritoneum and the Mid‐urethral slings mesh. This is a rare complication that, to our knowledge, has not been reported in the surgical literature. This paper will discuss the clinical presentation, diagnostic studies, therapeutic intervention and outcome of this unique case.

Exploration and Practice of Closed-loop Management of Drug Valid Date in the Intelligent Outpatient Pharmacy / 中国药房

OBJECTIVE：To explore the closed-loop management mode of drug valid date in the intelligent outpatient pharmacy，and to provide reference to improve the management level of drug valid date and ensure the safety of drug use in patients. METHODS ：The model and practice of closed-loop management of drug valid date in the intelligent outpatient pharmacy were summzired from the aspects of dispensing system ， logistics system ， temperature and humidity monitoring system ， management of drugs to be about to expired ，internal quality control and performance evaluation. The patients ’satisfaction degree of the indicators were compared between the new and old hospital districts. RESULTS ：The intelligent drug dispensing system ， logistics and information flow system ，temperature and humidity monitoring system were established in the new district of our hospital，and management system of drugs to be about to expire ，internal quality control and performance evaluation system were established. The workflow of drug validity management was optimized ，the pharmacy working environment was improved ，and the pharmaceutical service quality and pharmacy management level were improved. The results of satisfaction survey of outpatients in new and old distrcts showed that the indicators of patients ’satisfaction（service attitude ，work quality ，drug consultation ，waiting time）in new distrct were improved to different extents ，compared with old district. The satisfaction of special storage tips and waiting time in new district were all significantly higher than old district ，with statistical significance （P＜0.05）. CONCLUSIONS ： The design and management concept of intelligent outpatient pharmacy in our hospital has been significantly improved ，the drug valid date management is more scientific and reasonable than before ，and the patient satisfaction is improved.

Research status of dynamic three-dimensional tissue culture driving methods / 中国组织工程研究

BACKGROUND: In vitro models are widely used in toxicology, pathology, and pharmaceutical research due to their short experimental cycles, low cost, and small species differences compared with animal models. Dynamic three-dimensional tissue culture mode is an important trend in the development of in vitro models. Dynamic three-dimensional culture in vitro models can be achieved by means of driving fluids in microfluidic systems. OBJECTIVE: To describe the microfluidic driving methods in the field of microfluidics, their respective advantages and disadvantages, and the application of different driving methods to different tissue culture requirements. METHODS: A computed-based retrieval of CNKI and Web of Science databases was performed for the articles concerning dynamic three-dimensional tissue culture and microfluidic driving methods to achieve dynamic culture of cells or tissues. The search terms were “microfluidic; micropump; organ-on-chip; three-dimensional tissue culture” in English and Chinese, respectively. RESULTS AND CONCLUSION: The microfluidic driving methods include passive driving and active driving. Whereas passive driving includes surface tension pump, osmotic pump and gravity pump. Active driving includes syringe pump and peristaltic pump. Each driving method has its advantages and disadvantages. To achieve accurate control of the medium flow rate in a dynamic three-dimensional tissue culture system, the best choice is to use syringe pumps or valve-type peristaltic pumps. To achieve closed-loop flow of culture medium in a dynamic three-dimensional tissue culture system, the best choice is to use gravity pumps or peristaltic pumps. To fulfill the need for a sterile environment in the experimental process in a dynamic three-dimensional tissue culture system, the best choices are surface tension pumps, gravity pumps, and pneumatic peristaltic pumps. To achieve high-throughput culture in dynamic three-dimensional tissue culture systems, the best choices are surface tension pumps, gravity pumps and pneumatic peristaltic pumps.

Comparison of anesthesia effects between closed / 中南大学学报(医学版)

OBJECTIVES@#Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery.@*METHODS@#From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group (@*RESULTS@#In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both @*CONCLUSIONS@#Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.

Discussion on primary closed-loop management mode of chronic diseases in Ningxia / 中华医院管理杂志

The pre-during-post hospital closed-loop management of chronic diseases is an efficient way to upgrade the current chronic disease management level. The authors described the feasibility, what to build and imperative problems in implementing such a closed-loop management in primary level in Ningxia. The introduction focused on the construction of a chronic disease management path for multiple diseases, the implementation of a closed-loop management model for chronic diseases based on the " three in one model(specialist-family physician-health manager)" , the promotion of primary physician training and standardization management level, as well as the establishment of a community-centered three-level prevention and treatment system for chronic diseases. These efforts aim at promotion of chronic disease management outcomes, elevation of patients′ health and quality of life, and minimization of people′s economic burden.

Whole process closed-loop traceability management for high-value consumables using international standard bar code / 中华医院管理杂志

Scientific management of high-value medical consumables is key to hospital development and service. By setting up a lean logistics management(SPD)platform in the hospital and decoding the international standard bar code(GS1/HIBC), the hospital has established a general coding library of high-value consumables. With RFID Internet of things technology and equipment introduced and business operation templates of each link combined, we have achieved a closed-loop management of both sides of the high-value consumables process.

Reform and effects on administrative ward rounds at hospitals / 中华医院管理杂志

The study is to establish the administrative ward round system and its effect evaluation system under the modern hospital management conditions, and explore the formation of a standardized, scientific and replicable standard mode of Administrative Ward round. According to the annual ward rounds plan, clinical departments and administrative departments were organized to decide the major issues of a department according to the procedures of " hearing-evaluation-discussion-decision " , and to ensure the implementation of management. Since 2016, administrative ward round has been carried out in 9 departments, and the medical quality and operational efficiency have been improved significantly. The closed-loop administrative ward rounds mode can effectively promote the modernization of hospital management system through the joint decision-making of clinical departments and functional departments.