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Purpose/Significance To improve the classification and evaluation mode of medical safety incidents,and to improve work efficiency and timeliness.Method/Process The data of previous medical safety incidents are pre-processed,BERT model is used for training,testing and iterative optimization,and an intelligent classification and prediction model for medical safety incidents is built.Re-sult/Conclusion The model is used to classify 466 medical safety incidents reported by clinical departments from January to November 2022,and F1 value reaches 0.66.The application of BERT model in the classification and evaluation of medical safety incidents can im-prove work efficiency and timeliness,and help timely intervene in medical safety risks.
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This article aims to comprehensively review the concept, etiology, classification, classical cortical mapping, assessment, a proposed flowchart for the diagnosis and differential diagnosis, treatment, rehabilitation, mechanisms of development and recovery, prognosis, and influencing factors for post-stroke aphasia(PSA)types in the Chinese language.We emphasize the necessity and significance of neuroimaging assessment of the brain and blood vessels and neuropsychological assessment in the diagnosis and differential diagnosis of PSA in Chinese.We also recommend and encourage the use of the dichotomies of internal vs.external and anterior vs.posterior as a starting point, based on the association of anatomical locations of the brain and blood vessels with brain language areas and language disorders.A classification system of PSA in Chinese developed from this approach in the form of a flowchart is well-suited for guiding the clinical treatment of cerebral stroke.Incorporating the "four elements" , the flowchart enables convenient diagnosis, classification and differential diagnosis of PSA in Chinese and facilitates targeted and personalized rehabilitation planning to benefit the patient.This article introduces the use of memantine, piracetam, donepezil and other drugs for PSA treatment, evaluates clinical trials on memantine conducted in China and abroad and its mechanisms of action for the treatment of PSA, and discusses how rehabilitation therapy achieves therapeutic effects.For the treatment of PSA, clinical research and practice using drugs such as memantine, piracetam and donepezil in combination with non-pharmacotherapy and rehabilitation training should be promoted.
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Systemic immunoglobulin light chain amyloidosis is a protein-misfolding disease caused by the highly organized amyloid fibrillar aggregates that lead to irreversible organ dysfunction. This review summarizes systemic therapies for this disease according to the disease risk stratification. Patients with low-risk systemic immunoglobulin light chain amyloidosis are eligible for chemotherapy combined with autologous hematopoietic stem cell transplantation. Patients with high-risk systemic immunoglobulin light chain amyloidosis can be treated with protease inhibitors (such as bortezomib, carfilzomib and ixazomib) , immunomodulatory agents (such as lenalidomide, pomalidomide) and new immunological agents (such as daratumumab and NEOD001) .
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In recent years, Internet plus medical care has developed rapidly, and many aspects including quality control need to be further standardized. The authors summarized the current situation of quality control in Internet plus medical care, analyzed the difficulties of quality control in Internet plus medical care, and constructed the quality control system and evaluation focus of the Internet plus medical care system from the following aspects: management system framework, personnel management, quality control in the process, post evaluation and continuous improvement.
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The medical management department of individual hospitals varies with their organizational structure and operational mechanism, instead of following a general pattern. Inspired by the"super-ministry" system of government,the hospital has integrated successively the Medical Affairs Office, Patient Safety Office,Medical Quality Control Office,Hospital-acquired Infection Control Office and Medical insurance office. Through integration and innovation of duties, regulations, culture, decision-making progress,coordination and talent training mechanism, the " Five-in-One" super-ministry model of medical management came into being,achieving collaborative and efficient medical management as a result.
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Objective To discuss the application effect of improved intervention of skin care at PICC site for very low birth weight infants.Methods By convenience sampling method,70 cases admitted from July 2015 to June 2016 were selected as the control group,other 70 cases admitted from July 2016 to June 2017 were selected as the experimental group.The control group was applied with conventional nursing,while the experimental group was applied with improved intervention.Skin damage around PICC insertion site was observed and compared between two groups.Results The incidence rate of PICC site with skin injury in the experimental group was significantly lower than that in the control group(P<0.05).Conclusion The improved intervention for the very low birth weight infants with PICC can significantly reduce the incidence rate of PICC site with skin injury,and guarantee the safety of infants.
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The construction of DRGs management information system proves conducive to hospital medical quality management .In order to better understand the status of the hospital′s DRGs, further improve the quality of medical care , and embrace the DRGs reform in medical insurance , the hospital built the DRGs management information system in 2015 , and integrated it with the electronic medical record management system, and the medical record management system .The system consists of such modules as inpatient medical service evaluation , disease surveillance , case analysis , and real-time dynamic monitoring , applied to homepage evaluation and performance management at both hospital and department levels .Such a system can provide practical data for decision support of clinicians , and enable decision makers , thus improving fine management of medical care in the full course .
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<p><b>BACKGROUND</b>Patients with Alzheimer's disease (AD) manifest progressive decline in writing abilities. Most studies on agraphia in AD have been performed in the alphabetic system, such as English. However, these findings may not be applicable to other written language systems. The unique features of the Chinese written script could affect the patterns of agraphia in Chinese AD patients. The aim of this study was to explore the features of writing errors in Chinese patients with AD and amnestic mild cognitive impairment (a-MCI), as well as to study the relationship between their writing errors and neuropsychological functions.</p><p><b>METHODS</b>In this study, we performed an observational study in a group of subjects including 17 AD patients, 14 patients with a-MCI, and 16 elderly healthy controls. We analyzed the writing errors in these subjects and also studied the relationship between their writing errors and neuropsychological functions.</p><p><b>RESULTS</b>Our study showed that in patients whose mother tongue is Chinese, writing ability was comparatively well preserved in the MCI phase but significantly impaired when the disease progressed to the stage of AD. The writing errors showed corresponding increase with the severity of cognition decline, both in the types of errors and rate of occurrence. Analysis of the writing errors showed that word substitution and unintelligible words were the most frequent error types that occurred in all the three study groups. The occurrence rate of unintelligible words was significantly higher in the AD group compared with the a-MCI group (P = 0.024) and control group (P = 0.018). In addition, the occurrence rates of word substitution were also significantly higher in AD (P = 0.013) and a-MCI groups (P = 0.037) than that of control group. However, errors such as totally no response, visuospatial impairment, paragraph agraphia, ideograph, and perseverative writing errors were only seen in AD group. Besides, we also found a high occurrence rate of visuoconstructional errors (13.3%) in our AD group.</p><p><b>CONCLUSIONS</b>Our study confirmed that agraphia is an important feature in patients with AD. The writing error profile in patients whose native language is Chinese was unique compared to patients using the alphabetic language system.</p>
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Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Agrafia , Diagnóstico , Enfermedad de Alzheimer , Pueblo Asiatico , Trastornos del Conocimiento , Diagnóstico , Disfunción Cognitiva , Diagnóstico , Pruebas NeuropsicológicasRESUMEN
<p><b>BACKGROUND</b>The clinical behavior and management of poorly differentiated thyroid carcinoma (PDTC) are very different from papillary thyroid carcinoma (PTC). By comparing the clinical and ultrasonographic features between the two tumors, we proposed to provide more possibilities for recognizing PDTC before treatment.</p><p><b>METHODS</b>The data of 13 PDTCs and 39 age- and gender-matched PTCs in Peking Union Medical College Hospital between December 2003 and September 2013 were retrospectively reviewed. The clinical and ultrasonic features between the two groups were compared.</p><p><b>RESULTS</b>The frequencies of family history of carcinoma, complication with other thyroid lesions, lymph node metastases, recurrent laryngeal nerve injuries, and distant metastases were higher in PDTCs (30.8%, 61.6%, 69.2%, 23.1%, and 46.2%, respectively) than those in PTCs (2.6%, 23.1%, 25.6%, 2.6%, and 2.6%, respectively) (P < 0.05). The mortality rate of PDTCs was greatly higher than PTCs (P < 0.01). Conventional ultrasound showed that the size of PDTCs was larger than that of PTCs (3.1 ± 1.9 cm vs. 1.7 ± 1.0 cm). Clear margins and rich and/or irregular blood flow were found in 92.3% of PDTCs, which differed substantially from PTCs (51.7% and 53.8%, respectively) (P < 0.05).</p><p><b>CONCLUSIONS</b>PDTC is more aggressive and its mortality rate is higher than PTCs. Accordingly, more attention should be given to suspicious thyroid cancer nodules that show large size, regular shape, and rich blood flow signals on ultrasound to exclude the possibility of PDTCs.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma , Diagnóstico , Patología , Carcinoma Papilar , Estudios Retrospectivos , Neoplasias de la Tiroides , Diagnóstico , Patología , UltrasonografíaRESUMEN
<p><b>BACKGROUND</b>Obstructive sleep apnea hypopnea syndrome (OSAHS) is the most common sleep-disordered breathing and is still underdiagnosed. This study was designed to evaluate the value of the STOP-Bang questionnaire (SBQ) in screening OSAHS in sleep-disordered breathing clinics in order to extend it into the general Chinese population.</p><p><b>METHODS</b>Two hundred and twelve patients undergoing overnight polysomnography (PSG) in the sleep-disordered breathing clinic of Pecking Union Medical College Hospital between May 2011 and January 2012 were prospectively included and were asked to fill in the SBQ. A score of 3 or more of the SBQ indicated a high risk of OSAHS. We analyzed the sensitivities and specificities of SBQ in screening OSAHS. Logistic regression analysis was used to evaluate the probabilities of the severity of OSAHS based upon the apnea hypopnea index (AHI).</p><p><b>RESULTS</b>The patients at high risk of OSAHS had higher AHI, higher oxygen desaturation index (ODI), lower pulse oxygen saturation (LSpO2) during sleep time and less sleep time in stage N3. SBQ scores were positively correlated with AHI, ODI and the ratio of SpO2 lower than 90%, and negatively correlated with LSpO2 during sleep. The sensitivities of the SBQ with AHI ≥ 5/h, AHI ≥ 15/h, AHI ≥ 30/h as cut-offs were 94.9%, 96.5%, and 97.7%, respectively, and the specificities were 50.0%, 28.6%, and 17.9%, respectively. The Logistic regression analysis showed the probability of severe OSAHS increased and the probability of normal subjects decreased with increasing SBQ score.</p><p><b>CONCLUSIONS</b>The STOP-Bang questionnaire has excellent sensitivity in screening OSAHS patients and can predict the severity of OSAHS. More studies will be required to determine the value of SBQ in the general Chinese population.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Logísticos , Polisomnografía , Apnea Obstructiva del Sueño , Encuestas y CuestionariosRESUMEN
<p><b>BACKGROUND</b>Obstructive sleep apnea hypopnea syndrome (OSAHS) is underdiagnosed. Screening patients at high risk of OSAHS is extremely important. Using the standard questionnaire to screen OSAHS is a practical method. This study aimed to evaluate the value of the STOP-Bang questionnaire (SBQ) in screening OSAHS in sleep-disordered breathing clinic by comparing it with the Epworth sleepiness scales (ESS), Berlin questionnaire, and STOP questionnaire.</p><p><b>METHODS</b>In this study, 212 patients at the sleep-disordered breathing clinic of the Peking Union Medical College Hospital between May 2011 and January 2012 were prospectively included. They were asked to fill in the SBQ, ESS, Berlin questionnaire, and STOP questionnaire before overnight polysomnography (PSG). Using PSG as gold standard, the sensitivities and specificities of SBQ were compared with those of ESS, Berlin questionnaire, and STOP questionnaire.</p><p><b>RESULTS</b>There was no significance in applying ESS score ≥11 to screen OSAHS and detect moderate and severe OSAHS (P > 0.05). SBQ was superior to Berlin questionnaire and STOP questionnaire in screening OSAHS and detecting the severity of OSAHS patients. The sensitivities of SBQ score ≥3 with apnea hypopnea index (AHI) ≥5/h, AHI ≥15/h, and AHI ≥30/h as gold standards were 94.9%, 96.5%, and 97.7%, respectively. The specificities were 50.0%, 28.6%, and 17.9%, respectively. The area upper curves were 0.815 (0.706-0.925, P < 0.01), 0.746 (0.665-0.828, P < 0.01), and 0.751 (0.686-0.817, P < 0.01), respectively. According to SBQ, the population was classified into high-risk group and low-risk group. The gender, BMI, neck circumference, AHI, LSpO2, and number of subjects of AHI ≥5/h, AHI ≥15/h, and AHI ≥30/h of these two groups were significantly different.</p><p><b>CONCLUSIONS</b>The SBQ has superior predictive value compared with ESS, Berlin questionnaire, and STOP questionnaire. It should be used further in screening for OSAHS in the general population.</p>
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Estudios Prospectivos , Apnea Obstructiva del Sueño , Diagnóstico , Encuestas y CuestionariosRESUMEN
<p><b>BACKGROUND</b>Currently, slightly more than 50% of bloodstream infections (BSIs) are hospital acquired. When these infections occur in patients in intensive care units, they are associated with a high mortality rate, additional hospital days and excess hospital costs. Because of multifactor of nosocomial BSIs, measurements of control nosocomial BSIs are wide variety and lead to some confusion in practice. The aim of this study was to explore special way in accordance with self-hospital base on common principle.</p><p><b>METHODS</b>In one ward of the Intensive Care Unit, Peking Union Medical College Hospital, at first, we divided the all operation about bloodstream way into three sections used as keypoints. By surveying keypoints respectively, some operation faults of blood way were discovered. For decreasing the mobidity of nosocomial BSIs, some intervention measurements were executed. The rate of nosocomial BSIs was analyzed by chi-square test.</p><p><b>RESULTS</b>According to the statistics from January to June, we received and cured 618 patients in total; among them, there were 13 cases of nosocomial BSI and the average occurrence was 2.3 cases/month. After intervention measurements from July to December 2011, we received and cured 639 patients in total with seven cases of nosocomial BSI, and the average occurrence was 1.2 cases/month (P < 0.05). From January to April 2012, no nosocomial BSI occurred in the investigated ward.</p><p><b>CONCLUSION</b>Removing the operation faults of bloodstream way might decrease the nosocomial BSI rapidly and efficiently by utilizing a key point survey.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Bacteriemia , Terapéutica , Infección Hospitalaria , TerapéuticaRESUMEN
Objective To investigate the safety and efficacy of intravenous thrombolytic therapy with recombinant tissue plasminogen activator(rtPA)in patients with isolated penetrating artery territory infarct (IPAI).Methods Data of retrospectively collected clinical,laboratory,and radiological from 75 consecutive patients with acute ischemic stroke treated with intravenous rtPA therapy from June 2009 to April 2011.Etiological classification was carried out according to the Chinese Ischemic Stroke Classification of Subgroups(CISS).The rates of hemorrhagic transformation(HT)and clinical outcomes of patients were compared between IPAI group and non-IPAI group.Results All 75 patients with mean age of 67.4years and 25(33.3%)fenale,were treated with intravenous rtPA.Before treatment,their average score of the National Institutes of Health Stroke Scale(NIHSS)was 12.3 ± 6.4,and mean length of time from onset to treatment was 239.6 ±97.5 minutes.After thrombolytic therapy,the radiological HT was found in 24 patients(32%).Symptomatic intracraneal hemorrhage(ICH)occurred in 4 patients(5.3%).Of 22 (29.3%)patients with IPAI,only one experienced HT.Logistic regression analysis suggested that IPAI wasan individualized predictor used alone for determining the low risk of HT.In the patients with IPAI,82% of them had an individual clinical outcome(mRS < 2)one month after onset,and the neurological outcomes were better in patients with IPAI than those in patients with non-IPAI(P < 0.01).Conclusions The risk of hemorrhagic complication was low and the clinical outcome was good in patients with isolated penetrating artery territory infarct after intravenous thrombolytic therapy with rtPA.Imaging diagnosis of IPAI might facilitate the treatment with rtPA in this cohort of patients.
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Objective To measure the expression of activin receptor-like kinases 1(ALK1)in dermal fibroblasts from patients with systemic scleroderma(SSc)and to estimate its role in the production of fibronectin and plasminogen activator inhibitor-1(PAI-1).Methods Dermal fibroblasts were isolated from the lesions of 12 patients with SSc as well as the normal skin of 14 healthy controls,and subjected to a primary culture.The third-passage fibroblasts were used in the next experiment.Western blot and indirect immunofluorescence technique were utilized to quantify the expression of ALK1.A specific siRNA targeting ALK1 was designed,constructed,and transiently transfected into the control dermal fibroblasts,which were then classified into 2 groups to be cultured with or without the presence of transforming growth factor(TGF)-β1 for 72 hours followed by the detection of fibronectin and PAI-1 expression with Western blot.Results As Western blot and direct immunofluorescence technique showed,both control and SSc fibroblasts showed an expression of ALK1 in the cytoplasm and membrane,and the expression intensity of ALK1 in SSc fibroblasts was significantly higher than that in the control fibroblasts(1.97 ± 0.05 vs.1.12 ± 0.03,t =50.96,P < 0.05).The expression of ALK1,fibronectin and PAI-1 was decreased by 90%,58% and 31% respectively in specific siRNA-transfected SSc fibroblasts compared with the control siRNA-transfected fibroblasts.TGFβ1 significantly increased the expression of ALK1,fibronectin and PAI-1 in the control siRNA-transfected fibroblasts,but the increase was markedly inhibited by the siRNA-targeting ALK1.Conlusion TGFβ1 can promote the production of fibronectin and PAI-1 via ALK1 in fibroblasts,and ALK1 may be involved in the development of sclerosis in SSc.
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Objective To evaluate the clinical efficacy and safety of piperacillin and sulbactam sodium combinations in the treatment of common infections. Methods This was a multi-centre, prospective and open study. All subjects from 57 wards caught common infection like respiratory ( RTI) or urinary diseases ( UTI). The dosages of piperacillin and sulbactam sodium combinations 2. 5 g injection were determined according to indications:for adult, 2. 5 g or 5 g per time, 2 time/day; for severe or obstinate infection, 2.5 g or 5 g per time, 3 time/day. General information, clinical response pre- and posttreatment, infected locus, drug recipe and protocol, prognosis and adverse reaction were recorded. Results Data of 579 cases were collected with 388 males and 191 females. The average age was (66. 8 ± 17. 0) years. There were 500 patients who were suffering with RTI, with 362 cases of pneumonia, 102 of acute exacerbation of chronic bronchitis, and 36 of other infections. There were 50 cases with UTI, with 31 of simple urinary tract infection, and 19 of complex urinary tract infection. In addition, there were 9 cases of combined RTI and UTI, and 20 of other infections including peritonitis. The average duration of antimicrobial for RTI and UTI was (8. 65 ± 3. 78 ) days and (7. 45 ± 3. 46) days respectively with the total efficacy rate was 92. 6% and 98. 0% respectively for RTI and UTI. The incidence of adverse events was only 0.86% (5 cases), including nausea, rash, itching, ALT elevation and suspected drug induced fever in each one. Conclusion Piperacillin and sulbactam sodium compound had high clinical efficacy and safety in the treatment of common infections including RTI and UTI.
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Condiloma Acuminado/patología , Enfermedades de la Laringe/patología , Adulto , Femenino , HumanosRESUMEN
Psoriatic arthritis is an inflammatory joint disease associated with psoriasis. Due to difficulty for early diagnosis and lack of effective therapy, the disease leads to chronic course and frequent relapse. Patients may suffer from ankylosis,disability and even death. The past treatments neither can control the disease effectively, nor be capable of inhibiting the development of structural joint damage. Based on the current psoriasis pathogenesis, novel biologics have been developed,which can aim the specific targets, resulting in more effective and safer management for psoriatic arthritis.
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Humanos , Adalimumab , Antiinflamatorios no Esteroideos , Usos Terapéuticos , Anticuerpos Monoclonales , Usos Terapéuticos , Anticuerpos Monoclonales Humanizados , Artritis Psoriásica , Quimioterapia , Fármacos Dermatológicos , Usos Terapéuticos , Etanercept , Inmunoglobulina G , Usos Terapéuticos , Receptores del Factor de Necrosis Tumoral , Usos Terapéuticos , Proteínas Recombinantes de Fusión , Usos TerapéuticosRESUMEN
<p><b>OBJECTIVE</b>To determine the autocrine effect of vascular endothelial growth factor (VEGF) on epidermal keratinocytes HaCaT cells.</p><p><b>METHODS</b>Cultured HaCaT cells were treated with various concentrations of VEGF(165) (0,1,5,10,25,50,100 ng/ml) or Avastin (0,0.063,0.125,0.25,0.50,1.0,2.0 mg/ml) in vitro. HaCaT cell proliferation was determined by MTT assay and the cell migration was measured by migration assay. The effect of VEGF(165) (10 ng/ml) on phosphorylation of ERK1/2 was detected in HaCaT cells pretreated or not pretreated with Avastin (0.5 mg/ml).</p><p><b>RESULTS</b>VEGF enhanced the proliferation and migration of HaCaT cells in a dose-dependent manner, while Avastin inhibited the effects of VEGF also in a dose-dependent manner. VEGF(165) (10 ng/ml) induced the phosphorylation of ERK1/2 in HaCaT cells,but which was blocked by Avastin (0.5 mg/ml).</p><p><b>CONCLUSION</b>VEGF enhanced the proliferation and migration of HaCaT cells in a dose-dependent manner, while Avastin inhibited the effects of VEGF also in a dose-dependent manner. VEGF(165) (10 ng/ml) induced the phosphorylation of ERK1/2 in HaCaT cells,but which was blocked by Avastin (0.5 mg/ml).</p>
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Humanos , Comunicación Autocrina , Línea Celular , Proliferación Celular , Relación Dosis-Respuesta a Droga , Epidermis , Biología Celular , Queratinocitos , Biología Celular , Piel , Biología Celular , Factor A de Crecimiento Endotelial Vascular , FarmacologíaRESUMEN
<p><b>OBJECTIVE</b>To investigate and take a case study on a Klebsiella pneumoniae outbreak in a newborn intensive care unit (NICU).</p><p><b>METHODS</b>Using epidemiological investigation method to cultivate bacilli and detect the homology.</p><p><b>RESULTS</b>Klebsiella pneumonia was detected in 4 NICU patients. Based on environmental sample analyses, four Klebsiella pneumonia strains were identified and confirmed to be highly homologous. The outbreak was effectively controlled after the strict implementation of hand hygiene practice and environment disinfection.</p><p><b>CONCLUSION</b>Klebsiella pneumonia outbreak in NICU may be caused by the route of hand transmission.</p>
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Femenino , Humanos , Recién Nacido , Masculino , Infección Hospitalaria , Epidemiología , Microbiología , Brotes de Enfermedades , Unidades de Cuidado Intensivo Neonatal , Infecciones por Klebsiella , Epidemiología , Microbiología , Klebsiella pneumoniae , GenéticaRESUMEN
<p><b>OBJECTIVE</b>To investigate the clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in phlegm specimens of positive patients, so as to provide evidences for the nosocomial infection control.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 211 hospitalized patients who were MRSA-positive in their phlegm specimens in PUMC Hospital from January 2005 to October 2007.</p><p><b>RESULTS</b>Among the 211 patients, 196 (92.9%) had received antibiotics three months before the detection of MRSA, and 128 (60.7%) had received more than three antibiotics. Over 90% of MRSA were resistant to levofloxacin, erythromycin, clindamycin, and gentamicin, and 73.9% were resistant to rifampicin.</p><p><b>CONCLUSIONS</b>Improper use of antibiotics should be avoided. Vancomycin is the first choice for MRSA treatment.</p>