Background: Accreditation of healthcare institutions serves as a fundamental mechanism for ensuring patient safety and validating the quality of medical services provided to the population. At Intermed Hospital, a quality measurement system for healthcare services has been established since 2015, encompassing 126 quality indicators at both institutional and departmental levels. This system facilitates continuous quality improvement efforts. In this context, quality indicators specific to the endoscopy department play a pivotal role in objectively assessing the quality of endoscopic services. Aim: To assess the quality indicators in gastrointestinal endoscopy unit. Materials and Methods: A retrospective single-center study was conducted by collecting data from the Intermed hospital’s electronic information systems which included HIS and PACS and Quality and Safety Department’s Database and the results were processed using the SPSS software. Ethical approval was granted by the Intermed hospital’s Scientific research committee. The quality of endoscopic services in the Intermed hospital was assessed based on: a) the average values of four quality indicators measured monthly; b) sample survey data from five categories of quality indicators. Results : Between 2016 and 2024, the quality indicators of the endoscopy unit measured as the level of early warning score evaluations for patients was 95.97%±3.33, the level of cases where peripheral blood oxygen saturation decreased during sedation was 1.54%±3.78, the level of cases where patients experienced paradoxiical response during sedation was 5.82%±1.75, surveillance culturing level for validation of endoscopy reprocessing was 11.6%. The endoscopic documentation quality by peer review showed 95.7-100%, the colonoscopy quality indicators were followings as adenoma detection rate: 24.5% Cecal intubation rate: 99.1%, 95.2%, Colonoscope withdrawal average time: 13.28±10.62 minutes, Bowel preparation quality (Boston Scale): 89.3% 95.7%), patient discharge from the recovery room, Average discharge time post-procedure: With propofol alone: 30.92 minutes; With propofol and fentanyl combined: 31.52 minutes, The intermediate risk was 0.28% by the TROOPS evaluation during procedural sedation. Conclusion The quality benchmark levels for these endoscopic units, as determined by a single-center study, can be effectively implemented by benchmark endoscopy centers to enhance their quality and safety operations.

The clinical sign of children’s kidney and urinary tract petrification diseases and the result of eswl Background: A substance exchange disorder where stones form in the kidney or urinary tract with a tendency toward inheritance is called urinary tract petrification disease. In many countries throughout the world, the incidence of urinary tract petrification disease is one to fifteen percent. Urinary tract permeability disease affects 7% of people under the age of 17. Due to the unique nature of the habitat, the incidence of urinary tract petrification disease is higher in India, Thailand, Scandinavian countries, and the Caucasian, Ural, Siberia, and Equator areas. However, the incidence of urinary tract petrification disease spread is two to three percent for children, but the reoccurance risk is 6.5–54 percent. In our country’s case, J. Horloo’s 1993 research indicates that 4.1 to 4.7 percent of kidney and urinary tract patients have urinary tract disease. During urinary tract disease, the common symptoms are abdominal pain, macro- and microhematuria, and kidney and renal bacterial infection. But in younger children, those symptoms are quite grim. In the last 15 years, mongolian’s urine’s oxalate stone’s volume increased by 5 times and mixed stones decreased by 2.5 times. The research of G. Erdenetsetseg’s 1990–1998 study on 305 children and the 2001–2003 study on 161 children indicate that the incidence of urinary tract disease is high between ages 1-3, and 65 percent of the stones consist of calcium oxalate. In 1980, German scientists invented the stone crushing technology using electrohydraulic shockwaves, which turned out to be a beneficial treatment for kidney surgery practice. The National Hospital for Maternal and Child Health's kidney surgery team had 17 surgeries in 2015, 19 surgeries in 2016, 24 surgeries in 2017, and 28 surgeries in 2018, and all of those surgeries were done and treated open. In the last 10 years of our country, children’s urinary tract petrification disease has gradually increased, but research on those diseases risks and factors is lacking. Also, the stone crushing method is necessary for our country’s children's treatment. That’s why we decided to do research on the risk factors of urinary tract disease and its relation to the stone crushing method. Aim: Describe the features of children’s kidney and urinary tract petrification disease and study the stone crushing method’s results. Materials and methods: The study was done between December of 2019 and April of 2022, with the assistance of NCMCH's children's kidney surgery team. Within the parameter of the first objective, within the group of cases of kidney and urinary tract disease, there were 13 children under the age of 17. The research study was conducted cross sectional. The research results were processed by the SPSS 25 program. On the seventh meeting of the health ministry, we got the acceptance of a research patent with the assistance of EHEMUT. Results: The research group consisted of 13 children ages 0–17. The average age of participants was 10.6+-4.2.74. 4 percent of it consisted of men. The research of symptoms showed that back pain n = 13 (100), right side abdominal pain n = 13 (100), disurie n = 3 (23.1), mouth drying n = 2 (15.4), nausea n = 3 (23.1), urine with blood n = 10 (76.9), urine with smell n = 9 (69.2). The position of the stone consisted of 8 (61.5) in the kidney cup, 8 in the kidney cradle. Showing it in which kidney showed that 8 (61.5) were in the right kidney, 3 (23.1) in the left kidney, and 2 (15.4) in both kidneys. The density of the stones was n = 265.8+ 41.9 on average. Kidney stone coming out time was measured by Caplan-Myer’s survivability scale. The stones on the right side of the kidney came out within 14 days on average, while the left and both-sided kidney stones came out within 30 days. Conclusions: 1. Showing the number of stones and locations indicates that 8 (61.5) were in the right kidney, 3 (23.1) in the left kidney, and 2 (15.4) in both kidneys. 2. The results of Caplan-Meyer's scale indicate that kidney stones within the right kidney came out within 14 days, and left- or both-sided stones came out within 30 days.

Background: Lead is known for their neurotoxicity and compared to adults, children are more vulnerable to lead exposure. Varieties of diseases are developed by lead induced damage in children, including decreased intelligent quotient and behavioral changes, such as anxiety. In normal condition lead does not exist in children’s blood and this toxic heavy metal enters into human body through respiratory way and accumulates in blood and bone to harm neurodegenerative and urinary systems. Therefore, the present study aimed to investigate whether the emitted lead from recycling factory for lead acid batteries, which is located in 9 km distance from Khonkhor town and 39 km faraway from Ulaanbaatar city with north-east direction, is affecting the intelligence of the local children. Methods: There are 13 children involved in this study and the participants are divided into two groups, including subjects, who live in areas outside (n=10) and within (n=3) the 1000 m region of the factory zone. The blood sampling was collected according to WHO guidelines and lead level in blood was determined by Leadcare instruments at Environmental health and toxicological laboratory of National Center for Public Health. The intelligence analysis was conducted by Raven’s progressive matrices test. And the statistical analysis was performed by SPSS 21 software to assess correlation of blood lead levels and the intelligence among participated children. Results: It is resulted that average lead level for children’s blood samples is 3.1±1.5 ug/dL and which is found beyond the acceptable range in WHO guidelines. The children’s intelligence was assessed by Raven’s colored Progressive Matrices analysis, which is practically accepted in China, which estimated that average intelligence score of participants were 48.3±13.2. According to correlation analysis of age, sex, intelligence and blood lead level, there was a weak positive correlation was found between children’s age and lead level in blood. In contrast, a weak reverse correlation was observed in regarding with sex and blood lead level and intelligence score was weakly reverse correlated with the lead level in children’s blood samples. Conclusions The determined average lead level was 3.1±1.5 ug/dL for blood samples collected from 13 children who involved in this study and the value is found under the WHO guidance value. Furthermore, their average intelligence score was estimated as 48.3±13.2. The comparative analysis shown that intelligence score of 3 children, who lives within 1000 m region of the recycling factory was lower than those who lives in outside region of the factory and have same age.

INTRODUCTION: Nursing home (NH) residents with out-of-hospital cardiac arrests (OHCA) have unique resuscitation priorities. This study aimed to describe OHCA characteristics in NH residents and identify independent predictors of survival. MATERIALS AND METHODS: OHCA cases between 2010-16 in the Pan-Asian Resuscitation Outcomes Study were retrospectively analysed. Patients aged <18 years old and non-emergency cases were excluded. Primary outcome was survival at discharge or 30 days. Good neurological outcome was defined as a cerebral performance score between 1-2. RESULTS: A total of 12,112 cases were included. Of these, 449 (3.7%) were NH residents who were older (median age 79 years, range 69-87 years) and more likely to have a history of stroke, heart and respiratory diseases. Fewer NH OHCA had presumed cardiac aetiology (62% vs 70%, <0.01) and initial shockable rhythm (8.9% vs 18%, <0.01), but had higher incidence of bystander cardiopulmonary resuscitation (74% vs 43%, <0.01) and defibrillator use (8.5% vs 2.8%, <0.01). Non-NH (2.8%) residents had better neurological outcomes than NH (0.9%) residents ( <0.05). Factors associated with survival for cardiac aetiology included age <65 years old, witnessed arrest, bystander defibrillator use and initial shockable rhythm; for non-cardiac aetiology, these included witnessed arrest (adjusted odds ratio [AOR] 3.8, <0.001) and initial shockable rhythm (AOR 5.7, <0.001). CONCLUSION Neurological outcomes were poorer in NH survivors of OHCA. These findings should inform health policies on termination of resuscitation, advance care directives and do-not-resuscitate orders in this population.

A once-daily formulation of tacrolimus, Advagraf®, is increasingly being used in place of twice-daily tacrolimus, Prograf®, as a standard immunosuppressive agent for transplant patients. In this study, the clinical safety and efficacy of Advagraf® were compared with Prograf®, among multi-ethnic Malaysian renal transplanted population.