Objective To explore a new method of comparing the references images first to enhance the precision of the central point of the radiation treatment planning(RTP), try to establish a reference standard for this method in the nasopharyngeal cancer(NPC)and carcinoma of utercin cervix in the work of position verification. Methods For 50 RTPs of NPC and 20 RTPs of carcinoma of utercin cervix, the reference-CT-images in set-up and in position verification were compared, and to measure the difference between the two images. Then, in the same way, compare and measure the difference in the central-pointimages. Results For NPC, there was over 90% RTPs in which every difference measured was less than 2 mm;for carcinoma of utercin cervix, over 80% RTPs meet the criterion:the value of △MU1 ' or △MU2' was less than 5 mm and the others are less than 3 mm. Conclusions By comparing the references-CT-images in set-up and in position verification, the precision of the central point of the RTP is enhanced. The marks on the skin become more credible. So, it is feasible to perform the criterions in the work of position verification:for NPC every difference measured is less than 2 mm;for carcinoma of utercin cervix the value of △MU1 ' or △MU2 ' is less than 5 mm and the others are less than 3 mm.

Objective To investigate the status of palliative care knowledge and attitude of nurses in primary hospitals, and analyze the influencing factors, so as to provide bases and decisions for the further popularization of palliative care. Methods Totally 362 nurses from primary hospitals were selected as this research object, and their knowledge and attitude of palliative care were investigated by self-designed questionnaires. Results The standard score of palliative care of nurses from primary hospitals was ( 54. 28 ± 14. 06), 123 nurses were qualified (33.98%), and 26 nurses were good (7.18%);the standard score of caring attitude was (82.76±9.24). The influencing factors of palliative care knowledge and caring attitude included religion, department, working years and title(β′=0.308,0.263,0.121,0.104). Conclusions The attitude of nurses in primary hospitals is positive, but their related knowledge of palliative care is incomplete, especially the knowledge of spiritual care. Targeted training can improve the knowledge of palliative care of nurses, and popularizing it successfully.

Objective To formulate strategies for the construction of clinical specialty capabilities in hospitals,providing relevant experiences for peers to enhance clinical specialty capability development.Methods Taking a public hospital in Shenz-hen as an example,this study employs SWOT-PEST analysis to explore the external environment(opportunities and challenges)and internal environment(strengths and weaknesses)facing clinical specialty capability construction from four aspects:policy en-vironment,economic environment,social environment,and technological environment.Results The hospital's strengths include opportunities such as the construction of a national science city in the region,an aging population,and increased governmental fo-cus on the healthcare industry.Additional strengths include the integration of the hospital with community health services,strong support for key disciplines,and a deeply ingrained commitment to public welfare services.However,weaknesses include intense regional competition,the development of external internet hospitals,and increasingly strained doctor-patient relationships.The hospital also faces challenges due to inadequate research capabilities and levels,insufficient information technology infrastructure,and an incomplete internal incentive mechanism.Conclusion Based on the results of the SWOT-PEST analysis,the following strategies are proposed:SO Strategies(Strengths+Opportunities):Collaborate between the hospital and community health cen-ters;attract and cultivate talent to develop specialty clusters and key disciplines;and implement a comprehensive health manage-ment plan for the entire population and lifecycle in the region.ST Strategies(Strengths+Threats):Integrate management across various campuses and community health services,and pursue differentiated development.WO Strategies(Weaknesses+Opportu-nities):Engage in school-local collaborations for cross-disciplinary research innovation and translation;and deepen performance distribution reforms.WT Strategies(Weaknesses+Threats):Strengthen clinical research;enhance the hospital's information technology capabilities;and improve patient experience.Ultimately,these strategies aim to support the construction of clinical specialty capabilities within the hospital.

To analyze and evaluate the knowledge of Chinese Guidelines of Diabetes Prevention and Treatment in Shanghai medical staff. 175 medical staff working in endocrinology or community health were enrolled and evaluated by a questionnaire of guidelines about the state of professional, training, and related knowledge. Only 16. 6% medical staffwere trained about the guidelines( 46. 67% from the general hospitals, 14. 75% from secod-level hospital and 7. 14% persons from the community hospitals, P＜0. 01 ). The total correct answer rate of the guidelines was 37. 36%. The correct rate of community hospitals was lower than others( P＜0. 05 ). The rate of doctors' was higher than nurses'( P＜0. 05 ). There were difference between doctors and nurses with the key point of diabetes care knowledge in different level hospitals. The effective method of clinical training in diabetes care should be explored. We still have to work hard to promote the effect of diabetes control and prevention. Effective training about the guidelines should be enhanced. The cooperation between general hospitals and community health institutions in diabetes prevention and treatment should be enhanced.

Objective To cxplore the optimal levels of serum calcium,phosphorus and intact parathyroid hormone (iPTH) in peritoneal dialysis (PD) patients.Methods This study is a single center,retrospective cohort study.The associations between serum calcium,phosphorus and iPTH and all-cause mortality in 217 PD patients were analyzed.All patients started PD between January 1,2008 and April 30,2016 were enrolled and followed up to December 31,2016.At baseline and every 3 months,biochemical and therapeutic information was collected.Cox proportional hazard regression models and cubic splines analysis were employed to assess the lowest mortality risk ranges in serum markers of bone metabolism.Results There was no significantly difference between patients within target ranges based on KDOQI or KDIGO guideline and those outside the target ranges by Kaplan-Meier survival analysis.The lowest mortality risk ranges were 2.17-2.40 mmol/L for serum calcium,1.20-1.67 mmol/L for serum phosphorus and 180-350 ng/L for serum iPTH by using Cox models and cubic splines analysis.Moreover,cumulate survival had significant difference between patients within the descriptive ranges and those out of the descriptive ranges at time-averaged values but not at baseline values.Conclusions The optimal time-averaged ranges of PD patients are 2.17-2.40mmol/L for serum calcium,1.20-1.67 mmol/L for serum phosphorus and 180-350 ng/L for serum iPTH.These ranges need further validation by large population studies to further conform.

BACKGROUND: Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion. METHODS: Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test). RESULTS: We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42-39.42%; odds ratio, 3.78%; 97.5% CI: 2.70-5.30%; P <0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91-65.57%; odds ratio, 20.06; 97.5% CI: 12.74-31.57; P <0.001). No statistically significant differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies. CONCLUSION: The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries. TRIAL REGISTRATION ClinicalTrials.gov, NCT01597232.
Humans ; Adult ; Postoperative Complications ; Erythrocyte Transfusion/adverse effects* ; Blood Transfusion ; Hospitals ; Hemoglobins/analysis*