It is one of the focal points among present hospital works to improve clinic efficiency and the patient medical service environment.This article has described the current situation of the hospital clinic procedure and its short-comings,put forward the idea of establishing a patient-friendly clinic service,mainly introduced a magnetic medical card to solve the problem so called "three long and one short",and pointed out some possible problems for the application of the card,which offer a reference for the setting up of a patient-centered modern clinic in an all-round way in the hospital.

It is prevalent that patients waiting too long but receiving little service in the out-patient department in general hospital nowadays.To solve this problem,we had analyzed its current service process according to BPR(business process reengineering) theory in enterprise,and reengineered the service process in specialized clinic by means of cutting waste,simplifying steps,merging works and using modern information.We established the renal disease specialized clinic,which had practiced for three years and "one station service" has been achieved.The specialized clinic provides much convenience to patients.

Objective: To investigate the prevalence, antibiotic resistance and risk factors of Acinetobacter Baumannii hospital-acquired pneumonia (ABHAP) in Respiratory Intensive Care Unit (RICU) of our hospital for guidance of clinical prevention and treatment of ABHAP. Methods: Clinical information and results of Antibiotic susceptibility test for all of the patients with hospital-acquired pneumonia (HAP) in RICU of our hospital from May 2007 to October 2008 were collected. Antibiotic resistance and risk factors of ABHAP were analyzed retrospectively. Results: 159 patients suffered from HAP. Of which, 49 patients had ABHAP and accounted for 30.8% of all cases. Acinetobacter Baumannii was the second commonest pathogen of HAP. The resistance rate of Acinetobacter Baumannii strains to the third generation of Cephalosporin and Fluoroquinolone were over 90%. And the resistance rate to Imipenen was 42.7%. Pan-resistant rate was 23.5%. Univariate analysis showed that APACHEII score≥20, hospitalization in RICU ≥2 weeks,invasive mechanical ventilation, invasive mechanical ventilation ≥7 days, trachea intubation or tracheotomy, trachea intubation or tracheotomy ≥7 days and broad-spectrum antibiotic therapy ≥7 days were associated with BAHAP. Multivariate logistic analysis showed that hospital ization in RICU ≥2 weeks,invasive mechanical ventilation ≥7 days, APACHEII score ≥20 and broad-spectrum antibiotic therapy ≥7 days were independent risk factors of ABHAP. Conclusions: The present study found high incidence rate, severe drug-resistance and therapeutic difficulties of ABHAP in RICU. Shortening duration of hospitalization and invasive mechanical ventilation, rational use of antibiotics are helpful to prevent and treat ABHAP.

Objective:To analyze the risk factors,clinical characteristics and pathogenesis in chronic obstructive pulmonary disease(COPD) complicated with ventilator-associated pneumonia(VAP) after mechanical ventilation.Methods:Retrospective analysis was performed on 122 cases of COPD complicated with VAP after mechanical ventilation for the clinical characteristics,bacterial culture and antibiotics sensitivity.These cases were divided into two groups with or without VAP.Results:The patient with COPD complicated with VAP often had no typical clinical presentation.Etiological microorganisms were predominated by Gram-negative bacterium.Mixed infections were common.Bacteria were often resistant to varieties of antibiotics.The incidence of VAP was 55.8%.Nutrition,complication,duration of mechanical ventilation,duration of antibiotics and steroid were related to the development of VAP.Conclusion:COPD complicated with VAP often has no typical clinical presentation.Development of VAP is associated with multiple predisposing factors.Etiological microorganisms are complex and often resistant to varieties of antibiotics.The combination of multidiscinplary therapy is necessary for prophylaxis and treatment of VAP.

Objective:To investigate the prevalence,antibiotic resistance and risk factors of Acinetobacter Baumannii hospital-acquired pneumonia(ABHAP)in Respiratory Intensive Care Unit(RICU)of our hospital for guidance of clinical prevention and treatment of ABHAP.Methods:Clinical information and results of Antibiotic susceptibility test for all of the patients with hospital-acquired pneumonia(HAP)in RICU of our hospital from May 2007 to October 2008 were collected.Antibiotic resistance and risk factors of ABHAP were analyzed retrospectively.Results:159 patients suffered from HAP.Of which,49 patients had ABHAP and accounted for 30.8% of all cases.Acinetobacter Baumannii was the second commonest pathogen of HAP.The resistance rate of Acinetobacter Baumannii strains to the third generation of Cephalosporin and Fluoroquinolone were over 90%.And the resistance rate to Imipenen was 42.7%.Pan-resistant rate was 23.5%.Univariate analysis showed that APACHEII score ≥20,hospita1ization in RICU ≥2 weeks,invasive mechanical ventilation,invasive mechanical ventilation ≥7 days,trachea intubation or tracheotomy,trachea intubation or tracheotomy≥7 days and broad-spectrum antibiotic therapy≥7 days were associated with BAHAP.Multivariate logistic analysis showed that hospita1ization in RICU≥2 weeks,invasive mechanical ventilation≥7 days,APACHEII score≥20 and broad-spectrum antibiotic therapy ≥7 days were independent risk factors of ABHAP.Conclusions:The present study found high incidence rate,severe drug-resistance and therapeutic difficulties of ABHAP in RICU.Shortening duration of hospitalization and invasive mechanical ventilation,rational use of antibiotics are helpful to prevent and treat ABHAP.

BACKGROUND: Cone-beam CT (CBCT) and orthopantography are two imaging methods mostly used in the preoperative evaluation of dental implantation. CBCT has high cost and low penetration rate, but orthopantography can result in a larger error in the measurement of bone quantity.OBJECTIVE: To compare the accuracy of bone quantity measurement using CBCT and orthopantography, and to evaluate the clinical effect of simulation in posterior implant region. METHODS: 115 implants from 72 patients undergoing implantation of posterior teeth in the Eye & ENT Hospital of Fudan University were selected. The horizontal heights from the top of the alveolar bone to the important anatomic structures (mandibular nerve or maxillary sinus floor) were measured using CBCT and orthopantography and then analyzed statistically. The implantation simulations were performed using Planmeca Romexis3.8 (for CBCT) and Cliniview9.3 (for orthopantography) to compare the differences in stimulated and postoperative horizontal heights.RESULTS AND CONCLUSION: There were significant differences in the measured data between CBCT and orthopantography (P < 0.05), especially in the maxilla (P < 0.01). There were significant differences between the simulated and postoperative results of the two methods (P < 0.05). The average error and standard deviation in orthopantography were larger than those in CBCT. The average error of implantation simulation using CBCT in the maxilla was smaller than that using orthopantography, whereas the error was similar in mandibular simulations. To conclude, CBCT is more accurate for assessing the quantity of bone in posterior implant region, especially in the maxilla. The accuracy of CBCT and orthopantography in implantation simulation needs to be improved.

BACKGROUND:Implanted site and direction of miniscrew implants, post-implantation movement of implants, contact between tooth and implant after tooth movement al can cause root damage.
OBJECTIVE:To investigate the changes of the root surface, periodontal tissue and osteoprotegerin expression in the periodontal tissue at periods of time after miniscrew implant loading.
METHODTwo beagle dogs were selected. For each dog, miniscrews were implanted into the labial alveolar bone near the roots of the maxil ary second, third, and fourth premolars and the maxil ary second, third, and fourth premolars and first molar. Fourteen miniscrew implants were in one dog, including six in the maxil ary and eight in the mandible;two miniscrews of the maxil ary acted as control group with no loading, and the rest miniscrews were as experimental group under orthodontics force. Two weeks after miniscrew implantation, 150 g force was loaded between two miniscrews with nickel-titanium closed-coil springs. The dogs were sacrificed after miniscrews loading 4 and 8 weeks respectively, the teeth were cut completely with alveolar bone tissue and decalcified to make the histological specimen. The histological changes of the root and periodontal tissue were observed by hematoxylin-eosin staining and expression of osteoprotegrin in the periodontal ligament was also inspected by using immunohistochemistry.
RESULTS AND CONCLUSION:When the miniscrews were adjacent to the roots, absorption lacuna occurred in the alveolar bone;after horizontal force was loaded opposite to the roots, alveolar resorption became much more animate. When the miniscrews contacted with the pericementum, some areas of the cement absorbed seriously and even reached the dentin;when sustaining pressure from the miniscrews, the whole layer of the cement absorbed and the dentin was exposed and began to be absorbed. The osteoprotegrin in the periodontal ligament of control group expressed sharply and its expression was notable at 8 weeks;while the osteoprotegrin of experimental group weakly expressed at 8 weeks, and there was significant divergence between control group and experimental group at 8 weeks (P<0.01). The roots and periodontal tissue were al damaged variously after miniscrew implantation adjacent to the roots. When horizontal orthodontic force was loaded opposite to the roots, the expression of osteoprotegrin was influenced slightly;as the loading period prolonged, pressure dramatical y restrained the expression of osteoprotegrin. When discovering the miniscrew implant adjacent to roors, the miniscrew implant anchorage should not be used to load orthodontical force opposite to the roots but ought to be removed in order to leave the root repair autonomously and avoid further damage.

Based on the analysis of 5-year collected data,our study showed that the teacher and course characteristics influence student ratings significantly.The scientific and rea-sonable evaluation approaches provides fundamental information for teaching capacity enhancement and course improvement.

Some problems have influence on the quality of Clinical practice teaching of foreign students,including language communication barriers,teacher shortage and so on.To solve these problems,we worked hard on the rationale use of teachers,improvement of the teacher’s English level,giving lecture and collecting opinions to improve the quality of teaching.

Objective: To analyze and estimate the risks of failure modes in a pharmaceutical Co.Ltd.in Nanjing producing solid preparations by collinear production, and come up with measurements to improve the quality level accordingly.Methods: The quality risk level evaluation table for the failure modes in the various steps of collinear production was obtained through the failure mode and effects analysis (FMEA).The risk control measurements were put forward in order to control and improve different failure modes with various unacceptable risk levels.Results: The risks of solid preparations by collinear production were greatly reduced through FMEA.Conclusion: The FMEA method is an effective way to improve the quality level of collinear products.Meanwhile, there are limitations of FMEA, and other risk management methods should be combined to control the overall risk of drug production.Moreover, the failure modes at the same risk level with different properties should be analyzed and controlled accordingly.The above methods can improve the risk management level of a company and reduce the risks of cross-contamination, mistakes and air-transferring in order to enhance the efficiency of quality management system and produce safe and effective drugs.