OBJECTIVE:To explore the changes of serum phenytoin levels and its pharmacokinetics in menstrual epilepsy.METHODS:9cases of menstrual epilepsy patients who were treated with phenytoin were collected,whose blood concentra?tions of phenytoin in menstrual period and ovulation period were respectively determined by HPLC,pharmacokinetics study was performed in three of them.RESULTS:The mean serum phenytoin levels in menstrual period and ovulation period were(9.25?2.71)?g/ml and(13.33?3.22)?g/ml,respectively(P

Adenine ; analogs & derivatives ; Hepatitis B, Chronic ; Humans ; Organophosphonates ; Tenofovir ; Treatment Failure

OBJECTIVES: This study is aimed at developing a set of data groups (DGs) to be employed as reusable building blocks for the construction of the eight most common clinical documents used in China's general hospitals in order to achieve their structural and semantic standardization. METHODS: The Diagnostics knowledge framework, the related approaches taken from the Health Level Seven (HL7), the Integrating the Healthcare Enterprise (IHE), and the Healthcare Information Technology Standards Panel (HITSP) and 1,487 original clinical records were considered together to form the DG architecture and data sets. The internal structure, content, and semantics of each DG were then defined by mapping each DG data set to a corresponding Clinical Document Architecture data element and matching each DG data set to the metadata in the Chinese National Health Data Dictionary. By using the DGs as reusable building blocks, standardized structures and semantics regarding the clinical documents for semantic interoperability were able to be constructed. RESULTS: Altogether, 5 header DGs, 48 section DGs, and 17 entry DGs were developed. Several issues regarding the DGs, including their internal structure, identifiers, data set names, definitions, length and format, data types, and value sets, were further defined. Standardized structures and semantics regarding the eight clinical documents were structured by the DGs. CONCLUSIONS: This approach of constructing clinical document standards using DGs is a feasible standard-driven solution useful in preparing documents possessing semantic interoperability among the disparate information systems in China. These standards need to be validated and refined through further study.
Asian Continental Ancestry Group ; China ; Delivery of Health Care ; Electronic Health Records ; Health Level Seven ; Hospitals, General ; Humans ; Information Systems ; Semantics

Objective To explore the effect of lean management on cost control of single disease in patients with acute cerebral infarction (ACI) in stroke center. Methods A retrospective study was conducted. The patients with ACI who underwent intravenous thrombolysis in the stroke center of Taizhou Central Hospital in Zhejiang Province were enrolled. Thirty patients adopted traditional management procedures from July 2016 to September 2017 were enrolled in the control group, and 32 patients received lean management from October 2017 to December 2018 were enrolled in the lean group. The patients in the control group were treated with traditional intravenous thrombolysis, and the patients were sent to the neurology ward for intravenous thrombolysis. The patients in the lean group applied lean management value stream to optimize process management, the lean management team of the stroke center was established, and the green channel for stroke treatment was established to eliminate the waiting time as far as possible. The location of thrombolysis was changed from neurology ward to the neurological intensive care unit (NICU) in emergency department. The patients in the two groups were compared in terms of intravenous thrombolytic door-to-needle time (DNT), admission time to the neurologist's visit time (T1), CT examination time to neurology ward or NICU admission time (T2), neurology ward/NICU visit time to medication time (T3), and the proportion of patients with DNT controlled within 40 minutes, recovery of neurological impairment 7 days after thrombolysis [national institutes of health stroke scale (NIHSS) score], activity of daily living assessment (Barthel index), length of hospital stay, cost of hospital stay and patient satisfaction. At the same time, the main process quality and the implementation rate of easily missed indexes of cerebral infarction single disease were recorded. Results Compared with the control group, DNT, T1 and T2 in the lean group were significantly shortened [DNT (minutes): 39.56±11.12 vs. 63.03±19.63, T1 (minutes): 16.23±6.79 vs. 33.48±12.63, T2 (minutes): 13.45±3.84 vs. 17.47±5.56, all P < 0.01], T3 was slightly shortened (minutes: 9.88±1.95 vs. 10.95±2.69, P > 0.05), and the proportion of DNT control within 40 minutes was significantly increased [75.0% (24/32) vs. 16.7% (5/30), P < 0.01], the 7-day NIHSS score was decreased significantly (8.66±4.12 vs. 13.00±5.63, P < 0.01), 7-day Barthel index was increased significantly (71.6±16.7 vs. 54.7±17.1, P < 0.01), the length of hospital stay was significantly shortened (days: 9.69±4.06 vs. 12.47±3.83, P < 0.01), the hospital costs were significantly reduced (Yuan: 16 338±5 481 vs. 19 470±5 495, P < 0.05), the satisfaction of patients was improved significantly [(91.38±2.69)% vs. (86.53±2.78)%, P < 0.01]. In terms of the implementation rate of quality indicators such as pre-application evaluation of thrombolytic drugs, evaluation of dysphagia, and evaluation of vascular function, health education of ACI, rehabilitation evaluation and implementation within 24 hours, etc., the lean group was significantly improved as compared with the control group [(87.5% (28/32) vs. 53.3% (16/30), 96.9% (31/32) vs. 73.3% (22/30), 78.1% (25/32) vs. 43.3% (13/30), 100.0% (32/32) vs. 76.7% (23/30), 75.0% (24/32) vs. 33.3% (10/30), all P < 0.05]. Conclusion Lean thinking can realize the standardization of stroke center process, effectively utilize medical resources, improve medical quality and reduce the cost of cerebral infarction single disease.

Objective:To explore the risk factors of hepatocellular carcinoma (HCC) in patients with hepatitis B cirrhosis receiving nucleoside/nucleotide analogues (NAs) antiviral therapy.Methods:The clinical data of 253 patients receiving NAs antiviral therapy in Zhejiang Provincial People’s Hospital from November 2014 to October 2019 were retrospectively analyzed. During treatment, HCC occurred in 116 patients. Multivariate logistic regression was used to analyze the risk factors of progression to HCC in patients with hepatitis B cirrhosis.Results:Multivariate logistic regression analysis showed that age( OR=1.094, 95% CI 1.034-1.158, P<0.01), smoking history( OR=5.056, 95% CI 1.453-17.594, P<0.05), family history of hepatocellular carcinoma( OR=6.763, 95% CI 1.253-36.499, P<0.05), Lamivudin (LAM) resistance( OR=6.097, 95% CI 1.370-27.134, P<0.05), fasting blood glucose(FBG)level( OR=7.219, 95% CI 3.716-14.024, P<0.01) were independent risk factors for the progression of hepatitis B cirrhosis to HCC; while HBV DNA negative conversion( OR=0.028, 95% CI 0.006-0.137, P<0.01) was a protective factor. Conclusions:For hepatitis B cirrhosis patients receiving antiviral therapy, drug resistance, HBV DNA, FBG levels should be closely monitored, intervention measures such as quitting smoking should be taken and NAs with high drug resistance gene barrier should be selected to prevent the occurrence of HCC.

Objective:To evaluate the effect of multidimensional model of laparoscopic suture training in spread of laparoscopic pancreatic surgery.Methods:The surgeons who took advanced training in Department of Gastroenterology and Pancreatic Surgery in Zhejiang Provincial People’s Hospital from September 2018 to March 2020 were enrolled. Theoretical presentation, simulation training and assessment, clinical practices were included in the multidimensional training model. The " mattress suture" module (2 mattress sutures) in the LAP Mentor laparoscopic advanced simulator was used as the initial assessment and post-training assessment. The average needle loading time, time to form a knot, total time, accuracy rate of precise needle passage through the entrance and exit dots, and total aggressive tissue handing provided in the LAP Mentor were analyzed pre- and post-training. The trained surgeons were followed up for their clinical work in own hospitals.Results:A total of 13 surgeons were trained, including 4 deputy chief physicians, 7 attending physicians over 3 years, and 2 attending physicians under 3 years. The trainees had only primary laparoscopic surgery experience and no laparoscopic pancreatic surgery experience. After training in the above scheme, the average needle loading time was shortened from (93.6±31.6) s to (45.7±13.6) s, and the time to form a knot was reduced from (138.9±46.2) s to (62.1±22.9) s, and total time to accomplish the suture shortened from (15.9±3.8) min to (6.7±3.5) min. The accuracy rate of precise needle passage through the entrance and exit dots increased from (63.7±10.3)% to (89.6±9.8)%. The total aggressive tissue handing decreased from (18.2±12.5) to (6.7±4.9). All those data showed statistical differences ( P<0.05). During follow-up, all traineescan operate the laparoscopic pancreatic surgery proficiently. One trainee completed his first laparoscopic pancreaticoduodenctomy as the primary surgeon, and one trainee complete the splenic vein branch suture to stop hemostasis during laparoscopic pancreatectomy with spleen-preserving spleen, and 3 trainees completed laparoscopic pancreaticoduodenctomy as the first assistant surgeons with good outcomes. Conclusion:Multidimensional model of laparoscopic suture training can improve the trainee's suture skill and help perform complex laparoscopic pancreatic surgery with self-confidence.