In this paper,we focus on how to planning and implementing CRM system in hospital,and address this topic in three main sections.Firstly, The comprehending and urgent need of hospital leaders and managers about CRM are the most important.Secondly,before implementing CRM,the status of information management in hospital and characteristic of relationship between customers(or patients) and hospital should be sufficiently understood.Thirdly,which kind of CRM,and how much investment what you need should be analyzed.A general principle is put forward,that is "clear aim,macro planning,(uniform) disposal and stepping into implementing".

We examined diseases occurring farmed Whitmania pigra(L.) in Hebei province in the aspect of situation of disease,clinical symptoms and pathological changes.In addition,the molecular identification were conducted to representative strain,the 16S rRNA gene was sequenced and compared with that of related strains,molecular phylogenetic tree was constructed.The results showed that the disease was infected by Aeromonas hydrophila.Pure cultures of 10 strains have the same serotype.Selected representative strain was proved to be the corresponding primitive causal agent of the disease by artificial infection experiment to healthy Whitmania pigra(L.).Antibiotic sensitivity of the isolates to used thirty-seven antimicrobial agents showed that the tested strains were high sensitive to cefotaxime et al.,were sensitive to streptomycin et al.,were resistant to oxacillin et al.

Background The measurement of the extraocular muscle is critical for the diagnosis of extraocular muscle diseases,but conventional medical imaging techniques present some shortcomings because of the contact pattern.The anterior segment optical coherence tomography (OCT) is thought to be an in vivo noninvasive optical diagnostic imaging method.Objective This clinical study attempted to seek an available approach to the evaluation of the anatomic structure of human horizontal rectus insertion with Visante OCT.Methods One hundred and fourteen eyes of 58 subjects were included in this study and were divided into the low refractive power group (≤-3.00 D) with 43 eyes,moderate refractive power group(＞-3.00 D-≤-6.00 D) with 49 eyes and high refractive power group(＞-6.00 D) with 22 eyes.The horizontal rectus insertion distance to the scleral spur and its thickness were measured by Visante OCT.The correlation of the refractive power with the rectus insertion distance or thickness was analyzed.Written informed consent was obtained from each subject before medial assessment.Results The average distance from the scleral spur to the lateral and medial rectus insertion were (5.23±0.50)mm and (3.81±0.46)mm respectively.The average thickness of the lateral and medial rectus insertions were (0.39±0.06)mm and (0.39±0.06)mm respectively,showing no significant differences in comparison with those of ultrasound biomicroscopy (P=0.338,P=0.759).The lateral and medial rectus insertion distances were (5.25±0.45)mm and (3.74±0.53)mm in the low refractive power the group,(5.22±0.60)mm and (3.81±0.42)mm in the moderate group and (5.20±0.35)mm and (3.90±0.42)mm in the high refractive power group,presenting inconsiderable difference among these three groups(lateral rectus: χ2=0.054,P=0.974;medial rectus: F=0.508,P=0.604).The thickness of the lateral and medial rectus insertions were (0.41±0.06)mm and (0.40±0.06)mm in the low refractive power group,(0.40±0.07)mm and (0.37±0.07)mm in the moderate refractive power group,(0.36±0.05)mm and (0.39±0.05)mm in the high refractive power group with a significant difference among lateral rectus (F=4.922,P=0.009) but not medial rectus (F=2.152,P=0.125).The lateral rectus insertions thickness in the high refractive power group was thinner than that in low refractive power group (P＜0.05).A positive correlation was found between refractive power and the thickness of lateral or medial rectus insertions (r=0.284,P＜0.01).Conclusion Visante OCT is a uscful way in measuring the distance and thickness of the extraocular muscles.Lateral rectus insertions thickness tends to be thinner with the worsening of myopia,which is obvious in high myopia.

Objective: To investigate the effect of carboxymethylchitosan on autocrine growth factor and morphology of fibroblasts cultured in vitro, so as to discuss the possible mechanism by which carboxymethylchitosan alleviates overheating and prevents adhesion in wound healing. Methods: Fibroblasts were cultured in vitro. Fibroblasts of passage 4-6 were treated with different concentrations of carboxymethylchitosan (0.01,0.1,1.0 and 10 mg/ml) for 4 days or with 0.1 mg/ml carboxymethylchitosan for 1, 2, 3, 4, 5, and 6 days. The levels of autocrine transforming growth factor-β1 (TGF-β 1) and epidermal growth factor (EGF) of fibroblasts were determined by ELISA and radioimmunoassay. The fibroblastic morphology was detected by transmission electron microscopy (TEM) and microscope after fibroblasts were treated with different strategies. Results: Carboxymethylchitosan (≥ 0.1 mg/ml) inhibited autocrine TGF-β1 of fibroblast in a time- and concentration dependent manner (P< 0.05). However, Carboxymethylchitosan had no obvious influence on the secretion of EGF(P>0.05). Carboxymethylchitosan (≥ 0.1 mg/ml) also inhibited the proliferation of fibroblasts and caused their ultrastructural changes. Conclusion: Carboxymethylchitosan (≥0.1 mg/ml) can inhibit fibroblasts proliferation and reduce tissue adhesion, possibly through altering fibroblast ultrastructure and selectively inhibiting secretion of TGF-β1.

Objective: To prepare and evaluate the effectiveness of chitosan-carboxymethylcellulose membrane in preventing postoperative intestinal adhesion. Methods: Chitosan-carboxymethylcellulose membrane was prepared with 1:1 ratio of chitosan and carboxymethylcellulose. Glutaraldehyde and ammonium aluminium sulfate were used for cross-linkage, glycerin for enhancing plasticity; and then the product was dried. The membrane was observed with scanning electron microscopy (SEM) and its tensile strength and breaking elongation were measured. Forty-eight SD rats with ileum injury were randomly divided into A, B and C groups (n=16). During operation, the injury in group A was treated with chitosan-carboxymethylcellulose membrane, in group B with chitosan membrane, and in group C without treatment (control group). The adhesion was observed on the 14th postoperative day. Results: The tensile strength of chitosan-carboxymethylcellulose membrane was 20 MPa and the breaking elongation was 65%. SEM showed that the morphology of the membrane had crossed fibroid structures and irregular pores. The severity of adhesion in group A and B was significantly lower than that in group C (P<0.01). Milder inflammatory changes and less fibrous proliferation were found in group A and B compared with those in group C. Epithelia rehabilitated better in group A than in group B, and the proliferation of fibroblast was not significant under electron microscope. In group C, epithelia rehabilitated slowly and fibroblasts excreted collagen actively. Conclusion: Chitosan-carboxymethylcellulose membrane is feasible for suturing during operation and is effective in reducing intestinal adhesion and it is superior to chitosan membrane.

Amyloid beta-Peptides ; analysis ; Animals ; Frontal Lobe ; drug effects ; physiology ; Hippocampus ; drug effects ; physiology ; Learning ; drug effects ; Memory ; drug effects ; Rats ; Rats, Wistar ; Sodium Azide ; pharmacology ; Space Perception

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Arrhythmias, Cardiac ; diagnosis ; genetics ; therapy ; Child ; Child, Preschool ; Electrocardiography ; Humans ; Infant ; Male ; Middle Aged ; Syndrome

OBJECTIVETo study clinical results of the manual reduction in treatment.

METHODSFrom October 2010 to April 2013,39 children with Monteggia fracture associated with anterior interosseous nerve injury were treated by manual reduction and fixation on buckling rotation backward,including 17 females and 22 males with an average age of 6.3 years old ranging from 3.2 to 11 years old. Among them, 15 cases were on the right side and 24 cases on the left. The course of disease was 40 minutes to 8 days (averaged 1.5 days). There were 7 cases with skateboard injured, 13 cases with stumble injured, 11 cases with falling injured,8 cases with air bed injured. According to Bado classification, 13 cases were type II, 22 cases were type III, 4 cases were type IV.

RESULTSThe distal forefinger showed exercise normally in 34 cases at 3 weeks after treatment, and the patients restored normal activities at 6 weeks after treatment. All patients were follow-up from 54 days to 6 months (averaged 67 days. According to Mayo elbow functional evaluation standard,the scoring result was 19.62±1.35 in activity, 45.00 ± 0.00 in pain, 9.87 ± 0.80 in stability, 25.00±0.00 in strength, 99.49 ±1.92 in total. The outcome of all patients was excellent and good evaluation results.

CONCLUSIONIf the anterior interosseous nerve injury could be identified early and treated timely, patients could gradually restore reasonable function and recover with satisfactory results. Raising understanding of anterior interosseous nerve injury can effectively reduce misdiagnosis.

Arm Bones ; injuries ; innervation ; surgery ; Child ; Child, Preschool ; Female ; Forearm Injuries ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Median Nerve ; injuries ; Monteggia's Fracture ; surgery

Case report form (CRF) is a key document for data collection in clinical trials. A well-designed CRF is required for database construction, data accuracy, data query/cleaning, CRF completion and statistical analysis. A well-defined process or SOP should be in place for CRF design. Data collection should fully meet the demand of study protocol. The layout of CRF should be clear with well-structured fields and standard coding for fields.
Clinical Trials as Topic ; standards ; Data Collection ; standards ; Documentation ; standards ; Research Design ; standards

Female ; Humans ; Male ; Nasal Septum ; abnormalities ; surgery ; Otorhinolaryngologic Surgical Procedures ; Rhinitis, Allergic, Perennial ; complications ; surgery ; Treatment Outcome