Objective To evaluate the value of dual energy computed tomography (DECT) for the diagnosis of gout.Methods Twenty-fivc consccutive patients with gout were selected as the experimental group and 20 patients with rheumatoid arthritis (RA) were selected as the control group.DECT scans were performed for every patient (all peripheral joints for the experimental group and affected joints for the control group).And every patient with gout had X-ray examination of the involved joints.x2 test and t-test were used for statistical analysis.Results All 25 patients with gout showed urate deposits on their DECT scans,whereas none of 20 controls showed urate deposits (P＜0.01).DECT scans revealed a total of 184 areas of urate deposition in 25 patients,in which 107 (58.2％) were at feet and ankle,72 (39.1％) were at knees,4 (2.2％) were at hands and wrists,1 (0.5％) was at elbows,whereas physical examination only showed 64 areas of urate deposition,in which 38(59.4％) were at feet and ankle,24(37.5％) were at knees,2(3.1％) at hands and wrists,0 was at elbows(P＜0.01 ).Only 6 patients with gout showed nonspecific manifestations on X-ray.Conclusion DECT scans may have potential value for the diagnosis of gout since it could produce evident colour displays for urate deposits and help to identify subclinical tophus deposits.

Objective To enhance the data quality of the front page of inpatient medical records.Methods Ten coders were engaged to perform manual quality control,and system verification rules were integrated for the basic information,diagnosis,treatment information,and hospitalization process information on the front page of inpatient medical records before and after the implementation of grid management.Results A total of 808 defects were found on the front pages of 728 inpatient medical re-cords.Among these deficiencies,basic information,diagnosis and treatment information,and process information accounted for 40.84％,3.96％,and 55.20％respectively.Totally,282 defects on the front pages of the 796 inpatient medical records man-aged under grid management.Among them,basic information,diagnosis and treatment information,and process information ac-counted for 39.00％,7.80％,and 53.19％,respectively.The overall defect rate was significantly decreased under grid manage-ment compared to the rate without it,(x2=6.553 5,P＜0.05).After the implementation of grid management,the numbers of the defects in admission condition,ID number incompletion,incision healing status,and coding were significantly decreased(P＜0.05).After the normalized coding of the ID number,the defect in ID number incompletion on the pages disappeared con-sequently.Conclusion Grid management reduces communication and feedback time,improves the data quality of the front page of inpatient medical records,and enhances problem-solving efficiency.It is important to coordinate the control of the data on the front pages of inpatient medical records to enhance standardization,consistency,and integrity.Moreover,it can also be applied to other areas of hospital management,offering scientific methods to optimize overall hospital operations.

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.

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*