Objective To investigate the effect of limitation in flow of people on medical care quality in emergency resuscitation room (ERR).Methods This study was retrospectively performed to compare emergency medical quality before and after (October to December,2015 vs.February to April,2016) limitation of flow of people in ERR.Variables included noise level,occupational exposure,adverse event,hospital-acquired infection,length of stay (LOS) in ERR,mortality rate,return of spontaneous circulation (ROSC) rate after cardiopulmonary resuscitation (CPR),the rate of unexpected return to ERR,door to drug and door to balloon time for patients with ST-segment elevated myocardial infarction (STEMI),patients' and emergency personnels' satisfaction level.The data were analyzed with t-test,chi-square test or Poisson Z test where appropriate.Results There were 5 031 and 5 097 patients respectively admitted in ERR before and after limitation of flow of people.Patients' main diagnoses and severity of illness between the two periods had no significantly difference (P＞0.05).After the limitation of flow of people,the noise level in ERR was lowered (P＜0.01),the numbers of occupational exposure events (14 cases vs.4 cases,Z=2.357,P=0.018) and adverse events (18 cases vs.5 cases,Z=2.711,P=0.007) were decreased,the rate of hospital-acquired infection was reduced (1.1％ vs.0.5％,x2=8.111,P=0.004),the LOS in ERR was shortened [(6.3±0.8) h vs.(4.6±0.6) h,t=121.083,P＜0.01],the door to balloon time for STEMI patients was also decreased [(91.2±12.8) min vs.(89.3±8.0) min,t=2.486,P=0.013].Moreover,patients' and emergency personnels' satisfaction level were elevated.No significant difference was observed in mortality rate,ROSC rate,rate of unexpected return to ERR and door to drug time for STEMI patients.Conclusions The limitation of flow of people in ERR can lower the noise level,reduce emergency personnels' working pressure,improve their working efficiency,avoid medical errors,elevate patients' and emergency personnels' satisfaction level.

Objective:To investigate the predictive value of controlling nutritional status (CONUT) score in the prognosis of patients with advanced diffuse large B-cell lymphoma (DLBCL).Methods:A retrospective case series study was performed. The clinical data of 654 patients newly diagnosed with advanced DLBCL diagnosed in 7 medical centers in Huaihai Lymphoma Working Group from October 2009 to January 2022 were retrospectively collected. All the patients received rituximab-based immune chemotherapy regimens. The patients were randomly assigned to the training set (458 cases) and the validation set (196 cases) in a 7:3 ratio. The clinicopathological data of patients were collected, and the CONUT score was calculated based on albumin, lymphocyte count, and total cholesterol. The optimal critical value of CONUT scote was determined by using MaxStat method. Kaplan-Meier method was used to draw survival curves; Cox proportional hazards model was used to make univariate analysis and multivariate analysis on the factors influencing overall survival (OS). The efficacy of CONUT score in combination with the International prognostic index (IPI) and an enhanced IPI (NCCN-IPI) in predicting OS was evaluated by using receiver operating characteristic (ROC) curves.Results:The median follow-up time of 654 patients was 38.1 months (95% CI: 35.3 months- 40.9 months), and the 5-year OS rate was 49.2%. According to the MaxStat method, the optimal critical value for CONUT score was determined to be 6 points. All the patients were classified into the normal nutritional status group (CONUT score ≤ 6 points, 489 cases) and the poor nutritional status group (CONUT score > 6 points, 165 cases). The results of the multivariate analysis showed that CONUT score > 6 points, male, lactate dehydrogenase >240 U/L, high white blood cell count, low hemoglobin level and age > 60 years were independent risk factors for OS of patients with advanced DLBCL (all P < 0.05). Patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group in the overall cohort of advanced DLBCL. Subgroup analysis revealed that among patients with Eastern Cooperative Oncology Group-performance status (ECOG PS) score < 2 points, IPI low-intermediate risk, IPI intermediate-high risk, NCCN-IPI low-intermediate risk, and NCCN-IPI intermediate-high risk, the patients in the poor nutritional status group (CONUT score > 6 points) had worse OS compared with that in the normal nutritional status group (CONUT score ≤ 6 points) (all P < 0.05). Conclusions:CONUT score has a certain value in the assessment of the prognosis of patients with advanced DLBCL, and its predictive efficacy is further improved when combined with IPI and NCCN-IPI.