Objective To learn the burnout and turnover intention of physicians from township hospitals in Xi County,Henan province,for reference of health administrators and healthcare institution managers.Methods Cluster sampling method and qualitative interviews were used and all physicians from such hospitals were sampled for questionnaire survey in 2014,with 1 70 scales distributed.The questionnaire was the Markov Burnout Inventory generic version revised by Li Chaoping,and turnover intention questionnaire was that revised by Liang Kaiguang.Results 140 physicians from such hospitals were found with zero or low burnout (94.6%);Collaborative care in the county poses great positive effect on promoting professionalism and interpersonal relations, yet has limited positive impact on reducing workload and performance appraisal stress and increasing their income.Conclusion It is imperative to enhance training of managers of such hospitals for them to learn the appraisal method with organizational scale,and build a humanistic concern mechanism for physicians,for purposes of improving the organizational environment and minimize the burnout and turnover intention of the physicians.

Tourette syndrome is a neuropsychiatric disorder characterized by the presence of both multiple motor and vocal tics. The pathogenesis is obscure . Infection and the immunologic abnormality after infection may be associated with this disease.The major study is about streptococcal infection. Interleukin may play an important role. Morever, some studies indicate that Mycoplasma pneumoniae infection is related to the Tourette syndrome.

Diagnosis related groups (DRGs)have been widely used in many countries and regions.The versions of DRGs in different regions are modified according to the local circumstances and conditions.Beijing version DRGs (BJ-DRGs)is the first DRGs system in Chinese,which was developed locally based on the conditions of medical information system and health relative policies in Beijing.This paper introduced the grouping principles,logic and methodology of BJ-DRGs.Taking“ear,nose,mouth and throat disorders”for example,this paper demonstrated the grouping process of BJ-DRGs.

Objective To investigate the effect of the personalized nursing care plan sheet for critically ill patients in the emergency intensive care unit. Methods The personalized nursing care plan sheet including general, personalized nursing issues and related measures was designed according to the standard from the nursing department. A group of 116 critically ill patients were divided into the observational group (58 patients) and control group (58 patients) from January 2012 to September 2014. The personalized nursing care plan sheet were applied for record and hand over in the observational group, while the unified problem statement nursing care plan sheet were used in the control group. The indicators of nursing quality were observed in the two groups and the nurses′satisfaction with the nursing care plan sheets was compared. Results The nursing quality in the observational group was higher than it in the control group with the lower incidence of failure rate in fundamental nursing, professional nursing, plan sheet, disease treatment and adverse event (32.76% vs. 62.07%,37.93% vs. 67.24%,29.31% vs. 68.97%, 20.69% vs. 53.45%, 10.34% vs. 72.41%, the χ2 values were 2.98, 2.98, 4.09, 3.46 and 6.60 respctively, P<0.05). The nurses′satisfaction with the personalized nursing care plan sheet was also higher than the unified problem statement nursing care plan sheet (P<0.05). Conclusion The incidence of nursing defects could be reduced by avoiding the incomplete nursing assessment and omitted nursing plan.

Digestive tract reconstruction after proctocolectomy is a critical step of colorectal surgery, proper reconstruction can promote the recovery of digestive tract function and improve the quality of life.At present, there are some candidate reconstruction methods after proctocolectomy, but standardized and proper one is not still established.Since there are differences of the reconstruction methods after proctocolectomy at the different parts of colorectum, the best reconstruction methords should be selected according to the condition and intraoperative situation of patients.

Objective To improve the diagnosis and treatment for malignant adrenal tumors. Methods Clinical data of 50 cases of malignant adrenal tumors were retrospectively analyzed.Of them 7 cases of corticoadrenal carcinoma with endocrine function presented with relevant symptoms and endocrine abnormality.Among 23 cases of malignant pheochromocytoma high blood pressure existed in 19 and 18 had a high level of urinary catecholamine.Fifteen cases had corticoadrenal carcinoma without endocrine function and 5 cases developed adrenal metastic carcinoma.All of the patients underwent endocrinological and image examination before operation. Results Among the 27 cases of corticoadrenal carcinoma or metastasis,25 were confirmed by pathology and 2 were confirmed during follow-up.Of the 23 patients who were diagnosed as malignant pheochromocytoma,11 were confirmed to have extensive tumorous infiltration or metastasis by imaging procedures and operations and 12 were detected by follow-up to have metastasis.Tumors were resected in 14 cases of corticoadrenal carcinoma,8 of whom survived for 1～5 years.Twelve cases of malignant pheochromocytoma underwent radical operations with a survival of 1～14 years. Conclusions Most cases of corticoadrenal carcinoma can be diagnosed by pathology or image findings of metastasis.Pheochromocytoma is more likely to be malignant when it recurs,expecially for the extro-adrenal pheochromocytoma.The diagnosis of malignant pheochromocytoma must depend on the evidence of tumorous infiltration or invasion of the tissue without para ganglions found by imaging procedures or pathology.The prognosis of the late-stage corticoadrenal carcinoma is poor.For the cases of late-stage malignant pheochromocytoma dibenzyline or 131 I-MIBG treatment can extend their lives.

The development of laparoscopic techniques has made surgical treatment enter into the era of minimally invasive surgery,and the application of three-dimensional (3D) high-definition laparoscopic system has brought the important innovation for laparoscopic techniques,meanwhile,it also provides stereoscopic visions and more accurate spatial orientation for surgeons.During the process of laparoscopic radical resection of lower rectal cancer,3D vision can help to identify blood vessels,nerve and tissues around the rectum,ensure accurate lymph node dissection,reduce difficulty of operation,and the learning curve of laparoscopic radical resection of lower rectal cancer for inferior surgeons might be shorten by using 3D imaging system.With the development of technology,the value on clinical application of 3D high-definition laparoscope will become more evident.

Objective To investigate the adverse reactions induced by statins when combined with other drugs and its influencing factors,so as to provide reference for clinical rational drug use.Methods The clinical data of 78 patients with adverse reactions caused by statins combined with other drugs in our hospital from June 2011 to June 2016 were reviewed and analyzed.Results The adverse reactions of the 78 cases of patients were manifested as muscle toxicity,liver toxicity,digestive discomfort,respiratory discomfort,et al; Inwhich muscle toxicity and liver toxicity were the most common adverse reactions.The incidence rate of rhabdomyolysis was 20.51％,which was significantly higher than that of the other adverse reactions(P<0.05).The incidence rates of adverse reactions induced by simvastatin and atorvastatin were 44.87％and 28.21％,significantly higher than other statins(P<0.05).The incidence of side effects was the highest(30.77％)when the statins combined with antihypertensive drugs and anti myocardial drugs,and the incidence of adverse reactions was 20.51％when combined with lipid-lowering drugs.Conclusion The adverse reaction rate is relatively high when statins,especially simvastatin and atorvastatin combined with antihypertensive,anti-myocardial and lipid-lowering drugs,and the adverse reactions to liver toxicity and muscle toxicity are the main performance.Therefore a standardized and rational medication regimen should be made based on the clinical characteristics of patients and the type of drug in the clinical use of statins,in order to reduce the incidence of adverse reactions to the maximum limit.

Objective To explore prognostic relative factors of different therapy for patients with intracrani-al aneurysm. Methods In 93 intracranial aneurysm patients, 38 cases were managed through craniotomy, in whom the effects of operation time, intraoperative aneurysmal rupture(IAB), temporary arterial occlusion (TAO)on 30-day and 6-month prognosis were investigated; while other 67 cases experienced endovascular treatment,in whom the simi-lar parameters of the different therapy, types of endovascular treatment, and intracranial aneurysm embolization were evaluated. 30 days and 6 months prognosis were regarded as the dependent variable, and SPSS for Windows 11.5 was adopted for data processing. Chi-Square test was performed. Results IAR exerted significant difference to 30 days and 6 months prognosis in patients undergoing craniotomy and clipping, there were 42 intracranial aneurysm, of which 16 aneurysm ruptured (χ2 = 5. 203,10. 886, P < 0.05 ). For patients undergoing endovascular treatment, the new ma-terial application could improve 6 months prognosis, in whom there were totaly 74 intracranial aneurysm, of which 23 aneurysm were managed by the use of old material for endovascular treatment and 51 aneurysm were managed by the use of new material for endovascular treatment(χ2 = 5. 544 and RR = 2. 364,95% CI 1. 197～4.669 ,P < 0.05 ). Un-successful ratio in the endovascular treatment was reduced simultaneously,from 43.5% (old material group) to 18.0% ( now material group) (χ2 = 5. 542,P < 0.05). Conclusions IAR is the important risk factor, which effects 30 days or 6 months prognosis of patients with intracranial aneurysms managed through craniotomy and clipping. The new material application in the endovascular treatment improves 6 months prognosis, meanwhile unsuccessful ratio in the endovascular treatment is reduced simultaneously.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Chronic Disease ; therapy ; Female ; Humans ; Male ; Middle Aged ; Pterygopalatine Fossa ; innervation ; Rhinitis ; physiopathology ; therapy ; Smell ; Treatment Outcome ; Young Adult