Objective To investigate the safety of endoscopic suhmucosal dissection (ESD) in elderly patients with lesions of gastroesophageal mucosa. Methods Thirty-six elderly patients with flat elevation lesion of gastroesophageal mucosa were studied from July 2007 to May 2008. There were 14 cases with dysplasia, 9 cases with early carcinoma and 13 cases with leiomyoma confirmed by pathologic biopsy and endoscopic ultrasonography. All the patients were treated under consciousness condition, and the focus of lesion were completely resected with improved hook knife, IT knife and electrocoagulation or electro-cutting technique. The wound surface was managed with noradrenaline added in ice physiological saline, argon beam coagulator and metal clips. After operation, they were treated by abrosia, acid suppression and mucosa protection. The conditions of wound healing and residual lesions were reexamined four weeks after operation. Results Among the 36 patients (19 males and 17 females), there were 29 patients(80.6%) with complete focus ablation by ESD and 7 patients (19.4%) with resection by snare. Three cases (8.3%) of perforation occurred during operation and the perforations were treated with metal clips. After inserting stomach tube for fasting and anti-infection treatment for 5-7 days, all the three cases were recovered. One case(2.8%)had hematemesis 2 hours after operation and bleeding was stopped by endoscopic metal clip. Conclusions ESD is a safe and effective therapeutic tool in elderly patients with lesions of gastroesophageal mucosa.

Objective To discuss the safety of endoscopic sphincterotomy (EST) in treatment of choledocholithiasis in patients over 80 years.Methods From 2005 to 2007,893 patients with choledocholithiasis were divided into group A (n= 148,aged over 80 years) and group B (n=745,aged below 60 years).The clinical data,complications and EST successful rate were retrospectively reviewed between two groups.Results ① The important chronic concomitant diseases were significantly higher in group A than those in group B ( 29.3 % vs 8.1 % ,P＜0.01).② The EST successful rate in group A and B was 95.6% and 96.5%,respectively ( P＞0.05).③ Sixteen patients in group A had complications including 13 caused by EST itself,3 related with EST and one died of aspiration pneumonia.While in group B,41 complications were caused by EST itself and no EST related complications.There was a statistically difference in EST related complications between two groups (P < 0.01 ).In complications caused by EST itself,there was no difference between two groups (P 0.05 ).④ The average hospital stay was ( 7.2 ± 2.2) days in group A and (5.1 ± 1.4) days in group B with no significant difference (P 0.05),Conclusion The EST is safe and effective in treatment of patients over 80 years.

Clinical pathway management is an important part of public hospital reform, providing great significance for regulating medical behavior, improving medical quality, and controlling unreasonable medical expenses. In December 2020, a tertiary hospital conducted clinical pathway management practices based on clinical decision support systems. Through segmented design of clinical pathways, dynamic adjustment of pathway execution process, quality control throughout the entire process, and performance evaluation and continuous improvement, the management level of clinical pathways was comprehensively improved. After one year of practice, the hospital clinical pathway management based on clinical decision support systems had achieved good results. The average days of stay of patients decreased from 6.58 d in 2020 to 6.32 d in 2021, the proportion of admitted patients to discharged patients increased from 63.10% to 67.47%, the admission rate increased from 88.32% to 90.43%, and the variation rate decreased from 20.03% to 15.00%. This management practice provided a reference for public hospitals in China to improve the quality and efficiency of clinical pathway management.

Objective? To investigate the risks of malnutrition in patients with lung cancer during chemotherapy and to analyze their influencing factors. Methods? The inpatients with lung cancer receiving chemotherapy in the Department of Respiratory Medicine, Enze Medical Center from September 2017 to August 2018 were selected by convenient sampling. The 112 patients were divided into groups according to Nutrition Risk Screen (NRS) 2002. Their general information, diet and malnutrition risks were investigated successively. Logistic regression analysis was used to identify the influencing factors to malnutrition risks of the patients during chemotherapy. Results? Totally 112 patients completed the study. 28 of them showed no risk of malnutrition, while 84 had risks of malnutrition. There were statistically significant differences in age, place of residency, household monthly income, nutritional management, tumor staging, intake of protein and fat, nausea, emesis and diarrhea between two groups with different nutrition conditions(P＜ 0.01). Logistic regression analysis revealed that age, place of residency,monthly income, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea were the risk factors of malnutrition in patients with lung cancer during chemotherapy. Conclusions? Patients with lung cancer are at high risk of malnutrition during chemotherapy. Age, nutritional management, tumor staging, intake of protein, nausea, emesis and diarrhea are the risk factors of malnutrition in patients during chemotherapy. Effective nutritional management intervention shall be made for patients as early as possible, so as to reduce the incidence and worsening of malnutrition and improve patients' effects and quality of life.

Transportation service is an important part of hospital logistics management. In 2023, a tertiary hospital centered on patient service and guided by lean management, launched an intelligent transportation service in the " Didi" mode on the basis of the medical internet of things platform. This practice investigated the status of hospital transportation services and developed an intelligent transportation system that includes three subsystems: task reception and generation, dispatch and command of transportation center, and handheld computer accepting order. At the same time, standardized business processes were developed and transportation service performance evaluations were implemented. This practice had gradually piloted and achieved intelligent management of hospital transportation services. As of December 2023, the hospital had completed a total of about 310 thousand transportation tasks, of which 70% were intelligent system dispatching tasks. The timely delivery service rate had increased from 58% in 2022 to 98% in 2023. This practice had improved the quality and efficiency of transportation services, promoted the high-quality development of hospital logistics management, which could provide references for other hospitals to improve logistics management efficiency.