Objective:To analyze the operational effectiveness of a multi-medication management and consultation service platform for elderly patients based on quality function deployment (QFD) and “Internet+”.Methods:It was a non-randomized controlled trial. A total of 100 elderly patients were selected from the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University from September to November 2023 with convenience sampling method. The medication management was carried out through the multiple medication management and counseling service platform for the patients based on QFD and “Internet+”. The core modules included reminder module, evaluation module, consultation module and popularization module. A self-designed satisfaction questionnaire was used to collect the satisfaction scores of hospital service quality, medication adherence, medication knowledge, and medication safety before and one month after the platform was implemented. A total of 100 questionnaires were distributed, and 100 valid questionnaires (100%) returned. The t-test was used to analyze the differences between the satisfaction scores before and after the operation of the platform to evaluate the operation effects. Results:Among the 100 elderly patients with multiple medications included in the analysis, 65 were male and 35 were female, 84 patients had a combination of ≥2 chronic diseases. The patients aged (68.73±5.99) years, and the number of medications they were taking was (7.65±1.04). The scores of hospital service quality, medication adherence, medication knowledge, and medication safety after the application of the platform were all significantly higher than those before the launch of the platform [(3.66±0.48) vs (2.91±0.70) points, (3.90±0.30) vs (1.30±0.46) points, (3.39±0.49) vs (3.02±0.63) points, (3.75±0.44) vs (1.48±0.59) points](all P<0.05). Conclusion:The multiple medication management and consultation service platform for elderly patients based on QFD and “Internet+” can enhance the scientific management of multiple medication in elderly patients, reduce the burden of medication, improve the quality of medical services, and promote the development of intelligent elderly care services.

Objective:To analyze the operational effectiveness of a multi-medication management and consultation service platform for elderly patients based on quality function deployment (QFD) and “Internet+”.Methods:It was a non-randomized controlled trial. A total of 100 elderly patients were selected from the Department of Neurology of the First Affiliated Hospital of Wenzhou Medical University from September to November 2023 with convenience sampling method. The medication management was carried out through the multiple medication management and counseling service platform for the patients based on QFD and “Internet+”. The core modules included reminder module, evaluation module, consultation module and popularization module. A self-designed satisfaction questionnaire was used to collect the satisfaction scores of hospital service quality, medication adherence, medication knowledge, and medication safety before and one month after the platform was implemented. A total of 100 questionnaires were distributed, and 100 valid questionnaires (100%) returned. The t-test was used to analyze the differences between the satisfaction scores before and after the operation of the platform to evaluate the operation effects. Results:Among the 100 elderly patients with multiple medications included in the analysis, 65 were male and 35 were female, 84 patients had a combination of ≥2 chronic diseases. The patients aged (68.73±5.99) years, and the number of medications they were taking was (7.65±1.04). The scores of hospital service quality, medication adherence, medication knowledge, and medication safety after the application of the platform were all significantly higher than those before the launch of the platform [(3.66±0.48) vs (2.91±0.70) points, (3.90±0.30) vs (1.30±0.46) points, (3.39±0.49) vs (3.02±0.63) points, (3.75±0.44) vs (1.48±0.59) points](all P<0.05). Conclusion:The multiple medication management and consultation service platform for elderly patients based on QFD and “Internet+” can enhance the scientific management of multiple medication in elderly patients, reduce the burden of medication, improve the quality of medical services, and promote the development of intelligent elderly care services.

Objective To explore the correlation between serum glycosylated hemoglobin(HbA1c),lym-phocyte activation gene-3(LAG-3)and thyroid nodules in patients with type 2 diabetes mellitus(T2DM).Methods A total of 120 T2DM patients with thyroid nodules admitted to the Third Hospital of Hebei Medi-cal University from July 2021 to July 2022 were included as the study group,and 100 simple T2DM patients(without thyroid nodules)were included as the control group during the same period.According to the patho-logical examination results of thyroid nodules,the study group was grouped into a benign nodule group(85 ca-ses)and a malignant nodule group(35 cases).Enzyme linked immunosorbent assay was applied to detect the serum LAG-3 level of all study subjects.Fully automated glycated hemoglobin analyzer was applied to detect HbA1c level in all study subjects.Spearman method was applied to analyze the correlation between serum HbA1c,LAG-3,and thyroid imaging report and data system(TI-RADS)scores in patients with T2DM and thyroid nodules.Multivariate Logistic regression was applied to analyze the influencing factors of T2DM with thyroid nodules.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of HbA1c and LAG-3 levels in T2DM with thyroid nodules.Results Compared with the control group,the level of HbA1c in the study group was obviously higher(P<0.05),while the level of LAG-3 was obviously lower(P<0.05).Compared with the benign nodule group,the serum LAG-3 level in the malignant nodule group was obviously lower(P<0.05),while the level of LAG-3 was obviously lower(P<0.05).Spearman analysis showed a positive correlation between HbA1c level and TI-RADS score in T2DM patients with thyroid nod-ules(r=0.378,P<0.001),while the serum LAG-3 level was negatively correlated with TI-RADS score(r=-0.472,P<0.001).The results of multivariate Logistic regression analysis showed that HbA1c was a risk factor for the occurrence of thyroid nodules in T2DM patients(P<0.05),and LAG-3 was a protective factor for the occurrence of thyroid nodules in T2DM patients(P<0.05).The combination of HbA1c and LAG-3 in the diagnosis of T2DM with thyroid nodules was superior to their individual diagnosis(Zcombination-HbA1c=2.542,P=0.011;Zcombination-LAG-3=3.098,P=0.002).Conclusion Patients with T2DM combined with thyroid nodules have obviously lower serum LAG-3 level and higher HbA1c level,and the two are related to the malignancy of thyroid nodules.

Objective To investigate the habits of eye rubbing and sleeping posture of patients with keratoconus(KC)and analyze the correlation of the onset and severity of KC with eye rubbing and sleeping posture.Methods In this retrospective case-control study,KC patients who received diagnosis and treatment in the Eye Hospital of Shandong First Medical University from January 2018 to June 2022 were collected as the KC group,and myopia patients with matching ages and sexes who visited our hospital from February to June 2022 were recruited as the control group.All patients were inves-tigated by questionnaire and the details of eye rubbing,sleeping posture and related habits were recorded.According to the severity of the disease(corneal curvature),KC patients were divided into different stages,and the eye rubbing and sleep-ing posture of KC patients in different stages were compared.Results In this study,406 KC patients and 394 myopia pa-tients were included.It was found that 67.98％of KC patients and 24.87％of myopia patients rubbed their eyes,with a sig-nificant difference(P＜0.001);45.32％of KC patients and 24.87％of myopia patients were accustomed to sleeping on their side or stomach,with a significant difference(P＜0.001).The multivariate binary logistic regression analysis indica-ted that the following variables showed significant differences:patients with eyes at the later stages(steeper eyes)were more likely to rub eyes[odds ratio(OR)=3.547,95％CI:2.02-6.24,P＜0.001],sleep on side or stomach(OR=10.725,95％CI:5.77-19.94,P＜0.001),and turn head to the steeper eye when sleeping(OR=12.171,95％CI:7.23-20.49,P＜0.001).The statistical analysis demonstrated that the proportion of KC patients at the IV stage who were habitu-ated to rub their steeper eyes and turn their heads to the steeper eyes when sleeping was significantly higher than that of pa-tients at stages Ⅰ to Ⅲ(all P＜0.001).Conclusion Eye rubbing and sleeping on the side or stomach are risk factors for the onset of KC and are related to the severity of the disease.

As a safety culture placed between a culture of punishment and that of exemption, just culture can effectively improve the reporting rate of medical adverse events, promote medical staff to learn from events, and continuously improve patient safety management. The authors searched for literature on the study of just culture in medical institutions both domestically and internationally, including such databases as CNKI, Wanfang Data, and PubMed from 2001 to January 2023. They reviewed the concept of just culture and its connotation in the field of patient safety management, as well as the current research status of just culture in medical institutions both domestically and internationally. On such basis, they proposed for the construction of just culture in medical institutions in China, for reference in the construction and evaluation of a just culture in such institutions.

Objective To investigate the effects of sex hormone-binding globulin (SHBG)gene in the apoptosis of human trophoblastic cells.Methods The siRNA specific-targeting SHBG gene was transfected into human trophoblastic cells and they were divided into six groups:trophoblasts without transfection in normal control groups(group Ⅰ);transfect liposome in blank control groups(group Ⅱ);transfect nonspecific siRNA in negative control groups(group Ⅲ);transfect SHBG siRNA-Ⅰ,SHBG siRNA-Ⅱ,SHBG siRNA-Ⅲ respectively in trans-fection group(group Ⅳ,Ⅴ,Ⅵ).Hoechst 33258 dying method was used to detect cell apoptosis.SHBG and Caspase-3 mRNA profiling and the level of SHBG and caspase-3 protein were detected by real-time PCR and Western blot.Results There was no statistical significant difference in the gene expression and protein level of SHBG and caspase-3 in group Ⅰ,Ⅱ and Ⅲ (P >0.05).In Ⅳ,Ⅴ and Ⅵ group,there was no statistical significant difference in the expression level of SHBG and caspase 3 (P >0.05).Compared with group Ⅰ,Ⅱ and Ⅲ,the a-mount of SHBG gene expression decreased obviously,the caspase-3 mRNA and protein level increased obviously and the trophoblast cell ap-optosis increased markedly (P <0.05).Conclusion Through siRNA interference technology can reduce SHBG gene expression in human trophoblastic cells,and it can lead to excessive apoptosis of human trophoblasts cells.