Objective:To explore the effects of quality control circle(QCC) on the complaint management and patient satisfaction in the medical insurance center.Methods:We set up QCC,defined the subject,identified the problems and made the cause analysis,made the countermeasures and implemented them.Results:Mter QCC ac-tivities,patients'major unsatisfactory factors such as long waiting time and poor staff coordination ability were signif-icantly improved.In addition,patient complaints decreased significantly (P ＜ 0.01).Conclusion:The application of QCC management on patient complaints can not only increase patient satisfaction,but also provide an importantway for the hospital to build up the brand.

Objective To investigate the effects of ropivacaine infiltration combined with dezocine on the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.Methods Sixty patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,undergoing elective neurosurgery under general anesthesia,were randomly divided into 4 groups (n =15 each) using a random number table:control group (group C),ropivacaine group (group R),dezocine group (group D),and ropivacaine + dezocine group (group RD).Group C received local infiltration with normal saline 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and normal saline 2 ml was injected intravenously at 30 min before the end of operation in group R.Group D received local infiltration with normal saline 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation.The patients received local infiltration with 0.5％ ropivacaine 20 ml at 10 min before skin incision,and dezocine 10 mg was injected intravenously at 30 min before the end of operation in group RD.The time for recovery from anesthesia,extubation time,and development of agitation after extubation in PACU were recorded.Agitation was assessed and scored.Ramsay sedation score and VAS score were recorded immediately after extubation.The development of cardiovascular events and respiratory depression was recorded within 10 min after extubation.Before induction of anesthesia (T0),at the end of surgery (T1) and immediately after extubation (T2),blood samples were collected from the dorsal artery of foot for deter mination of the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine.Results Compared with group C,the agitation score,incidence of agitation,VAS score,and incidence of postoperative hypertension were significantly decreased in R,D and RD groups,especially in R and D groups.The time for recovery from anesthesia and time for extubation were significantly shorter in R and RD groups than in group C.Ramsay sedation scores were significantly higher at the onset of extubation in R,D and RD groups than in group C.Ramsay sedation scores were significantly higher in D and RD groups than in group R.Compared with group C,the levels of blood glucose,plasma cortisone,epinephrine and norepinephrine were significantly decreased in R,D and RD groups,especially in group RD.Conclusion Ropivacaine infiltration combined with dezocine can reduce the agitation during recovery from general anesthesia in the patients undergoing cerebral surgery.

Objective:To explore the effectiveness of humanism concept in the management of patients with spi-nal cord injury care.Methods:Choose between January 2011 and February 2011 hospitalized in our hospital 112 cases of spinal cord injury patients, randomly divided into control group and observation group ( 56 cases) , com-pared two groups of nursing effect.Control group routine nursing management, observation group will humanistic nursing management idea runs through in the routine nursing management.Results:Aware of knowledge about health education group is significantly higher than the control group, patients satisfaction survey in nursing, be-tween the two groups statistically significant depression levels lower than the control group.Conclusions:In the nursing management of patients with spinal cord injury in the application of humanistic nursing concept effect is good, not only improve the effect of the nursing, and obviously improve the patient′s satisfaction, promote the pa-tient′s psychological adaptability.

Objective: To investigate the clinical features and reliable diagnostic method in HIV/AIDS patients with smear negative pulmonary tuberculosis (TB). Methods: Clinical data of 112 HIV/AIDS patients complicated with smear negative pulmonary TB who were treated in our hospital from January 2013 to September 2015 were retrospectively analyzed. These clinical data includeded clinical symptom, blood routine test, blood biochemistry, T lymphocyte subsets classification, sputum acid-fast bacillus smear, mycobacterium tuberculosis culture, purified protein derivatives tuberculin (PPD) test, interferon gamma-release assay for Mycobacterium tuberculosis (T-SPOT.TB), TB-DNA and chest computed tomography (CT). Diagnostic specificity and sensitivity of these parameters were analyzed. Results: No specific clinical manifestation of these patients was identified. The chest CT feature was also atypical. The positive rates including T-SPOT, TB, TB-DNA and PPD test were all low. The positive rates of T-SPOT.TB and PPD test in patients with a CD4+ cell count >200 cells/μl was significantly higher than that of patients with a CD4+ cell count ≤50 cells/μl and 51≤CD4≤200 cells/μl (P<0.01). Conclusions The clinical feature of smear negative pulmonary TB in HIV/AIDS patients is atypical. For a definite diagnosis, a comprehensive analysis with clinical manifestations, laboratory test, imaging examination and etiologic detection is required.

Objective:To analyze the sleep quality before treatment and related risk factors of sleep disorder in patients with nasopharyngeal carcinoma (NPC). Methods: Totally 143 patients first diagnosed as nasopharyngeal carcinoma were selected [ average age (43 ± 10) years, 100 males and 43 females] in a NPC ward of one hospital, the Chinese version of Pittsburgh Sleep Quality Index (PSQI, total score ＞ 5 diagnosed as sleep disorder) was used to investigate the sleep quality before treatment, and the logistic regression analysis was used to analyze related factors of the sleep disorder before treatment Results: The rate of sleep disorder was 50.3％. The logistic regression analysis showed that age was a risk factor of sleep disorder before treatment in patients with NPC (OR = 1.04, 95％ CI: 1.01-1.08), while gender, culture degree, clinical stage, body mass index were not correlated with sleep disorder (Ps＞0.05). Conclusion: It suggests that patients with NPC may have a higher incidence of sleep disorder before treatment, and older patients may be more prone to pre-treatment sleep disorder.

Objective:To investigate the differential diagnostic value of 18F-FDG PET/CT in multiple myeloma (MM) and unknown osteolytic metastasis (UOM). Methods:A retrospective study was performed on 18F-FDG PET/CT imaging of 43 patients (29 males, 14 females, age: (61.5±12.9) years) with multiple bone destructions and without extraosseous primary malignant tumor between June 2017 and March 2020 in Tenth People′s Hospital of Tongji University. Through follow-up, 20 patients (13 males, 7 females, age: (61.1±12.2) years) were pathologically confirmed as MM and 23 patients (16 males, 7 females, age: (61.4±13.9) years) were pathologically confirmed as UOM. The whole body skeleton was categorized to 8 sites including skull, spine, ribs, pelvis, sternum, clavicle, scapula and limb bone. The differences of the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent were compared between the two groups in different parts. Independent-sample t test and Mann-Whitney U test were used to analyze data. Results:The UOM group was invisible on clavicles, and spine and pelvis were the most predilection sites in both MM and UOM groups (spine: 41.30%(299/724) and 49.37%(117/237); pelvis: 24.45%(177/724) and 26.58%(63/237)). The cross-sectional length of lesions in the skull, spine, ribs, pelvis and limb bone in MM group were significantly shorter than those in UOM group (5.45(4.30, 8.06) vs (13.89±11.66) mm, 6.15(3.89, 10.06) vs 11.48(7.73, 16.90) mm, 7.01(4.59, 10.56) vs (24.61±16.22) mm, 8.20(5.14, 13.71) vs (21.12±13.31) mm, (8.48±5.75) vs (19.13±14.26) mm; z values: from -8.88 to -2.52, t=-2.76, P<0.001 or P<0.05) and SUV max of above lesions and scapula in MM group were significantly lower than those in UOM group (1.50(1.00, 2.20) vs 17.15±11.40, 2.60(2.00, 4.10) vs 8.20(5.65, 11.90), 2.30(1.40, 5.28) vs 10.58±5.52, 2.50(1.80, 3.90) vs 9.34±6.01, 3.08±2.41 vs 11.38±6.38, 2.45(1.50, 4.43) vs 6.90(4.63, 17.80); z values: from -13.87 to -2.41, t=-4.85, P<0.001 or P<0.05). The imaging agents in lesions on the skull, spine, ribs, pelvis, scapula and limb bone were more evenly distributed in MM group, while the imaging agents in lesions were more unevenly distributed in UOM group. On the skull, spine and ribs sites, the MM group was more likely to show no cortical bone damage; however, the UOM group showed cortical bone damage in the above sites. Conclusion:It is helpful for doctors to distinguish MM and UOM by comparing the cross-sectional length of the lesion, cortical bone damage, SUV max and the distribution of imaging agent in 18F-FDG PET/CT imaging before getting pathologic results.

Insomnia is a common disorder in the elderly and seriously affects life quality of the elderly.This article reviews the efficacy and safety of pharmacological agents for the treatment of insomnia in the elderly, in order to provide a reference for clinical practice.

Objective To investigate a diabetic retinopathy ( DR ) detection algorithm based on transfer learning in small sample dataset. Methods Total of 4465 fundus color photographs taken by Gaoyao People ' s Hospital was used as the full dataset. The model training strategies using fixed pre-trained parameters and fine-tuning pre-trained parameters were used as the transfer learning group to compare with the non-transfer learning strategy that randomly initializes parameters. These three training strategies were applied to the training of three deep learning networks:ResNet50,Inception V3 and NASNet. In addition,a small dataset randomly extracted from the full dataset was used to study the impact of the reduction of training data on different strategies. The accuracy and training time of the diagnostic model were used to analyze the performance of different training strategies. Results The best results in different network architectures were chosen. The accuracy of the model obtained by fine-tuning pre-training parameters strategy was 90. 9％,which was higher than the strategy of fixed pre-training parameters (88. 1％) and the strategy of randomly initializing parameters ( 88. 4％) . The training time for fixed pre-training parameters was 10 minutes,less than the strategy of fine-tuning pre-training parameters ( 16 hours ) and the strategy of randomly initializing parameters (24 hours). After the training data was reduced,the accuracy of the model obtained by the strategy of randomly initializing parameters decreased by 8. 6％ on average,while the accuracy of the transfer learning group decreased by 2. 5％ on average. Conclusions The proposed automated and novel DR detection algorithm based on fine-tune and NASNet structure maintains high accuracy in small sample dataset,is found to be robust,and effective for the preliminary diagnosis of DR.

Objective: To observe the effect of clean water perineum nursing in preventing urinary catheter-associated urinary tract infection. Methods: From October 2015 to October 2016, 160 patients with indwelling urinary catheter were selected from the first affiliated Hospital of Shantou University Medical College, ICU and neurosurgery ICU. According to the order of admission, the patients were randomly divided into experimental group and control group. A total of 80 patients in the experimental group received clean water perineal nursing, while 80 patients in the control group received routine perineum nursing with 0.5% iodophor. The incidence of urinary tract infection was compared between the two groups on day 3rd, 7th and14th after indwelling urethral catheter. Results: In the control group, the incidence of urinary tract infection on day 3rd, 7th and14th was 0, 1.3%(1/80) and 5.0%(4/80), respectively. In the experimental group, the incidence of urinary tract infection on day 3, 7 and 14 was 0, 2.5% (2/80) and 3.8%(3/80). The difference was not statistically significant (χ²=0.340, 0.149, P> 0.05). Conclusions Using clean water perineum nursing does not increase the incidence of urinary tract infection. This method is simple, effective, and has no adverse reactions. It is worth popularizing in clinic because it can reduce the consumption of iodophor disinfectant and reduce the workload of nurses.

Neutrophil to lymphocyte ratio (NLR) can provide information of local or systemic inflammation and immune status. With the increasing attention to the role of inflammatory and immune factors in vascular cognitive impairment (VCI), it is very important to find new serum inflammatory markers for early identification and intervention of VCI. This article reviews the related research on NLR, VCI and their risk factors, expounds the role of inflammation in the pathogenesis of VCI, and provides help for the diagnosis and prevention of VCI.