emphysema(9.7%)、pneumonia(6.2%),every group has obvious difference(P

OBJECTIVE:To evaluate the application effects of PDCA cycle management in the outpatient prescription intervention.METHODS:A total of outpatient prescriptions (pre-intervention group) during Jan.-Dec.2014 and 918 659 (intervention group) were selected during Jan.-Dec.2015 were selected from a hospital.Irrational 9utpatient prescriptions were analyzed before and after the application of PDCA cycle management,and the improvement of main indexes were compared such as unsuitable usage and dosage,incomplete clinical diagnosis writing,no physicians' signature on the prescription or inconsistent with sample.RE SULTS:Before intervention,there were 2 347 irrational prescriptions,including 1 401 nonstandard prescriptions,849 unsuitable prescriptions and 97 abnormal prescriptions.After intervention,there were 1 161 irrational prescriptions,including 695 nonstandard prescriptions,425 unsuitable prescription and 41 abnormal prescriptions,decreasing 50.53％,50.39％ 49.94％ and 57.73％,respectively.The proportion of unsuitable usage and dosage,incomplete clinical diagnosis writing,no physicians' signature on the prescription or inconsistent with sample,nonstandard prescription paper,unsuitable indications,no signature and date for prescription revision or no reason and new signature for overdose use,outpatient prescriptions more than 7 d common dose or emergency prescriptions more than 3 d common dose without special situation in total amount of outpatient prescriptions decreased from 0.72‰,0.57‰,0.45‰,0.27‰,0.20‰,0.19‰ and 0.15‰ before intervention to 0.32‰,0.25‰,0.19‰,0.11‰,0.09‰,0.08‰ and 0.07‰ after intervention.CONCLUSIONS:PDCA cycle management significantly improves the quality of outpatient prescriptions.There still are irrational outpatient prescriptions in this hospital,and it is to be intervened continuously.

Homocysteine ( Hcy) is an independent risk factor for a variety of diseases and closely related to cardiac-cerebralvascu-lar diseases, neurological diseases, diabetes and diabetic com-plications. High homocysteine levels can significantly increase the recurrence risks of cardiac-cerebralvascular events and stroke in patients with stroke, leading to high all-cause mortality. The risk of Alzheimer’s disease is increased by 1. 8 fold when the concentration of Hcy is over 14 μmol·L-1 . For each 5 μmol· L-1 increase in plasma Hcy in diabetes patients, the mortality rate increases by 5 fold in the next five years. High Hcy triggers the pathogenesis of diseases via multiple mechanisms including oxidative stress, lesions of vascular endothelial cells, prolifera-tion of vascular smooth muscle cells, dysfunction of coagulation and lipid metabolism and genomic hypomethylation etc.

Diabetes mellitus is particularly prevalent among aging people in recent years.Compared with diabetes in young and middle aged,geriatric diabetes has specific pathophysiology.Macrovascular complications of Type 2 diabetes including coronary heart disease,myocardial infarction,heart failure,stroke and peripheral artery disease,cause increased disability and mortality in aged populations.In order to prevent macrovascular complications,management strategies should be taken in treating hyperglycemia,hypertension,dyslipidemia,and hypercoagulability.

MicroRNA-7(miR-7)was firstly found in Drosophila melanogaster,which participated in the formation of Drosophila wings,eggs and so on.In human being miR-7 is not only involved in cell prolifera-tion and differentiation,but also plays an important role in the development of tumor,especially in lung cancer. Most studies report that miR-7 is low expression in lung cancer with poor prognosis.Improving the expression of miR-7 can inhibit tumor growth.MiR-7 can regulate the expression of BCL-2,EGFR negatively,meanwhile it can regulate the sensitivity of tumor cells to radiotherapy chemotherapy and targeted therapy.Therefore,as a tumor suppressor,miR-7 is expected to become a new target for treatment of lung cancer.

Objective To investigate the effect of health education on compliance of the senile non-rheumatic atrial fibrillation patients receiving anticoagulative drug treatment.Methods 188 senile inpatients with on-rheumatic atrial fibrillation and receiving anticoagulative drug treatment were given the health education in three different manners:group instruction,individual instruction and self-study in the hospital for three to four weeks by a team consisted of nurses and doctors.Results After education,the average test scores were higher than before education(P33<0.05).The self-care skill and knowledge such as self-monitor of bleeding were improved.Conclusion Health education is an important method for the senile patients to learn anticoagulative knowledge and improve the ability of self-management.

Objective To analyze the imaging features and clinical significance of solitary costal hot spots in patient with lung cancer on SPECT/CT fusion imaging and the value of low-dose CT for diagnosis.Methods SPECT/CT scan was performed on 68 patients with lung cancer and costal single hot spots using whole body bone imaging.The sites of lesions were classified into four types:junction between costal cartilage and rib,frontal rib,lateral rib,posterior rib.The shapes of lesions were classified into two forms:punctiform and strip shapes,and were analyzed and classified.The differences of the diagnosis of whole body bone imaging and SPECT/CT scan were analyzed.Results Punctiform spots were mainly due to costal fractures(36/68,52.94％).The majority of spots in strip shape were costal metastases (21/23,91.30％).The lesions of junction between costal cartilage and rib were punctiform shape and benign.Hot spots in posterior ribs were mainly costal metastases (18/22,81.82％).Sensitivity of diagnosis of the metastatic bone tumor with whole body bone imaging and SPECT/CT in single hot spot of spine and rib was 69.23％ (18/26) and 92.31％(24/26),specificity 59.52％(25/42) and 85.71％(36/42),accuracy 63.24％(43/68) and 88.24％ (60/68),positive predictive value 51.43％ (18/35) and 80.00％ (24/30),negative predictive value 75.76％ (25/33) and 94.74％ (36/38).SPECT/CT scan had differences with whole body bone imaging in sensitivity (P ＜ 0.05),SPECT/CT scan had significant differences with whole body bone imaging in coincidence and specificity (P ＜ 0.01).Conclusions Useful imaging features can be obtained from SPECT/CT fusion imaging with single costal hot spots,being helpful to differential diagnosis of benign and malignant lesions.SPECT/CT fusion imaging may improve the accuracy to diagnose the rib disease.

Morning meeting is regular in clinical departments.Through enriching meeting contents, exten-ding meeting function, morning meeting becomes an effective internal management tool and platform in clinical depart-ments, and plays a positive role in the culture construction of the department, quality management, personnel train-ing, etc.

Objective To evaluate the clinical efficacy of total knee arthroplasty(TKA)in patients of osteo-arthris with valgus knee deformity after lateral meniscectomy(LMT). Methods Twenty six cases of osteo-arthris with valgus knee deformity after lateral meniscectomy were treated with total knee arthroplasty. Operation evaluations including the range of motion(ROM),the tibial and femur angle(T-F angle),Knee Society Score System(KSS)and the function score were performed as follow-up. Results The median follow-up periods was 22 months and ranged from 5 months to 3 years. The average ROM improved from 96° preoperatively to 116° at postoperatively. The average KSS improved from 22. 5 points preoperatively to 84. 4 points postoperatively. The average function score improved from 25. 5 points preoperatively to 84. 4 points postoperatively,and the average T-F angle was corrected from 22°( 13° - 31°) of valgus preoperatively to 7. 6°( 0° - 9°) of valgus postoperatively. Conclusion The TKA can provide excellent in patients undergoing osteo-arthris with valgus knee deformity after lateral meniscectomy.

Objective To investigate the polymorphism of the vitamin D receptor gene (VDR)TaqⅠin relation to diabetic retinopathy. Method Fragment length discrepant allele specific PCR(FLDAS-PCR) were used to determine VDR genetypes in 158 patients with diabetic retinopathy and in 198 normal subjects. Results The frequency distribution of VDR genotypes in diabetic retinopathy patients was 106 (67.1%) in TT, 33(20.9%) in Tt, 19(12.0%) in tt; and in normal persons was 165 (83.3%) in TT, 23(11.6%) in Tt, 10 (5.1%) in tt. There was a significant difference between diabetic retinopathy patients and normal persons in distribution of VDR gene TaqⅠgenotypes(P