Objective To compare the surgical and functional outcomes of single-site (transumbilical two-port) intracorporeal purse-suturing (IP) and single-port extracorporeal knotting (EK) for laparoscopic pediatric inguinal hernia (PIH) repair.Methods Between June 2008 and December 2014,358 PIH children underwent lapamscopic inguinal herniorrhaphy,including 126 treated by single-site intracorporeal purse string stitching using a needle-holder (IP group),and 232 by single-port extracorporeal knotting using an inner two-hook needle with preperitoneal hydrodissection (EK group).Results In all patients laparoscopic procedures were completed successfully without conversion.The operating time in IP group was significantly longer than that in EK group [unilateral:(20.4 ± 2.1) min vs.(9.4 ± 1.3) min,t=-5.23,P＜0.01;bilateral:(31.3 ±2.9) min vs.(15.2±1.7) min,t=-4.22,P＜0.01)].The hospital stay were similar between the two groups [(2.35 ±0.25) d vs.(2.38 ±0.18) d,t =-0.062,P ＞ 0.05].Five cases had intraoperative hematoma in the IP group while none in the EK group.One each suffered from recurrence in IP group and EK group.Three postoperative hydroceles were seen in IP group and one in EK group.Subcutaneous knot granulomas were seen in two in EK group.Conclusions Both IP and EK laparoscopic procedures are safe and feasible.With the assistance of preperitoneal hydrodissection technique,single-port laparoscopic EK herniorraphy is superior to single-site IP repair in easy performance and shorter operation time.

Objective To investigate the effectiveness of FOCUS-PDCA model in enhancing the quality of official hospi-tal documents in a Zhejiang-based hospital.Methods The FOCUS-PDCA model was adopted to identify and address the issues present in the hospital's document management system in 2021.An improvement team was established,tasked with identifying the root cause of the poor quality of documents through group ability assessments,critical factor voting,and brainstorming.High-risk,high-frequency,and error-prone issues were prioritized for improvement.The FOCUS-PDCA model,along with tools such as the 5W1 H and Gantt chart,were utilized to continuously enhance the quality of the hospital's official documentation.The pass rate of document preparation pre-and post-improvement was compared using SPSS software.Results After the improvement,the approval rate for hospital document writing increased from 25.4％to 51.2％,exceeding the target value and achieving the antici-pated outcome.The most significant improvement was observed in document formatting,which now adheres to national standards at a 100％standard rate.Conclusion The FOCUS-PDCA model,coupled with measures such as top-level system design,train-ing,and strict auditing,can significantly improve the quality of hospital documentation.This approach effectively enhances the standard of document management within the hospital,contributing to modernization efforts.

Objective To discover the existing problems and provide appropriate suggestions and countermeasures through the quality control inspection.MethodsA comprehensive quality control inspection was conducted for the radiotherapy equipment in 45 hospitals in Zhejiang province.The physical,technical,clinical and radiotherapy process and the parameters related to quality control were evaluated.Results As of December 31,2017,a total of 62 linear accelerators from 45 hospitals have been assessed.In the radiotherapy process,multiple quality control problems were identified in terms of radiotherapy equipment configuration,clinical work quality,radiotherapy technology and personnel qualifications.Besides,unreasonable equipment configuration,shortage of radiotherapy staff,clinical work flow and the quality assurance of physical radiotherapy remained to be resolved.Conclusion Regular quality control of radiotherapy plays a pivotal role in ensuring the accuracy,effectiveness and medical safety of radiotherapy.

Recently, great breakthroughs have been made in the treatment of melanoma with immune checkpoint inhibitors. However, only a small proportion of patients show a long-lasting response to immunotherapy, and risks of immune-related adverse events and drug resistance have been also increasing along with the emergence of combination treatment. This review summarizes biomarkers related to the efficacy of immune checkpoint inhibitors in the treatment of melanoma, aiming to predict and screen out patients who may benefit from immunotherapy, guide individualized clinical treatment, and reduce the occurrence of drug resistance and adverse reactions.

Objective To explore the chain mediating effect of interpersonal promotion and calling on work autonomy and work engagement of medical staff.Methods From June to July 2023,a total of 310 medical staff from 5 tertiary public hos-pitals in Hangzhou were selected by convenience sampling.The questionnaire included work autonomy scale,interpersonal promo-tion scale,calling scale and work engagement scale for accurate and effective investigation,and data analysis was conducted using SPSS2 6.0 and AMOS 26.0.Results A total of 310 questionnaires were distributed and 257 were recovered with a recovery rate of 82.90％.There were statistically significant differences in work engagement among medical staff with different ages,marital status,working time,titles and positions(all P＜0.05).Calling partially mediated the effect of work autonomy on work engage-ment(95％CI[0.090,0.291],P＜0.001),and interpersonal promotion and calling played a partially chain mediating role be-tween work autonomy and work engagement(95％CI[0.016,0.103],P＜0.001).Conclusion Interpersonal promotion and calling play a partially chain mediating role between work autonomy and work engagement of medical staff.Work autonomy of medical staff not only has an indirect effect on work engagement through the mediating role of calling,but also enhances calling through interpersonal promotion and ultimately affects work engagement.

Objective:To investigate the radiotherapy discipline construction and existing problems in non-public hospitals in Zhejiang province and put forward suggestions for improvement.Methods:In 2022, on-site inspection and investigation were carried out in 14 non-public hospitals in Zhejiang province, including equipment configuration and source, discipline setting, personnel qualification and professional experience, academic leaders and admission of patients, etc. Results:For 14 non-public hospitals in Zhejiang province, 19 treatment equipment, 15 positioning equipment and 77 quality control equipment were equipped, and a total of 249 radiotherapy practitioners were employed. A total of 4 224 patients were admitted throught 2022.Conclusion:Multiple problems exist in non-public radiotherapy hospitals in Zhejiang province, such as unscientific discipline setting, fewer professionals, lack of personnel training, unclear management mode, unqualified qualification of partial radiotherapy doctors, and insufficient refinement of clinical quality management, which need to be further improved.

Objective Based on the technology acceptance model,to explore the influence mechanism of technical support,perceived interactivity,perceived usefulness,perceived ease of use and perceived risk on medical staff's report intention on adverse events,and to provide path suggestions for improving medical staff's report intention adverse events.Methods The multi-stage sampling method was used to select 637 medical staffs of tertiary public hospitals in Hangzhou who used the information-based platform to report adverse events as the research respondents,and the self-developed scale of report intention on adverse events was used as the research tool,monofactor analysis were conducted by Wilcoxon rank-sum test,and the structural equation model was used to analyze the influence path of their report intention on adverse events.Results Perceived ease of use and perceived usefulness have positive effects on medical staff's report intention on adverse events(β=0.264,0.658;P＜0.001);Perceived risk negatively affected the medical staff's report intention on adverse events(β=-0.143,P＜0.001).The indirect effects of perceived usefulness and perceived ease of use on medical staff's report intention on adverse events are 0.538 and 0.205,respectively.Conclusion Perceived usefulness and perceived ease of use plays a mediating role in perceived interactivity and medical staff's report intention on adverse events.

Objective Based on the technology acceptance model,to explore the influence mechanism of technical support,perceived interactivity,perceived usefulness,perceived ease of use and perceived risk on medical staff's report intention on adverse events,and to provide path suggestions for improving medical staff's report intention adverse events.Methods The multi-stage sampling method was used to select 637 medical staffs of tertiary public hospitals in Hangzhou who used the information-based platform to report adverse events as the research respondents,and the self-developed scale of report intention on adverse events was used as the research tool,monofactor analysis were conducted by Wilcoxon rank-sum test,and the structural equation model was used to analyze the influence path of their report intention on adverse events.Results Perceived ease of use and perceived usefulness have positive effects on medical staff's report intention on adverse events(β=0.264,0.658;P＜0.001);Perceived risk negatively affected the medical staff's report intention on adverse events(β=-0.143,P＜0.001).The indirect effects of perceived usefulness and perceived ease of use on medical staff's report intention on adverse events are 0.538 and 0.205,respectively.Conclusion Perceived usefulness and perceived ease of use plays a mediating role in perceived interactivity and medical staff's report intention on adverse events.

Objective Based on the technology acceptance model,to explore the influence mechanism of technical support,perceived interactivity,perceived usefulness,perceived ease of use and perceived risk on medical staff's report intention on adverse events,and to provide path suggestions for improving medical staff's report intention adverse events.Methods The multi-stage sampling method was used to select 637 medical staffs of tertiary public hospitals in Hangzhou who used the information-based platform to report adverse events as the research respondents,and the self-developed scale of report intention on adverse events was used as the research tool,monofactor analysis were conducted by Wilcoxon rank-sum test,and the structural equation model was used to analyze the influence path of their report intention on adverse events.Results Perceived ease of use and perceived usefulness have positive effects on medical staff's report intention on adverse events(β=0.264,0.658;P＜0.001);Perceived risk negatively affected the medical staff's report intention on adverse events(β=-0.143,P＜0.001).The indirect effects of perceived usefulness and perceived ease of use on medical staff's report intention on adverse events are 0.538 and 0.205,respectively.Conclusion Perceived usefulness and perceived ease of use plays a mediating role in perceived interactivity and medical staff's report intention on adverse events.

Objective Based on the technology acceptance model,to explore the influence mechanism of technical support,perceived interactivity,perceived usefulness,perceived ease of use and perceived risk on medical staff's report intention on adverse events,and to provide path suggestions for improving medical staff's report intention adverse events.Methods The multi-stage sampling method was used to select 637 medical staffs of tertiary public hospitals in Hangzhou who used the information-based platform to report adverse events as the research respondents,and the self-developed scale of report intention on adverse events was used as the research tool,monofactor analysis were conducted by Wilcoxon rank-sum test,and the structural equation model was used to analyze the influence path of their report intention on adverse events.Results Perceived ease of use and perceived usefulness have positive effects on medical staff's report intention on adverse events(β=0.264,0.658;P＜0.001);Perceived risk negatively affected the medical staff's report intention on adverse events(β=-0.143,P＜0.001).The indirect effects of perceived usefulness and perceived ease of use on medical staff's report intention on adverse events are 0.538 and 0.205,respectively.Conclusion Perceived usefulness and perceived ease of use plays a mediating role in perceived interactivity and medical staff's report intention on adverse events.