Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

Objective:To explore the application effect of adjustable body position protection belt in patients undergoing not painless colonoscopy.Methods:A randomized and controlled trial was used, a total of 180 patients who planned to undergo not painless colonoscopy in the Endoscopy center, the First Hospital of Jiaxing from January to October 2022 were selected as the research objects. They were divided into the experimental group and the control group by the random number table method, with 90 cases in each group. The control group adopted the traditional method of colonoscopy body position placement, and on this basis, the experimental group used the adjustable body position protection belt to assist the patient body position placement. The maintenance rate of body position in colonoscopy, the cecal intubation time, the degree of intraoperative pain and the acceptance rate of re-examinationunder the same operating doctor and nurse were compared between the two groups.Results:The maintenance rate of body position in colonoscopy was 97.78%(88/90) in the experimental group and 58.89%(53/90) in the control group, the difference was statistically significant ( χ2 = 37.84, P<0.05). The cecal intubation time was (7.84 ± 4.39) min in the experimental group and (10.13 ± 5.85) min in the control group, the difference was statistically significant ( t = 2.98, P<0.05). The intraoperative pain score was 2.96 ± 1.39 in the experimental group and 4.28 ± 1.42 in the control group, the difference was statistically significant ( t = 6.31, P<0.05). The acceptance rate for re-colonoscopy was 88.89%(80/90) in the experimental group and 72.22%(65/90) in the control group, the difference was statistically significant ( χ2 = 7.98, P<0.05). Conclusions:Use of adjustable body position protection belt to assist body position placement before the patients undergoing not painless colonoscopy, it can improve the maintenance rate of body position during not painless colonoscopy, shorten the time of cecal intubation, reduce the intraoperative pain degree, and patients also have a higher willingness to undergo colonoscopy again.

Objective To improve the quality for authorized distribution of traditional Chinese medicine pieces, reduce patient complaints and increase patient satisfaction. Methods Patient’s complaints against different drug dispensing modes were analyzed. PDCA cycle was used for quality improvements. Results The new quality control mode includes pre monitoring measures, such as pharmacist resident in pharmaceutical factories and unannounced factory inspections, the fast-track handing measures for the problems occurred in patients, pharmacies, pharmaceutical factories and express delivery companies, and retrospective measures, such as evaluation of pharmaceutical factories and quarterly pharmaceutical factory communication meetings. Conclusion Three years after the new quality control mode, patient’s complaints were significantly reduced. The authorized distribution quality for traditional Chinese medicine pieces was greatly improved.

Objective:To construct a close-loop path management model for aspiration risk screening of patients in Department of Neurosurgery, and verify its application effect in the nursing of inpatients in department of neurosurgery.Methods:Through literature retrieval and expert consultation, the close-loop path management model of aspiration risk screening was constructed. The convenient sampling method was adopted to select inpatients in the Neurosurgery Department of a ClassⅢ Grade A hospital in Jiangmen of Guangdong Province from January to December 2019. The patients admitted from January to June 2019 were set as the control group and received routine aspiration assessment and management while the patients admitted from July to December 2019 were set as the observation group and received close-loop management of aspiration risk screening. The incidences of aspiration and aspiration pneumonia were compared between the two groups.Results:In the control group, there were 506 patients, of whom 92 (18.18%) had aspiration. In the observation group, there were 543 patients, of whom 74 (13.63%) had aspiration. There was a statistically significant difference in the incidence of aspiration between the two groups (χ 2=4.078, P=0.043) . The incidence of aspiration pneumonia was 8.10% (41/506) in the control group and 5.52% (30/543) in the observation group. There was no statistically significant difference between the two groups (χ 2=2.758, P=0.097) . Conclusions:The close-loop management of aspiration risk screening standardizes the process of aspiration risk screening, guarantees the implementation of dynamic assessment and effectively reduces the incidence of aspiration, which can provide a reference for improving the management level of prevention and treatment of aspiration.

ObjectiveTo explore the application effect of outcome-based education model in clinical teaching for neurosurgery nursing students. MethodsBy convenience sampling, the nursing students on placement rotation in Department of Neurosurgery in Nanfang Hospital of Southern Medical University from August 2016 to July 2017 were selected and assigned into the control group (n=55), and those from August 2017 to July 2018 were put into the observation group (n=51). According to the requirements of the curriculum, the traditional teaching method was adopted for the control group, on the basis of that, the outcome-based education model was adopted for the observation group. The two groups of nursing students rotated in the Department of Neurosurgery for four weeks. Two independent sample t-test was used to compare the score of theoretical achievement, clinical achievement, Clinical Communication Ability Scale and Problem-solving Ability Scale between the two groups. ResultsThe average theoretical and operational scores of nursing students in the control group were (91.71±3.28) and (89.38±5.39) respectively. The average theoretical and operational scores of nursing students in the observation group were (94.06±2.73) and (91.71±4.67), respectively. There were significantly statistical differences between the two groups (P＜0.05). The total score of Clinical Communication Ability Scale of nursing students in the observation group was (90.08±7.43), higher than that of the control group (83.38 ±7.07), there were significantly statistical differences between the two groups (P＜ 0.01);the scores of Problem-solving Ability Scale of nursing students in the observation group were higher than that of the control group (P＜ 0.01), there was significantly statistical difference between the two groups. ConclusionsThe outcome-based education model in clinical teaching for neurosurgery nursing students can effectively improve the nursing students' theoretical and operational performance, enhance their clinical communication skills and problem-solving ability and is conducive to cultivating excellent practical talents in clinical practice.

Objective To investigate the factors affecting the efficacy of leflunomide combined with medium/low dose corticosteroids in the treatment of progressive IgA nephropathy (IgAN).Methods Clinical and pathological parameters were collected retrospectively in patients of primary IgAN with proteinuria＞ 1.0 g/24 h and chronic kidney disease (CKD) stage 1-3 treated with leflunomide combined with medium/low dose corticosteroids in Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University from Jan 2005 to Dec 2010.According to the treatment effects,patients were divided into complete remission group and non-complete remission group.The biochemical and pathological indexes of the two groups were compared.Results A total of 42 patients were included.The remission rates at 3,6,9 and 12 months were 62％,64％,67％ and 74％,respectively.Seventeen (40.5％) and fourteen (33.3％) patients achieved complete and partial remission after one-year treatment,and the remission rate remained stable within one year after withdrawal of drugs.The 24hour proteinuria was 1.50 (0.67,2.66) g,which was significantly reduced compared with the baseline 2.44 (1.36,3.74) g (P ＜ 0.01).The decrease rate was 31.3％.There was a slight decrease in proteinuriawithin one year after withdrawal of drugs.Estimated glomerular filtration rate (eGFR) remained stable during the treatment and a year of follow-up.No serious adverse event was observed during the followup period.Among 31 responder patients,6(19.4％) patients relapsed.Logistic multivariate regression analysis suggested that the degree of renal interstitial inflammatory infiltration was an independent predictor of complete remission with one-year treatment of leflunomide combined with medium / low dose corticosteroids (HR=0.067,95％ CI 0.008-0.535,P=0.011).Conclusions IgAN treated with leflunomide and medium/low dose corticosteroids can achieve remission in early stage,and the remission rate remains stable after withdrawal of drugs.It is a safe option for the treatment of IgAN.Renal interstitial inflammatory infiltration is an independent predictor of complete remission.

Through the analysis of current situation of the tension relationship between doctor and patient,this paper expounded that the harmonious management organization theory took the cooperation order as the core of the development of the group organization,and emphasized the running-in process of the internal staffs in the collective group.And it pointed out that the internal cooperation between doctor and patient had the certain cooperation order,and also had obstacles that might cause conflict in cooperation from the perspective of the harmonious management organization theory.This paper analyzed and understood the process of doctor-patient coordination at the group level of harmonious management organization theory,explored and analyzed the obstacles that might cause the conflict during the cooperation process and the reasons in the view of innovation,explored and concluded relevant measures to ease the tension of the doctor-patient relationship,and finally achieved the outcome of maximization of common interests and optimization of treatment effect.

Objective To compare the efficacy and safety of leflunomide (LEF) combined with medium/low dose corticosteroids and full dose of corticosteroids in the treatment of IgA nephropathy. Method Primary IgAN patients diagnosed by renal biopsy with 18?65 years old and eGFR≥30 ml·min?1·(1.73 m2)?1 and proteinuria>0.5 g/24 h were enrolled in a prospective controlled clinical study. They were randomly divided into leflunomide combined with medium/low dose corticosteroids (LEF group) and corticosteroids alone (steroid group). The primary outcomes were (1) end stage renal disease or dialysis (2) 50% increase in serum creatinine above the baseline. Secondary outcome was the remission of proteinuria. Results Ninety patients completed the follow?up. The 24?hour proteinuria at baseline were 2.00(1.10, 2.88) g and 1.87(1.13 ,3.08) g in LEF group and steroid group respectively. Compared with baseline, it was significantly decreased in both groups at 6 months [0.30(0.11, 0.93) g, 0.30(0.14, 1.33) g] and 12 months [0.30(0.09, 0.82) g, 0.32(0.14, 0.66) g], (P<0.05). Estimated glomerular filtration rate (eGFR) at baseline, 6 months and 12 months were (80.39 ± 28.56), (87.12±28.70) and (88.20±30.26) ml·min-1·(1.73 m2)-1. It was decreased in steroid group (P<0.05), while no significant difference was detected in LEF group[baseline (87.63 ± 27.35), 6 months (86.91 ± 32.45), 12 months (90.06 ± 30.00) ml·min-1·(1.73 m2)-1, P>0.05]. At 6 and 12 months, there was no significant difference in terms of 24?hour proteinuria, serum creatinine and eGFR (CKD?EPI) between groups (P>0.05). There was no statistically significant difference in adverse events between groups during the treatment (9/40 cases in LEF group and 11/50 cases in steroid group, P>0.05). The average follow?up was 79 months, and there was no difference in the renal prognosis between the two groups. Multivariate Cox regression analysis revealed that serum creatinine at baseline and renal interstitial inflammatory cell infiltration predicted the risk of the progress of IgA nephropathy. Conclusion Leflunomide plus medium/low dose corticosteroids has a similar effect as full dose of corticosteroids in IgA nephropathy and does not increase the risk for adverse events during the treatment.

Objective To compare the complications and outcomes of urgent?start peritoneal dialysis (PD) and hemodialysis (HD) in end?stage renal disease (ESRD) patients, and explore the safety and effectiveness of PD which was as an urgent?start dialysis modality in ESRD patients. Methods All patients for urgent?start dialysis, who initiated dialysis without a long?term dialysis access or had the long?term dialysis access under 30 days in Renji Hospital from January 1st 2013 to December 31st 2014, were enrolled. According to the dialysis modalities, patients were divided into PD group and HD group. Participants were followed up until death, transferred to other centers, lost of follow up or January 1st 2016. Dialysis?related complications within 30 days of implantation, complications of reimplantation and the occurrence of bacteremia between two groups were compared, and their survival rates were tested by Kaplan?Meier curves. Results Among 178 patients in this study, there were 96 (53.9%) patients in PD group and 82 (46.1%) patients in HD group. Compared with those of HD group, patients of PD group presented more cardiovascular disease [21(21.9%) vs 8(9.8%), P=0.029], higher serum potassium [(4.5±0.8) mmol/L vs (4.3±0.8) mmol/L, P=0.038], but less heart failure (NYHA Ⅲ?Ⅳ) [26(30.2%) vs 40 (48.8%), P=0.014], lower brain natriuretic peptide (BNP) [328.5 (129.5, 776.8) ng/L vs 503.5(206.0, 1430.0) ng/L, P=0.008], higher hemoglobin [(81.5 ± 17.7) g/L vs (75.3 ± 22.5) g/L, P=0.039], higher serum albumin (33.5±5.7) g/L vs (31.3±6.7) g/L, P=0.022] and higher serum pre?albumin (304.5±78.0) mg/L vs (257.0 ± 86.1) mg/L, P<0.001]. PD group presented less dialysis?related complications [5 (5.2%) vs 20(24.4%), P<0.001], less dialysis?related complications requiring reimplantation [1(1.0%) vs 20(24.4%), P<0.001] and less bacteraemia [3(3.1%) vs 11(13.4%), P=0.011]. The 3?, 6?and 12?month patient survival rates of PD and HD group were 97.9% vs 98.4%, 97.9% vs 98.4%, and 92.1%vs 93.0% respectively, and no significant difference was found (Log ? rank=0.004, P=0.947). Conclusions Patients with urgent?start PD have less complications within 30 days of implantation and occurrence of bacteremia than patients with urgent?start HD, and the same survival rates. PD may be a feasible and safe urgent?start dialysis modality for ESRD patients.

Objective To analyze the features of menopausal syndrome and its risk factors in patients from menopausal outpatient clinic,and further to evaluate menopausal syndrome and standardization managenent pathway of treatment.Methods The objects were enrolled in the menopausal outpatient clinic from Apr.2010 to May.2015,completing the self-designed questionnaires through one-by-one interview,including demographic information,and modified Kupperman Index.Results The average age of 907 menopausal women was 51.74+4.94 (aging from 30 to 70 years old).The incidence of (peri-)menopause syndrome was 95.7％,increasing with the prolonging of menopausal duration.The incidence and severity of surgery-related menopausal syndrome were higher than those of natural menopause.The five most frequent symptoms were:fatigue (84.6％) ＞ insomnia (77.3％) ＞ hot flashes sweating (76.3％) ＞ mood swings (72.3％) ＞ joint pains and heart palpitations (72.1％).Other factors such asage,menopausal status etc.also affected the menopausal symptoms.Conclusions Prevalence of (peri-) menopausal syndromes was high and it has many influencing factors.The incidence and severity of surgery-related menopausal syndrome are higher than those of natural menopause.