A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Talent gather is a process of talent flow and aggregation caused by various factors.Talent gather can not only promote the high-quality development of public hospitals and the aggregation of medical resources but also enhance hospital international competitiveness to form good groups promotion effect.Besides,talent gather can also lead to decrease in management efficiency,an increase in the siphon effect of large hospitals on talents and patients,and existing systems hindering the agglomeration effect.Therefore,it is necessary to strengthen management functions and improve efficiency,to seize the opportunities and breakthroughs in institutional and mechanism reform,and solve the problem of siphoning.Enhance the adaptability of personnel management and promote the advantages of talent aggregation,and establish a talent highland in the field of life and health.

Objective: To analyze the issuance of Chinese adolescents mental health promotion policies and policy objects, and to explore the use of different object policy tools and the effectiveness of the policy, so as to provide reference for the improvement of the subsequent policy. Methods: Adolescents mental health promotion policies published and policy documents that included adolescents in mental health promotion policies and regulations in China from 2014 to the present were obtained, with the search period of July to August 2024. Policy content and effectiveness were analyzed by using content cross tabulation analysis and Policy Modeling Consistency Index Model (PMC index model). It coded with Nvivo 20 software to understand the types of tools that policy depends on. Results: A total of 41 documents were included. The number of adolescent mental health promotion policy texts rose by year, most of which were issued independently, accounting for 70% of the total number of texts issued; 30% were jointly issued, with the Ministry of Education and the National Health Commission as the core subjects. Supply type policy tools accounted for 47.45 % of the total, while environment type and demand type policy tools accounted for 29.68% and 22.87% respectively; the use of policy tools by different policy targets varies, with families and social organizations using more supply type and demand type policy tools, while the education system and healthcare institutions were more inclined to supply type policy tools, and the government departments were more inclined to supply type policy tools and environment type policy tools. In terms of policy effectiveness, there was a common problem of a lack of incentives and constraints, and the PMC values of two long term planning mental health policies were high (7.76, 7.56), and both reached the excellent level. Conclusions China has paid more attention to adolescents mental health, and the basic guarantees have been established and overall policy effectiveness is good, but the use of policy tools is uneven. There is a need to improve the operational content of medium and long term policies and to strengthen synergies between implementing departments.

OBJECTIVE To evaluate the influence of pharmaceutical quality control on the efficiency and outcomes of standardized medication therapy management （MTM） services for patients with coronary heart disease by using Economic， Clinical and Humanistic Outcomes （ECHO） model. METHODS This study collected case data of coronary heart disease patients who received MTM services during January-March 2023 （pre-quality control implementation group， n＝96） and June-August 2023 （post-quality control implementation group， n＝164）. Using propensity score matching analysis， 80 patients were selected from each group. The study subsequently compared the economic， clinical， and humanistic outcome indicators of pharmaceutical services between the two matched groups. RESULTS There were no statistically significant differences in baseline data between the two groups after matching （P＞0.05）. Compared with pre-quality control implementation group， the daily treatment cost （16.26 yuan vs. 24.40 yuan， P＜0.001）， cost-effectiveness ratio [23.12 yuan/quality-adjusted life year （QALY） vs. 32.32 yuan/QALY， P＜0.001]， and the incidence of general adverse drug reactions （2.50% vs. 10.00%， P＝0.049） of post-quality control implementation group were decreased significantly； the utility value of the EuroQol Five-Dimensional Questionnaire （0.74± 0.06 vs. 0.71±0.07， P＝0.003）， the reduction in the number of medication related problems （1.0 vs. 0.5， P＜0.001）， the medication adherence score （[ 6.32±0.48） points vs. （6.10±0.37） points， P＝0.001]， and the satisfaction score （[ 92.56±1.52） points vs. （91.95±1.56） points， P＝0.013] all showed significant improvements. Neither group experienced serious adverse drug reactions. There was no statistically significant difference in the incidence of new adverse reactions between the two groups （1.25% vs. 3.75%， P＝0.310）. CONCLUSIONS Pharmaceutical quality control can improve the quality of pharmaceutical care， and the ECHO model can quantitatively evaluate the effect of MTM services， making pharmaceutical care better priced and more adaptable to social needs， thus being worthy of promotion.

A 36-year-old male developed unconsciousness and no response to voice stimuli after taking approximately 2 050 mg felodipine (the specific time was unknown). Two hours later, he was sent to the department of emergency by his family and admitted to the hospital. His vital signs showed body temperature 35.1 ℃, pulse 148 times/min, respiration 32 times/min, and blood pressure 65/34 mmHg. Acute drug poisoning, acute toxic cardiomyopathy, acute toxic shock, acute type Ⅱ respiratory failure, acute toxic encephalopathy, and acute renal failure were diagnosed based on the patient′s clinical manifestations combined with laboratory tests results, cardiac ultrasound, chest and abdominal CT scans. Endotracheal intubation connected to a ventilator for invasive assisted ventilation, pressure boosting, and fluid resuscitation were given. At the same time, repeated gastric lavage and enema were performed to remove toxins. Blood perfusion was intermittently and repeatedly administered, and continuous renal replacement therapy was used. The blood concentration of felodipine was 1 298 μg/L at 2 hours after admission, and cardiac arrest occurred at 4 hours. Venous-arterial extracorporeal membrane oxygenation (V-A ECMO) treatment was administered immediately. After 48 hours of ECMO operation, sedatives were discontinued and the patient′s consciousness was improved after 4 hours. On the 5th day of ECMO treatment, his heart rate was 72 beats per minute, and blood pressure was 127/65 mmHg. The blood concentration of felodipine decreased to 2 μg/L. The patient′s vital signs were significantly improved and ECMO supportive treatment was withdrawn. After 26 days of hospitalization, the patient recovered and was discharged.

Talent gather is a process of talent flow and aggregation caused by various factors.Talent gather can not only promote the high-quality development of public hospitals and the aggregation of medical resources but also enhance hospital international competitiveness to form good groups promotion effect.Besides,talent gather can also lead to decrease in management efficiency,an increase in the siphon effect of large hospitals on talents and patients,and existing systems hindering the agglomeration effect.Therefore,it is necessary to strengthen management functions and improve efficiency,to seize the opportunities and breakthroughs in institutional and mechanism reform,and solve the problem of siphoning.Enhance the adaptability of personnel management and promote the advantages of talent aggregation,and establish a talent highland in the field of life and health.

Objective To investigate the risk factors of drug resistance in patients with ischemic stroke by clopidogrel therapy and provide references for promoting clinical individualized drug therapy. Methods A total of 202 inpatients diagnosed with ischemic stroke were admitted and given dual anti-treatment (aspirin+clopidogrel). CYP2C19 genotype was detected by microarray hybridization during hospitalization, and CYP2C19 gene polymorphisms were classified into fast metabolism group, medium metabolism group and slow metabolism group according to the type of drug metabolism. Patients were tested for platelet inhibition induced by adenosine diphosphate (ADP) according to thromboelastographic (TEG) on 7~14 d of drug administration. ADP <30% was classified as clopidogrel drug resistance group and ADP ≥30% as non-resistance group. Logistic regression analysis was used to study the risk factors for the development of clopidogrel resistance. Results Among 202 patients with ischemic stroke, 87 were in the resistant group and 115 in the non-resistant group. The proportion of patients with clopidogrel resistance combined with diabetes and the level of white blood cell count were higher than that in the non-resistant group, and the differences were statistically significant (P<0.05).The proportion of patients with clopidogrel resistance in the CYP2C19 intermediate metabolism group was significantly higher than that in the fast metabolism group, and the rate of platelet inhibition was also significantly lower than that in the fast metabolism group, all with statistically significant differences (P<0.05). Conclusion Combined diabetes mellitus, high white blood cell count levels and CYP2C19 mid-metabolic phenotype are independent risk factors for the development of clopidogrel resistance in patients with ischemic stroke.

Objective To discuss the application value of video health education mode in patient's self-maintenance of totally implantable venous access port(TIVAP).Methods A total of 208 patients,who received implantation of TIVAP at the Second Affiliated Hospital of Naval Military Medical University of China From September 2021 to December 2022,were enrolled in this study.The patients were divided into control group(n=108)and observation group(n=100).Traditional health education was conducted for the patients of the control group,while on the basis of traditional health education an additional video health education based on visual communication theory was carried out for the patients of the observation group.Evaluation of self-care ability(ESCA)was used to evaluate the self-care ability before the intervention and 6 months after the implantation of TIVAP in the two groups.The complications,the incidence of adverse events,and the indwelling duration of the infusion port were compared between the two groups.Results Before intervention,the differences in each dimension score and total score of ESCA table between the two groups were not statistically significant(all P＞0.05).After intervention,the each dimension score and total score of ESCA table in the observation group were significantly higher than those in the control group(all P＜0.05).After intervention,both the total incidence of complications and the total incidence of adverse events in the observation group were remarkably lower than those in the control group(both P＜0.05),besides,the indwelling duration of the infusion port in the observation group was obviously longer than that in the control group.Conclusion The use of video health education mode can significantly improve the self-care ability of patients carrying a TIVAP,reduce the incidence of complications and adverse events,and extend the effective duration of TIVAP.Therefore,it is an effective health education mode.

Objective To construct a Nomogram prediction model based on body position exercise training for patients with chronic constipation. Methods A total of 327 patients with chronic constipation from March 2021 to March 2023 were divided into qualified group (n=279) and unqualified group (n=48) according to their performance in body position exercises. General clinical materials of the patients were collected, and univariate and multivariate Logistic regression analyses were performed to identify risk factors for unqualified body position exercises in patients with chronic constipation; the R software was used to construct a Nomogram model for predicting unqualified body position exercises in patients with chronic constipation, and the receiver operating characteristic (ROC) curve and calibration curve were applied to verify the discrimination and consistency of the Nomogram model. Results There were no significant differences in gender, education level, history of smoking, history of alcohol abuse, history of hypertension, history of abdominal surgery, history of colonoscopy, and correct medication administration ratio between the two groups (P>0.05); the unqualified group had higher age, longer duration of chronic constipation, and a higher proportion of diabetes history compared to the qualified group (P < 0.05); age, duration of chronic constipation, and diabetes history were independent risk factors for unqualified body position exercises in patients with chronic constipation (P < 0.05). The constructed Nomogram prediction model demonstrated excellent discrimination (area under the curve was 0.923, 95%CI, 0.888 to 0.949, with sensitivity and specificity of 87.50% and 81.00% respectively) and consistency (H-L goodness-of-fit test χ²=2.246, P=0.973). The clinical value of this Nomogram model in predicting unqualified body position exercises for patients with chronic constipation was high when the high-risk threshold probability ranged from 0.06 to 0.80. Conclusion Age, duration of chronic constipation, and diabetes history are independent risk factors for unqualified body position exercises in patients with chronic constipation, and the Nomogram model constructed based on these multi-factor results has high discrimination and consistency in predicting unqualified body position exercises for patients with chronic constipation.

Objective:To compare the influence of dronedarone and amiodarone on the bleeding risk of patients with atrial fibrillation treated with rivaroxaban anticoagulation.Methods:Clinical data of 81 patients with atrial fibrillation treated with rivaroxaban anticoagulation at Xi'an International Medical Center Hospital from January 2020 to July 2023, including 36 patients treated with dronedarone and 45 patients treated with amiodarone, were retrospectively analyzed. The effects of dronedarone and amiodarone on the anticoagulation of rivaroxaban were compared using the incidence of bleeding events, thrombosis events, and adverse reactions as outcome measures.Results:The total bleeding in the dronedarone group [22.22% (8/36)] was significantly higher than that in the amiodarone group [6.67% (3/45)] ( χ2 = 4.12, P < 0.05). The total bleeding of conventional-dose rivaroxaban in the dronedarone group was 30.00% (6/20), while the total bleeding of low-dose rivaroxaban was 12.50% (2/16), with no statistical significance ( χ2 = 1.58, P > 0.05). No thrombotic events or adverse reactions to dronedarone or amiodarone were observed in all patients. Conclusion:Compared with amiodarone, dronedarone significantly increases the bleeding risk of rivaroxaban anticoagulation in patients with non-valvular atrial fibrillation, and reducing the dose of rivaroxaban in patients using dronedarone does not reduce the bleeding risk.