Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective:To evaluate the impact of implementing a regional hierarchical medical management model based on the medical internet of things (medical IoT) on the frequency of emergency department visits and hospitalizations, as well as related medical expenses, in patients with chronic obstructive pulmonary disease (COPD).Methods:This retrospective study included COPD patients enrolled in the regional hierarchical medical management system based on Medical IoT across 21 community health service centers in Songjiang District, Shanghai, between July 2017 and May 2018. Utilizing patient data from the year prior to enrollment as the baseline, changes in the number of emergency visits, hospitalizations, and associated medical costs during the first and second years of management were compared. Changes for patients receiving drug treatment were also analyzed.Results:A total of 973 COPD patients were enrolled. The mean age was 75.2±17.0 years, and 64.34% (626/973) were male. Compared to baseline, all COPD patients in the first year of management showed significant reductions: emergency visits decreased by 33.67%, total emergency costs by 45.60%, hospitalizations by 27.15%, and total hospitalization costs by 25.42%. In the second year, reductions were: emergency visits by 28.08%, total emergency costs by 36.10%, hospitalizations by 35.26%, and total hospitalization costs by 18.13% (all P<0.05). Among patients receiving drug therapy, reductions in the first year were: emergency visits by 39.66%, total emergency costs by 47.54%, hospitalizations by 25.19%, and total hospitalization costs by 28.40%. In the second year, reductions were: emergency visits by 46.98%, total emergency costs by 45.99%, hospitalizations by 41.98%, and total hospitalization costs by 24.94% (all P<0.05). No significant differences were observed before and after management for patients without drug treatment. Conclusion:The implementation of the regional hierarchical medical management model based on Medical IoT significantly reduced the frequency of emergency visits and hospitalizations, as well as related costs, for COPD patients.

Objective: To explore associated factors of mobile phone dependence and its relation with psychological resilience among college students. Methods: College students from 5 universities in Hefei were randomly selected through multi-stage sampling (stratified clustering) and investigated with questionnaires. A total of 2 502 college students were included in the analysis. Results: Mobile phone dependence among college students differed by gender (χ2=18.25, P<0.01), residence (χ2=17.71, P<0.01), whether in a relationship(χ2=8.09, P<0.01), grade(χ2=19.58, P<0.01), only child(χ2=7.48, P<0.01), family economic status (χ2=17.43, P<0.01) and time spent in mobile phone (χ2=73.46，P<0.01) while no similar differences were found by family structure and length of mobile phone ownership. Spearman correlation showed negative correlation (P<0.01) between mobile phone dependence and psychological resilience. Logistic regression model results showed that female, not in a relationship, lower grade, less time spent in mobile phone and high psychological resilience were negatively correlated with mobile phone dependence. Compared with students from rural areas, urban area was positively associated with mobile phone dependence. Emotional control, family support, and interpersonal assistance associated with lower risk for mobile phone dependence. Conclusion Mobile phone dependence is affected by gender, relationship status, grade, usage duration, and residence. High psychological resilience associated negatively with risk for mobile phone dependence.

OBJECTIVE:To systematically evaluate therapeutic efficacies of perioperative application of single-dose and multipie-dose of antibiotics for preventing surgical site infection after closed fractures patients receive incision and internal fixation,and to provide evidence-based reference.METHODS:Retrieved from PubMed,EMBase,CBM,Cochrane Library,CBM,CJFD,VIP and Wanfang database,RCTs about perioperative application of single-dose (trial group) and multiple-dose (control group) of antibiotics for preventing surgical site infection after closed fractures patients receive incision and internal fixation were collected.Meta-analysis was performed using Rev Man 5.3 statistical software after literature screening,data extraction and quality evaluation by improved Jadad.RESULTS:Finally 8 clinical studies were included,involving 3 457 patients.The results of Meta-analysis showed that there was no statistical significance in the rate of surgical site infection [OR=1.02,95％ CI(0.63,1.66),P=0.94)].Cefazolin stadies were included in subgroup analysis according to drug use,and results of Meta-analysis showed that there was no statistical significance in the rate of surgical site infection[OR=1.33,95％CI(0.55,3.20),P=0.52].CONCLUSIONS:Prophylactic application of single-dose of antibiotics is recommended for preventing surgical site infection after closed fractures patients receive incision and internal fixation.

OBJECTIVE:To discuss the risk factors for lung infection of CRAb in ICU,and to provide reference for clinical di-agnosis and treatment. METHODS:The univariate analysis and multivariate Logistic regression analysis were conducted with the method of case-control study,in which the clinical data of 105 cases of lung infection of CRAb in ICU were collected from our hospital during Jun. 2012 to Jun. 2014,with the 81 cases of CRAb and 24 cases of CSAb. RESULTS:The univariate analysis showed that those factors were significantly correlated with lung infection of CRAb in ICU,such as ICU hospitalization days be-fore isolation of Ab,total stay in ICU,respiratory failure,hypoproteinemia,mechanical ventilation,mechanical ventilation days, the application of carbapenem antimicrobial agents and combined use of antimicrobial agents within 15 days before isolation of Ab, abnormal C-reactive protein detection,abnormal procalcitonin detection. The multivariate analysis showed that ICU hospitalization days before isolation of Ab,the application of carbapenem antimicrobial agents within 15 days before isolation of Ab,mechanical ventilation,hypoproteinemia were the independent risk factors of CRAb. CONCLUSIONS:Based on risk factors,the measures should be taken for high-risk patients as soon as possible in ICU to prevent and treat lung infection of CRAb.

Objective To observe the effects of trimetazidine (TMZ) on the cardiac function and neurohormonal of heart failure model in rats.Methods Partially banding abdominal aortic artery to achieve congestive heart failure rats model.Interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter (LVESD),left ventricular ejection fraction(LVEF) and shortening fraction(FS) were measured by echocardiogram,Pathological changes of myocardial cells was observed,B-type natriuretic peptide (BNP)、C-type natriuretic peptide receptor (NPRC),atrial natriuretic peptide (ANP),myosin heavy chain (β-MHC) and angiotensinl (AT1) were measured by Real-Time PCR,superoxide dismutase (SOD) was measured by immunohistochemistry method.Results Trimetazidine treatment of the high-dose group and the model group compare IVST LVPWT,LVESD,LVEDD were (0.63 ± 0.05) mn,(0.73 ± 0.06) mm,(0.73 ±0.05)mm,(0.87 ±0.06)mm and (1.07 ±0.06)mm,(1.13 ±0.06) mm,(0.93 ±0.06)mm,(1.33 ±0.06) mm,was significantly reduced (P ＜ 0.05),LVEF,FS increased to (27.75 ± 1.83) ％,(11.44 ± 0.76) ％ and (11.78 ±0.56)％,(4.27 ± 0.22)％ (P ＜ 0.01),Myocardial cell structure were remarkably improved.The expression of BNP,ANP,NPRC,ATI,β-MHC were remarkably decreased.The expression of SOD was elevated.Conclusion TMZ treatment group can improve the secretion of neurohormonal of heart failure model in rats,and also obviously improve the cardiac contractility.