Objective:To investigate the influencing factors of green procurement for medical equipment,so as to provide theoretical basis and policy insights for promoting practices of green procurement for medical institutions.Methods:Based on literature review and expert interviews,a questionnaire about influencing factors of green procurement for medical equipment was formulated,which was used to conduct questionnaire survey for medical institutions of secondary and tertiary grades in Shandong province.The questionnaire included the measured indicators and basic information of medical institutions from four dimensions:pressure of external system(7 items),leadership support(4 items),organizational inertia(5 items),and collaboration degree of stakeholder(5 items).The Likert 5-level scale was adopted to conduct scoring of questionnaire,and the differences in various influencing factors between secondary grade hospital and tertiary grade hospital were compared and analyzed.Results:The scores of tertiary grade hospital were respectively 4.00(3.14,4.82),4.25(4.00,5.00),and 3.60(3.00,4.00)at pressure of external system,leadership support(4 items),organizational inertia(5 items)of three dimensions,and they were 3.86(3.11,4.14),4.00(3.75,5.00),and 3.20(2.80,3.80)at secondary grade hospital,and the differences of them between secondary grade hospital and tertiary grade hospital were significant(Z=-2.243,-2.654,-2.538,P<0.05).There was not significant difference at the dimension of collaboration degree of stakeholder between secondary and tertiary hospitals(P>0.05).Conclusion:A series of measures,such as adopting policy support with differentiation,establishing multi-level incentive mechanisms,reducing organizational change resistance,and improving multi-party coordination mechanisms,can further promote green procurement of medical institutions.

Objective:To investigate the influencing factors of green procurement for medical equipment,so as to provide theoretical basis and policy insights for promoting practices of green procurement for medical institutions.Methods:Based on literature review and expert interviews,a questionnaire about influencing factors of green procurement for medical equipment was formulated,which was used to conduct questionnaire survey for medical institutions of secondary and tertiary grades in Shandong province.The questionnaire included the measured indicators and basic information of medical institutions from four dimensions:pressure of external system(7 items),leadership support(4 items),organizational inertia(5 items),and collaboration degree of stakeholder(5 items).The Likert 5-level scale was adopted to conduct scoring of questionnaire,and the differences in various influencing factors between secondary grade hospital and tertiary grade hospital were compared and analyzed.Results:The scores of tertiary grade hospital were respectively 4.00(3.14,4.82),4.25(4.00,5.00),and 3.60(3.00,4.00)at pressure of external system,leadership support(4 items),organizational inertia(5 items)of three dimensions,and they were 3.86(3.11,4.14),4.00(3.75,5.00),and 3.20(2.80,3.80)at secondary grade hospital,and the differences of them between secondary grade hospital and tertiary grade hospital were significant(Z=-2.243,-2.654,-2.538,P<0.05).There was not significant difference at the dimension of collaboration degree of stakeholder between secondary and tertiary hospitals(P>0.05).Conclusion:A series of measures,such as adopting policy support with differentiation,establishing multi-level incentive mechanisms,reducing organizational change resistance,and improving multi-party coordination mechanisms,can further promote green procurement of medical institutions.

Purpose: Tumor recurrence is the principal cause of poor outcomes in remnant gastric cancer (RGC) after resection. We sought to elucidate the recurrent patterns according to tumor locations in RGC. Materials and Methods: Data were collected from the Shanghai Cancer Center between January 2006 and December 2020. A total of 129 patients with RGC were included in this study, of whom 62 had carcinomas at the anastomotic site (group A) and 67 at the non-anastomotic site (group N). The clinicopathological characteristics, surgical results, recurrent diseases, and survival were investigated according to tumor location. Results: The time interval from the previous gastrectomy to the current diagnosis was 32.0±13.0 and 21.0±13.4 years in groups A and N, respectively. The previous disease was benign in 51/62 cases (82.3%) in group A and 37/67 cases (55.2%) in group N (P=0.002). Thirty-three patients had documented sites of tumor recurrence through imaging or pathological examinations. The median time to recurrence was 11.0 months (range, 1.0–35.1 months). Peritoneal recurrence occurred in 11.3% (7/62) of the patients in group A versus 1.5% (1/67) of the patients in group N (P=0.006). Hepatic recurrence occurred in 3.2% (2/62) of the patients in group A versus 13.4% (9/67) of the patients in group N (P=0.038). Patients in group A had significantly better overall survival than those in group N (P=0.046). Conclusions The tumor location of RGC is an essential factor for predicting recurrence patterns and overall survival. When selecting an optimal postoperative follow-up program for RGC, physicians should consider recurrent features according to the tumor location.

Objective To investigate the clinical efficacy of laparoscopic surgery combined with gonadotropin-releasing hormone agonist (GnRH-a) in the treatment of endometriosis (EMs).Methods 86 patients with EMs were selected as study subjects.The patients were divided into two groups by random number table.43 patients in the control group underwent laparoscopic surgery,while 43 patients in the observation grouop received GnRH-a treatment based on laparoscopic surgery,and the clinical effect was analyzed.Results The total effective rate was 93.02％ in the observation group,which was significantly higher than 72.09％ in the control group.The recurrence rate in the observation group was 11.63％,which was significantly lower than 32.56％ in the control group,the difference was statistically significant (x2 =7.55,8.41,all P ＜ 0.05).After treatment,the levels of FSH,LH,and E2 of the observation group were (1.71 ± 0.64) U/L,(2.66 ± 0.75) U/L,(96.72 ± 14.51) pmol/L,respectively,which were significantly lower than before treatment (t =8.80,7.80,7.55,all P ＜ 0.05),and the differences were statistically significant compared with the control group (t =8.55,7.48,7.19,all P ＜ 0.05).The total pregnancy rate of the observation group was 70.59％,which was significantly higher than 38.71％ of the control group,the difference was statistically significant (x2 =7.77,P ＜ 0.05).The pain relief rate,dysmenorrhea rate,remission rate of chronic pelvic pain in the observation group were 90.70％,86.05％,93.02％,which were significantly higher than those in the control group (x2 =6.55,7.01,7.88,all P ＜ 0.05).The incidence rate of adverse reactions in the observation group was 11.63％,which was significantly lower than 27.91％ in the control group,the difference was statistically significant (x2 =7.06,P ＜ 0.05).The main adverse reactions were hot flashes sweating,vaginal dryness,insomnia,fatigue and other low estrogen symptoms,which could tolerate,after treatment to relieve or disappear,liver and kidney function tests had no abnormalities.Conclusion Laparoscopic surgery combined with GnRH-a in the treatment of endometriosis can improve the treatment effect,improve the symptoms and reproductive hormone levels,improve the postoperative pregnancy rate,reduce the recurrence rate,and with high safety,it is worthy of clinical promotion and application.