Objective In order to fully mobilize the enthusiasm of clinical physicians and explore the construction of a performance evaluation physician index system in tertiary public hospitals under the background of the annual salary system.Methods This study used literature research method and systematically reviewed relevant policy documents and research results,initially constructed an index pool and set up a questionnaire for expert consultation.Relevant experts were selected to conduct two rounds of Delphi consultation,and statistical methods were used to analyze the results of expert consultation and further im-prove the index system.Finally,the weight coefficients of each level of indicators were determined using the analytic hierarchy process(AHP)to construct a reasonable index system.Results Based on expert opinions,the index system for physician eval-uation under the annual salary system in public hospitals was finally constructed through two rounds of expert consultation.The in-dex weights were obtained by using the analytic hierarchy process,with five primary indicators(0.246 for workload,0.277 for work quality and safety,0.176 for work efficiency,0.176 for medical ethics and comprehensive quality appraisal,and 0.125 for scientific and educational capabilities)and 21 secondary indicators.The consistency test of the weights of each indicator had a CR value less than 0.01.Conclusion The construction of a physician evaluation index system for public hospitals under the an-nual salary system is closely in line with the current trend of medical system reform and provides a scientific and effective physi-cian evaluation tool for hospitals with the annual salary system.

Objective In order to fully mobilize the enthusiasm of clinical physicians and explore the construction of a performance evaluation physician index system in tertiary public hospitals under the background of the annual salary system.Methods This study used literature research method and systematically reviewed relevant policy documents and research results,initially constructed an index pool and set up a questionnaire for expert consultation.Relevant experts were selected to conduct two rounds of Delphi consultation,and statistical methods were used to analyze the results of expert consultation and further im-prove the index system.Finally,the weight coefficients of each level of indicators were determined using the analytic hierarchy process(AHP)to construct a reasonable index system.Results Based on expert opinions,the index system for physician eval-uation under the annual salary system in public hospitals was finally constructed through two rounds of expert consultation.The in-dex weights were obtained by using the analytic hierarchy process,with five primary indicators(0.246 for workload,0.277 for work quality and safety,0.176 for work efficiency,0.176 for medical ethics and comprehensive quality appraisal,and 0.125 for scientific and educational capabilities)and 21 secondary indicators.The consistency test of the weights of each indicator had a CR value less than 0.01.Conclusion The construction of a physician evaluation index system for public hospitals under the an-nual salary system is closely in line with the current trend of medical system reform and provides a scientific and effective physi-cian evaluation tool for hospitals with the annual salary system.

Objective:To investigate the analgesic effect of ultrasound-guided transversus abdominis plane block versus ultrasound-guided quadratus lumborum block in older adult patients undergoing inguinal hernia repair surgery. Methods:A total of 150 older adult patients who underwent inguinal hernia repair surgery at the Marine Police Corps Hospital of Chinese People's Armed Police Force from April 2019 to May 2022 were included in this study. They were randomly divided into a control group ( n = 75) and a study group ( n = 75) using a random number table method. All patients underwent elective laparoscopic tension-free inguinal hernia repair surgery. Patients in the control group received ultrasound-guided transversus abdominis plane block after inguinal hernia repair surgery, while those in the study group received ultrasound-guided quadratus lumborum block. The changes in Visual Analog Scale (VAS) score and Ramsay score within 48 hours after surgery were compared between the two groups. Inflammatory factors and stress factors including serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol, were measured at 24 and 48 hours after surgery. The use of analgesics, drug-related adverse reactions, and incidence of nerve block-related complications within 48 hours after surgery were also compared between the two groups. Results:There was no significant difference in Ramsay score between the two groups at 4, 8, 12, 24, and 48 hours after surgery (all P > 0.05). There was no significant difference in VAS score between the two groups at 4 and 8 hours after surgery (both P > 0.05). At 12, 24, and 48 hours after surgery, the VAS score in the study group was (1.36 ± 0.57) points, (2.05 ± 0.56) points, and (1.79 ± 0.55) points, respectively, which were significantly lower than (1.92 ± 0.59) points, (2.68 ± 0.62) points, and (2.36 ± 0.59) points in the control group ( t = 6.65, 7.31, 5.86, all P < 0.001). At 24 and 48 hours after surgery, serum tumor necrosis factor alpha, interleukin-6, norepinephrine, and cortisol levels in the study group [24 hours: (63.89 ± 4.65) ng/L, (156.59 ± 8.62) ng/L, (97.02 ± 6.95) g/L, (36.95 ± 3.26) g/L; 48 hours: (49.66 ± 3.74) ng/L, (131.45 ± 7.73) ng/L, (74.63 ± 5.91) g/L, (30.41 ± 2.96) g/L] were significantly lower than those in the control group [24 hours: (76.42 ± 5.17) ng/L, (189.32 ± 10.41) ng/L, (105.53 ± 7.83) g/L, (45.16 ± 3.74) g/L; 48 hours: (58.15 ± 3.94) ng/L, (162.74 ± 8.49) ng/L, (89.51 ± 6.37) g/L, (36.92 ± 3.31) g/L, t = 10.49-26.38, all P < 0.001]. The proportion of patients who received analgesics within 48 hours after surgery in the study group was 8.00% (6/75), which was significantly lower than 25.33% (19/75) in the control group ( χ2 = 8.11, P = 0.004). The overall incidence of drug-related adverse reactions within 48 hours after surgery in the study group [6.67% (3/75)] was significantly lower than that in the control group [11% (11/75), χ2 = 4.61, P = 0.032]. Conclusion:Compared with ultrasound-guided transversus abdominis plane block, ultrasound-guided quadratus lumborum block better helps alleviate postoperative pain in older adult patients undergoing inguinal hernia repair surgery, inhibits inflammation and stress reactions, reduces the dosage of analgesic drugs, and decreases the incidence of adverse drug reactions.

The complexity of coding surgical procedures related to renal replacement therapy in nephrology stems from a deficiency in clinical knowledge regarding renal replacement therapies and an incomplete understanding of the classification rules within the ICD-9-CM-3 coding system.This paper delves into the clinical aspects of renal replacement therapy and organizes the corresponding coding classification rules,clarifying the codes for various treatment modalities.For instance,the establishment of dialysis access is coded as 38.95 for hemodialysis venous intubation,39.27 for vascular fistula,and 54.93 for peritoneal dialysis intubation via a cutaneous peritoneal stoma.Maintenance hemodialysis is coded as 39.95,while peritoneal dialysis is coded as 54.98.The removal of dialysis catheter is differentiated into surgical and non-surgical;surgical removal is coded as 86.05,and non-surgical removal as 97.86 or 97.89.For instances of internal fistula stenosis or thrombosis,balloon dilation is coded as 39.50.Stent implantation for stenosis or isolation of a false aneurysm is coded as 39.90 for bare stent,and 00.55 for covered stents.The resection and reconstruction involving stenosis,thrombus segments,or false aneurysms,are coded as 39.42.This classification aims to improve the accuracy of coding for such procedures.

Objective By analyzing the main diagnostic choices of inpatient records in obstetrics and the problems exist-ing in ICD codes,we can improve the quality of the main diagnostic choices and coding in obstetrics.Methods A total of 205 obstetric inpatient medical records were randomly selected from a hospital from January 1 to April 30,2024,and the medical re-cords were checked jointly by three senior coders,and the errors were summarized and analyzed by using the check table.Results Among 205 obstetrical medical records,72(35.12％)were found to have errors in the selection and coding of major diagnoses;among them,there were 55 cases of incorrect selection by clinician and incorrect compilation by coders,13 cases of correct selection by clinician,incorrect compilation or omission by coders,4 cases of omission by clinician and omission by cod-ers.Conclusion The selection and coding of the main diagnosis in obstetrics are very special and difficult,so the training of cli-nicians should be strengthened,the writing of clinicians should be standardized,and the importance of the main diagnosis selec-tion should be strengthened.At the same time,strengthen the management of coders,standardize the coding operation process,strengthen the learning of professional knowledge,improve professional reserves,strengthen the two-way communication with cli-nicians,and jointly improve the main diagnosis selection and coding accuracy rate of obstetrics,so as to ensure the quality of data on the first page of obstetric inpatient medical records.

Objective:To investigate the clinical efficacy of different enteral nutrition methods combined with swallowing rehabilitation training in the treatment of Alzheimer's disease complicated by dysphagia.Methods:A total of 120 patients with Alzheimer's disease and dysphagia who received treatment in the Department of Geriatric Medicine, the Second Hospital of Jinhua from October 2019 to March 2021 were included in this study. They were randomly and evenly divided into four groups: A, B, C, and D. Patients in groups A, B, C, and D were given nasogastric tube feeding, naso-intestinal tube feeding, nasogastric tube feeding + swallowing rehabilitation training, and naso-intestinal tube feeding + swallowing rehabilitation training, respectively. After 12 weeks of treatment, total response rate, nutritional status, and complications were compared between the four groups.Results:After 12 weeks of treatment, total response rate in group D was the highest (100.0%), which was significantly higher than that in the other three groups (group A: 13.3%; group B: 40.0%; group C: 73.3%; χ2 = 45.88, 25.71, 9.23, all P < 0.05). After treatment, the nutritional status [body mass index (BMI): (21.42 ± 1.85) kg/m 2, (23.17 ± 2.03) kg/m 2] and patient satisfaction (60.0%, 100.0%) in groups C and D were significantly superior to those in group A [BMI: (19.01 ± 1.72) kg/m 2; patient satisfaction: 10.0%) and group B [BMI: (19.86 ± 1.69) kg/m 2; patient satisfaction: 33.3%]. Group D had the best nutritional status ( t = 7.01, 5.14, 1.78, all P < 0.05) and the highest patient satisfaction ( χ2 = 49.09, 30.00, 15.00, all P < 0.001). Conclusion:Naso-intestinal tube feeding combined with swallowing rehabilitation training is the best treatment for Alzheimer's disease complicated by dysphagia among the studied enteral nutrition feeding methods and therefore deserves clinical promotion.

Objective:To investigate the analgesic effects of Dexmedetomidine combined with Ropivacaine for abdominal fascia block(AFB, with transverse abdominis plane block and rectus abdominis sheath block)in elderly patients undergone open surgery for colon cancer.Methods:This was a prospective study.Fifty elderly patients following ASA Ⅰ-Ⅲ open surgery for colon cancer were randomly divided into Group R and Group RD.Patients in Group R were treated with Ropivacaine for AFB, and those in Group RD were given Dexmedetomidine 0.5 μg/kg and Ropivacaine.All patients received Morphine-based patient-controlled intravenous analgesia(PCIA)after surgery.The total dose of postoperative Morphine, the time to first required use of Morphine, and the visual analog score(VAS)at 4, 8, 16, and 24 h after surgery were compared between the two groups.Results:Compared with Group R, patients in Group RD were associated with a significantly decreased total amount of Morphine at 24 h after surgery [25(20-32)mg vs.30(22-38)mg, Z=5.00, P<0.001], a lower VAS at 4 h [17(15-19) vs.36(23-39), Z=23.04, P<0.001]and 8 h after surgery [20(18-22) vs.41(38-55), Z=25.47, P<0.001], a longer time to first required use of Morphine [233(204-256)min vs.183(167-195)min, Z=4.367, P<0.001], and less postoperative nausea and vomiting(20.0% vs.48.0%, P=0.037). Conclusions:For elderly patients after colon cancer surgery, transverse abdominis plane and rectus sheath block with Dexmedetomidine plus Ropivacaine can enhance the analgesic effect, prolong the time of effective analgesia, reduce the amount of Morphine used postoperatively, and is beneficial for early recovery.

Objective: To investigate the sodium,potassium and blood pressure of adult residents in Liandu District of Lishui,and to provide evidence for salt reduction intervention. Methods: A stratified random sampling method was used to select residents aged 18 to 69 years in Liandu District from December 2016 to February 2017. A questionnaire survey and physical examination were conducted to collect basic information. The 24-hour urine samples were collected to detect sodium and potassium intake. Results: Among 300 participants,the average daily intake of sodium was（10.59±3.90）g,which was higher in men than in women [（11.11±4.33）g vs.（10.08±3.37）g,P<0.05]. There were 274 participants with average daily intake of sodium more than 6 g,accounting for 91.33%. The average daily intake of potassium was（1.67±0.71）g,which was higher in women than in men [（1.77±0.72）g vs.（1.57±0.68）g,P<0.05]. The average daily intakes of potassium were significantly different among different age groups,with participants aged 20 to 29 years the lowest（P<0.05）. There were 217 participants with average daily intake of potassium less than 2 g,accounting for 72.33%. The ratio of sodium to potassium was 4.7±2.2,which was higher in men than in women（5.3±2.7 vs. 4.1±1.4,P<0.05）and decreased with age（P<0.05）. There were 291 participants with the ratio more than 1.87,accounting for 97.00%. The prevalence of hypertension was 31.67%,which was 33.65% in men and 29.80% in women. Conclusion The residents in Liandu District have high intake of sodium and prevalence of hypertension,yet low intake of potassium.

Objective : To investigate the knowledge,attitude and practice of salt reduction for hypertension prevention among residents in Liandu District of Lishui,and to provide reference for intervention of salt reduction. Methods : Residents aged 18-69 years in two communities and three towns of Liandu District were selected by multistage stratified random sampling method. They were investigated the prevalence of hypertension and knowledge,attitude and practice of salt reduction for hypertension prevention. Logistic regression models were used to analyze the influencing factors for knowledge,attitude and practice of salt reduction for hypertension prevention. Results : Among 1 801 participants,1 509 completed the survey,with a response rate of 83.79%. The prevalence of hypertension was 31.88%. The proportions of the participants who had knowledge, attitude and practice of salt reduction for hypertension prevention were 33.40%,60.70% and 58.58%,respectively. The results of multivariate logistic regression analysis showed that women（OR=1.583,95%CI：1.248-2.008）,hypertension（OR= 1.734,95%CI：1.303-2.308）,30 to 39 years old（OR=0.368,95%CI：0.226-0.597）,junior high school and above education（OR=0.057-0.403,95%CI：0.036-0.577）were the influencing factors for the knowledge of salt reduction for hypertension prevention;women（OR=1.342,95%CI：1.072-1.679）,married（OR=1.582,95%CI：1.167-2.144）,junior or senior high school education（OR=0.235-0.525,95%CI：0.163-0.736）,having the knowledge（OR=2.640,95%CI：2.033-3.430）were the influencing factors for the attitude of salt reduction for hypertension prevention;women（OR=1.632,95%CI：1.304-2.044）,30 to 39 years old（OR=0.494,95%CI：0.346-0.705）,rural residents（OR= 1.617,95%CI：1.276-2.050）,family history of chronic diseases（OR=1.455,95%CI：1.148-1.845）,having the knowledge（OR= 1.396,95%CI：1.084-1.797）,having the attitude（OR=4.059,95%CI：3.203-5.145）were the influencing factor for the practice of salt reduction for hypertension prevention. Conclusion The residents in Liandu District had low levels of the knowledge,attitude and practice of salt reduction for hypertension prevention. The higher levels of the knowledge and attitude of salt reduction for hypertension prevention,the higher level of the practice.

Objective To evaluate the effect of partial neuromuscular blockade (NMB) on the efficacy and safety of nerve monitoring during microvascular decompression (MVD) of facial nerve.Methods Seventy American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 39-78 yr,weighing 44-84 kg,scheduled for elective MVD,were divided into 2 groups (n=35 each) using a random number table method:control group and partial NMB group.Anesthesia was induced by intravenous injection of 3-fold ED95 cisatracurium.In control group,muscle relaxants were not used after intubation.In partial NMB group,cisatracurium was continuously infused intravenously to maintain partial NMB,and the T1/Tc ratio was maintained at 20％-40％.Intraoperative neuroelectrophysiological monitoring was performed using lateral spread response (LSR).The success rates of LSR monitoring,occurrence of body movement,requirement for anesthetics and cardiovascular agents were recorded during operation,and the patients were followed up on day 7 after surgery,and the therapeutic efficacy and occurrence of neurological complications were recorded.Results Compared with control group,the incidence of intraoperative body movement was significantly decreased,the intraoperative consumption of propofol and remifentanil was decreased,and the intraoperative requirement for vasopressors was decreased in partial NMB group (P＜0.05).There was no significant difference in the success rate of LSR monitoring,therapeutic efficacy and incidence of neurological complications between two groups (P＞0.05).Conclusion Partial NMB (T1/Tc=20％-40％) can be effectively used for MVD monitored by LSR,decrease the occurrence of the body movement,and raise the perioperative safety in patients.