Against the backdrop of deep integration between digital technology and healthcare,internet hospitals are tran-sitioning from"channel supplementation"to"service reconstruction."Based on conventional internet hospital service processes,this paper proposes construction suggestions and optimization strategies for four key nodes:the development of intelligent triage systems,the improvement of appointment systems,the integration of online and offline services,and the expansion of post-consul-tation services.By focusing on patient experience,medical services can become more humanized and personalized,thereby en-hancing patient efficiency and satisfaction with internet-based healthcare services and promoting the overall development of the medical service industry.

Under the background of the in-depth implementation of the Healthy China initiative,the high-quality devel-opment of public hospitals has become a key link in deepening the reform of the medical and health system.This research,focu-sing on public hospitals in Tianjin,systematically investigates innovative approaches to operational management through literature review and field research methods.Typical case analysis illustrates the status of construction of operational management depart-ments of Tianjin's public hospitals.Meanwhile the study explores the issues such as underdeveloped management infrastructure,inadequate intelligentization,and challenges in inter-departmental coordination.Consequently,it proposes countermeasures and suggestions such as establishing a data-driven real-time monitoring systems and improving cross-departmental governance frame-works.This research offers theoretical insights for optimizing the operational and management system of public hospitals,provides replicable practical experience for healthcare reforms in similar cities,and contributes to achieving the synergistic alignment of so-cial benefits and operational quality of public hospitals.

Against the backdrop of deep integration between digital technology and healthcare,internet hospitals are tran-sitioning from"channel supplementation"to"service reconstruction."Based on conventional internet hospital service processes,this paper proposes construction suggestions and optimization strategies for four key nodes:the development of intelligent triage systems,the improvement of appointment systems,the integration of online and offline services,and the expansion of post-consul-tation services.By focusing on patient experience,medical services can become more humanized and personalized,thereby en-hancing patient efficiency and satisfaction with internet-based healthcare services and promoting the overall development of the medical service industry.

Under the background of the in-depth implementation of the Healthy China initiative,the high-quality devel-opment of public hospitals has become a key link in deepening the reform of the medical and health system.This research,focu-sing on public hospitals in Tianjin,systematically investigates innovative approaches to operational management through literature review and field research methods.Typical case analysis illustrates the status of construction of operational management depart-ments of Tianjin's public hospitals.Meanwhile the study explores the issues such as underdeveloped management infrastructure,inadequate intelligentization,and challenges in inter-departmental coordination.Consequently,it proposes countermeasures and suggestions such as establishing a data-driven real-time monitoring systems and improving cross-departmental governance frame-works.This research offers theoretical insights for optimizing the operational and management system of public hospitals,provides replicable practical experience for healthcare reforms in similar cities,and contributes to achieving the synergistic alignment of so-cial benefits and operational quality of public hospitals.

OBJECTIVE: To assess the clinical efficacy and health economic value of non-invasive prenatal testing (NIPT) for the prenatal screening of common fetal chromosomal aneuploidies. METHODS: 10 612 pregnant women from October 2017 to December 2019 presented at the antenatal screening clinic of the General Hospital of Tianjin Medical University were selected as the study subjects. Results of NIPT and invasive prenatal diagnosis and follow-up outcome for the 10 612 pregnant women were retrospectively analyzed and compared. Meanwhile, NIPT data for two periods were analyzed for assessing the health economic value of NIPT as the second- or first-tier screening strategy for the prenatal diagnosis of fetal trisomies 21, 18 and 13. RESULTS: The NIPT was successful in 10 528 (99.72%) subjects, with the sensitivity for fetal trisomies 21, 18 and 13 being 100%, 92.86% and 100%, and the positive predictive value (PPV) being 89.74%, 61.90% and 44.44%, respectively. The PPV of NIPT for sex chromosome aneuploidies was 34.21%. Except for one false negative case of trisomy 18, the negative predictive value for trisomy 21, trisomy 13 and other chromosomal abnormalities were 100%. For pregnant women with high risk by serological screening, advanced maternal age or abnormal ultrasound soft markers, NIPT has yielded a significantly increased high risk ratio. There was no statistical difference in the PPV of NIPT among pregnant women from each subgroup. NIPT would have higher health economic value as a second-tier screening until 2019, while compared to 2015 ~ 2017, its incremental cost-effectiveness ratio as a first-tier screening had declined clearly. CONCLUSION The screening efficacy of NIPT for trisomies 21, 18 and 13 for a mixed population is significantly better than conventional serological screening, but it is relatively low for sex chromosomal abnormalities. NIPT can also be recommended for populations with relatively high risks along with detailed pre- and post-test genetic counselling. From the perspective of health economics, except for open neural tube defects, it is possible for NIPT to replace the conventional serological screening in the future as its cost continues to decrease.
Pregnancy ; Female ; Humans ; Trisomy/genetics* ; Retrospective Studies ; Prenatal Diagnosis/methods* ; Down Syndrome/genetics* ; Aneuploidy ; Chromosome Aberrations ; Trisomy 18 Syndrome/genetics* ; Sex Chromosome Aberrations ; Fetus

Objective:To evaluate the clinical efficacy of Wanfu-Qutong Decoction combined with esomeprazole in the treatment of chronic atrophic gastritis (CAG). Methods:A total of 106 CAG patients who met the inclusion criteria from June 2017 to June 2019 were randomly divided into two groups with 53 in each group. The control group took esomeprazole magnesium enteric coated tablets, and the observation group took Wanfu-Qutong Decoction on the basis of the control group. Both groups were treated continuously for 3 months. TCM syndrome score was performed before and after treatment, and the new Sydney system intuitive simulation score method was used to score the histopathology of gastric mucosa. The levels of gastrin 17 (G-17), pepsinogen (PGⅠ , PGⅡ) and the PG Ⅰ/Ⅱ were measured by ELISA. Results:The total effective rate was 96.2% (51/53) in the observation group and 79.2% (42/53) in the control group. There was significant difference between the two groups ( χ2=7.414, P<0.01). After treatment, the scores of epigastric pain, fullness, liking temperature and pressing, vomiting clear water, eating less and staying foolish, and limb burnout in the observation group were significantly lower than those in the control group ( t values were 2.788, 3.632, 3.816, 1.590, 2.183, 2.103, respectively, all Ps<0.05), and the scores of chronic inflammatory reaction, inflammatory activity, atrophy degree, dysplasia and intestinal metaplasia in the mucosa were significantly lower than those in the control group ( t values were 2.983, 2.106, 2.106, 3.773, 1.922, 3.095, respectively, all Ps<0.05). After treatment, the serum G-17 [(14.47 ± 3.06) pmol/L vs. (10.67 ± 2.47) pmol/L, t=10.510] and PG Ⅰ [(130.31 ± 14.79) μg/L vs. (102.36 ± 12.63) μg/L, t=8.178] and PG Ⅰ/Ⅱ [(10.45 ± 0.48) vs. (9.17 ± 0.72), t=2.104] in the observation group were significantly higher than those in the control group ( P<0.01 or P<0.05). Conclusion:Wanfu-Qutong Decoction combined with esomeprazole tablets can effectively improve the clinical symptoms of CAG patients, regulate the levels of G-17, PG Ⅰ , PG Ⅱ and PGⅠ/Ⅱ, and promote the repair of gastric mucosa.

The prone position ventilation, as a new type of mechanical ventilation treatment technology, has been widely used in clinical practice. Patient populations and disease types have been obviously expanded. The implementation of the technology needs medical staff's cooperation. The intervention effect, safety and quality critically depend on nursing work. In the whole process, the nursing quality has been put forward higher request. In recent years, increasing scholars have paid attention to the related researches. This paper summarizes the clinical application, nursing points, and the challenges of the prone position ventilation in patients with respiratory failure, in order to provide reference for the development and optimization of the clinical nursing.

Objective To quantify the workload rate of nurses at clinical departments and to clarify the current situation of clinical nursing work. Methods We randomly selected three departments respectively from the medical system and the surgery system as observation areas, and the nurses on the job as observation objects. Then we drew up the to-do-list of nursing work, and defined the concepts and activities of various items. The nurses of the department were observed and recorded every 5 minutes by uniformly-trained observers, and the data were collected and entered into the Excel software to set up the database by using the method of work sampling combined with the random starting point and other time intervals. Based on data collation and analysis of SPSS19. 0 statistical software, the improvement and control scheme was put forward. Results The average nursing workload rates of medicine and surgical systems were 93. 52％ and 92. 13％ respectively. Direct nursing in the surgical system accounted for 10. 59％, and indirect nursing accounted for 62. 89％; direct nursing for the medical system accounted for 16. 20％ and indirect nursing for 57. 32％. The proportions of nursing work belonged to operation increment were relatively large (77. 32％ and 81. 54％). Conclusions The work sampling method is more comprehensive and objective to reflect the intensity of nursing workload. To define the workload of clinical nurses and distinguish the increment and waste items of nursing process are helpful to improve the quality of nursing management and the efficiency of service.

Objective To explore the effects of heated humidified high flow nasal cannulae (HFNC) oxygen therapy among patients with pulmonary fibrosis. Methods A total of 60 patients in accord with diagnostics guide for idiopathic pulmonary fibrosis and admitted to Department of Respiratory at a Class III Grade A hospital in Tianjin for pulmonary fibrosis were selected by convenience sampling from May 2016 to March 2017. They received oxygen inhalation through nasal cannula for 24 hours and sequentially HFNC oxygen therapy for 24 hours respectively. The blood gas analysis,degree of comfort,severity of dyspnea and incidence of complications were compared two,four and twenty-four hours after adopting oxygen inhalation through nasal cannula and HFNC oxygen therapy. Results There were statistically significant differences in PaO2,SpO2,base excess (BE) and respiratory rate (RR) between oxygen inhalation through nasal cannula and HFNC oxygen therapy (P<0.05). The degree of comfort and severity of dyspnea significantly improved by HFNC oxygen therapy (P<0.05). There was a statistically significant difference in the incidence of complications (P<0.05). However,there was no statistically significant differences in PaCO2and PH between two oxygen methods (P>0.05). Conclusions The application of HFNC can increase PaO2and SpO2,and slow RR among patients with pulmonary fibrosis. Meanwhile,it can also effectively improve the severity of dyspnea,promote patients′ comfort and reduce the incidence of complications.