Objective To develop an evaluation system for quality palliative care and provide an evaluation tool for quality palliative care service.Methods A preliminary evaluation system was drafted by using literature review and group discussion,aligning with the U.S.National Consensus Project for Quality Palliative Care(NCP).The system was revised and refined by two rounds of Delphi consultation with 15 palliative care experts(including specialists in clinical practice,nursing management,nursing research and education)from Tier-IIIA hospitals in Guangdong Province.Indicator weights were determined via consensus.Results Both rounds of expert consultation achieved 100.00%response rates.Expert authority coefficient(Cr)was 0.855.The importance scores of the level-1,level-2 and level-3 indicators of the second round of expert consultation were 4.90-5.00,4.80-5.00 and 4.37-5.00,respectively.Coefficients of variation were 0-0.06,0-0.1 and 0-0.19,respectively.The full score ratio ranged between 0.93 and 1.00,0.8 and 1.00,and 0.67 and 1.00.Kendall's W coefficients were 0.214,0.287 and 0.245,respectively(all P<0.01).The nine level-1 indicators were identified as care structure and process,physiological care,psychological care,social care,mental care,cultural care,end-of-life care,ethical care and quality improvement,with the weight coefficients of 0.123,0.153,0.110,0.106,0.098,0.082,0.119,0.092 and 0.117,respectively.The final evaluation system for quality palliative care included 9 indicators in level-1,22 in level-2 and 69 in level-3.Conclusion The evaluation system for quality palliative care developed on the basis of NCP is scientifically innovative and valid in content.Further studies are required to evaluate its validity..

Objective To develop an evaluation system for quality palliative care and provide an evaluation tool for quality palliative care service.Methods A preliminary evaluation system was drafted by using literature review and group discussion,aligning with the U.S.National Consensus Project for Quality Palliative Care(NCP).The system was revised and refined by two rounds of Delphi consultation with 15 palliative care experts(including specialists in clinical practice,nursing management,nursing research and education)from Tier-IIIA hospitals in Guangdong Province.Indicator weights were determined via consensus.Results Both rounds of expert consultation achieved 100.00%response rates.Expert authority coefficient(Cr)was 0.855.The importance scores of the level-1,level-2 and level-3 indicators of the second round of expert consultation were 4.90-5.00,4.80-5.00 and 4.37-5.00,respectively.Coefficients of variation were 0-0.06,0-0.1 and 0-0.19,respectively.The full score ratio ranged between 0.93 and 1.00,0.8 and 1.00,and 0.67 and 1.00.Kendall's W coefficients were 0.214,0.287 and 0.245,respectively(all P<0.01).The nine level-1 indicators were identified as care structure and process,physiological care,psychological care,social care,mental care,cultural care,end-of-life care,ethical care and quality improvement,with the weight coefficients of 0.123,0.153,0.110,0.106,0.098,0.082,0.119,0.092 and 0.117,respectively.The final evaluation system for quality palliative care included 9 indicators in level-1,22 in level-2 and 69 in level-3.Conclusion The evaluation system for quality palliative care developed on the basis of NCP is scientifically innovative and valid in content.Further studies are required to evaluate its validity..

Cost data caliber governance is key to fine cost management. To tackle the troubles in cost data management at multiple campuses of one hospital, the authors built a multi-campus cost data caliber governance mode. By means of enhanced top-level design, the mode carried out data governance by such measures as the establishment of data dictionary mapping library, standardizing department names and caliber, classification of charging items of medical services, precisely matching between fixed assets and charging items, interconnecting the management system of charging library and the procurement library of consumables, as well as precisely matching surgical disease types and charging items. These measures accomplished the consistency and comparability of cost data across campuses, building an automated, streamlined, standardized and integrated data governance mode for reference of hospitals with multiple campuses in need of cost management.

Objective:To evaluate the curative effect and adverse reactions of compound acid, alpha hydroxyl acid (AHA), and salicylic acid (SA) in the treatment of mild to moderate acne.Methods:A total of 105 patients admitted in Suzhou Municipal Hospital from August 2019 to May 2020 were divided into three groups randomly and treated with compound acid, AHA and SA, once every 3 weeks, 4 times totally. The efficacy was evaluated before treatment, 3 weeks after 1 time, 2 times, 3 times, and 4 times. The number of non-inflammatory lesions (comedos) and inflammatory lesions (papules or pustules) were recorded. VISIA image was used to record the patient＇s facial characteristics before treatment and 3 weeks after 4 times. The occurrence of adverse reactions was recorded.Results:Three groups were all safe and effective. The efficiency of non-inflammatory lesions showed that there was no statistically significant difference between the 3 groups (χ 2= 4.58, P=0.101). The effective rate of inflammatory lesions in the compound acid and SA groups were higher than that of AHA group, and the difference was statistically significant (χ 2=6.45, P=0.040). After 4 times, the clinical data of purpurin, red area, and spot in compound acid and SA groups were higher than those before treatment, and the difference was statistically significant ( P<0.05). While in the AHA group, the purple matter was higher than that before treatment after 4 times, the difference was statistically significant ( t=3.506, P=0.010), and the change in the red area was not statistically significant ( P>0.05). Conclusions:The compound acid is safe and effective in treating mild and moderate acne. It is effective for acne inflammatory and non-inflammatory lesions. It has less adverse reactions and is worthy of clinical application.

Amyloidosis ; Cardiomyopathy, Hypertrophic ; Humans

BACKGROUNDDuring the past decade, graft materials have been widespread used in the vagina in order to correct pelvic organ prolapse. The aim of this study was to describe and compare the exact anatomical position of the puncture devices and their relations to the relevant anatomical structures in the Prolift(TM) and a modified pelvic reconstructive surgery with mesh.

METHODSTwelve fresh cadavers were allocated randomly to either the Prolift(TM) or the modified pelvic reconstructive surgery group. Each group had six fresh cadavers. Relevant distances between the puncture devices and anatomical structures were recorded in both minimally invasive puncture surgeries.

RESULTSThe mean distances from the posterior puncture points of the obturator membrane to the posterior branch of obturator arteries were shorter ((0.60 ± 0.36) cm and (0.78 ± 0.10) cm) when compared with the distances to the anterior branch of obturator arteries ((1.53 ± 0.46) cm and (1.86 ± 0.51) cm) for the reconstruction of the anterior compartment in both surgeries (all P < 0.05). The distance from the puncture points of the pelvic floor through the ischiorectal fossa to the coccygeal and inferior gluteal arteries in the Prolift(TM) technique ((0.88 ± 0.10) cm) and ((1.59 ± 0.36) cm)) were much shorter than that in the modified pelvic reconstructive surgery ((2.95 ± 0.09) cm) and ((3.40 ± 0.36) cm)) for the reconstruction of the middle and posterior compartments (all P < 0.05).

CONCLUSIONSCompared with the Prolift(TM) technique, the modified pelvic reconstructive surgery with mesh would be safer not to cause great damage to the inferior gluteal arteries and the coccygeal arteries. The posterior branch of obturator arteries would be easier to be injured than the anterior branch of obturator arteries during anterior compartment reconstruction in both surgeries.

Aged ; Aged, 80 and over ; Cadaver ; Female ; Gynecologic Surgical Procedures ; methods ; Humans ; Pelvic Organ Prolapse ; surgery ; Postoperative Complications ; Reconstructive Surgical Procedures ; methods ; Surgical Mesh ; Treatment Outcome

Objective To investigate the effect and nursing experience of iliacus groin approaches and internal fixation treatment for patients with pelvic fractures. Methods Twenty- six patients with unstable pelvic fracture were obtained iliac groin approaches and internal fixation treatment, the changing symptoms in patients were monitored frequently, and all patients were performed general nursing. Results All patients were followed up for 0.5 to 5.0 years, without obvious complications, the results of surgical treatment included optimal 16 cases, good 7 cases, mean 3 cases. Conclusions Iliacus groin approaches and internal fixation with reconstruction plate treatment on pelvic fractures was proved to be reset accurate, reliable and strong, with better effects. Effective nursing measures can save life of patients with pelvic fractures, speed up rehabilitation of physiological function, improve life quality of the patients.

Objective To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse.Methods Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification (POP-Q) system received modified total pelvic floor reconstruction surgery.Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed Results Median operation time was 70 minutes (30-240 minutes),median blood loss was 100 ml (10-200 ml).Seventy-seven percent (30/39) patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml (0-650 ml).No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% (8/39 ).Median post-operative hospital stay was 4 days (1-11 days).The patients were followed up at median 24 months(13-29 months).According to POP-Q system evaluation,the successful rate of operation reached 100% .Two cases (5%,2/39) were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation.During follow-up,8% (3/39) patients were found to have erosion within 7 months after surgery,and urgent urinary incontinence was observed in 5% (2/39) cases,while constipation occurred in 8% (3/39) cases.The most remarkable complication was dyspareunia (36%,5/14); while 50% (7/14) experienced better sexual life after surgery.Conclusions Modified total pelvic reconstruction is a safe,efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse.However,its influence on post-operative sexual life should be concerned.

Objective To investigate the serum neuron-specific enolase (NSE) and high sensitivity C-reactive protein (hs-CRP) on neonatal hypoxic-ischemic encephalopathy (HIE) in children with illness and prognosis of assessed value. Method The serum NSE, hs-CRP levels of 40 patients with HIE (HIE group) of the acute stage and convalescence, and 20 healthy neonates (control group ) were measured and the clinical sub-degree relationships were analyzed. Results The serum NSE, hs-CRP levels in HIE group of the acute stage [ (32.88 ± 12.61 ) μ g/L, (6.43 ± 2.07) mg/L] were significantly higher than those in control group [(8.62 ± 3.58) μ g/L, (2.61 ± 0.95) mg/L](P ＜ 0.01 ). The serum NSE, hs-CRP levels in HIE group of the severe acute stage were significantly higher than those of the mild and light acute stage (P＜0.01 ). The more severe disease, the more higher NSE, hs-CRP. Conclusion The serum NSE, hs-CRP reflect the brain neuronal damage or necrosis of the objective indicators that could be used as early objective indicators to judge the pathogenetic condition and prognosis of HIE.

Objective To investigate the clinical efficacy and improvement of patients' quality of life in tension-free vaginal tape(TVT)and tension-free vaginal tape obturator(TVT-O)for surgical treatment of severe female stress urinary incontinence.Methods This study was a randomized,singleblinded,controlled trial.Patients were randomized by a computer-generated randomization schedule with allocation to either TVT or TVT-O procedure.TVT procedure was performed in 35 cases and TVT-O in 34 cases.None had received surgery for urinary incontinence or was in pregnancy.Transvaginal hysterectomy and prolapse reparation were done simultaneously in some of the patients.All patients were requested to complete the Urinary Distress Inventory(UDI-6)and Incontinence Impact Questionnaire(ⅡQ-7)as part of their pre-and postoperative assessment.Results All patients were evaluable and the mean follow-up was 14.5 months.The mean operative time was(18±5)min in the TVT-O group,Significantly shorter than in the TVT group(27±5)min(P＜0.01).The two groups did not differ significantly in perioperative blood loss,postoperative complications(including tape erosion,pain in thigh or behind pubis),postvoid residual volume,hospital stays or expenses(all P＞ 0.05).Sixty patients were successfully treated for stress urinary incontinence(88.6%and 85.3%for TVT and TVT-O groups,respectively).There were significant improvements in postoperative scores for both the ⅡQ-7 and the UDI-6(P＜0.01),except in subscale measuring symptoms of voiding dysfunction(P＞0.05).Conclusions Both techniques appear to be equally effective in the surgical treatment of severe stress urinary incontinence in a short term review.Significant improvements could also be seen in patients' quality of life.However.TVT-O has a shorter operative time.No evidence of increasing risk of urethral obstruction after the operation could be found.Long term followups axe necessary to evaluate outcomes of different types of surgery for stress urinary incontinence.