Objective To explore and implement a differentiated management strategy for multi-campus hospitals to improve patient experience and satisfaction,and achieve the goal of homogenized management.Methods In December 2021,the Picker Patient Experience Questionnaire was used to survey the patient experience at 3 campuses of a tertiary A hospital in Hangzhou,and the reasons for the differences were analyzed.Based on policy document reviews,special group discussions,and expert meetings,differentiated management strategy for multi-campus hospitals was formulated.The patient experience and satisfaction before(December 2021)and after(December 2023)the implementation were compared.Results After the application of the one-hospital multi-campus difference management strategy,the overall medical experience score of the patients in the 3 campus was(58.54±2.36)points,which was higher than(58.13±3.24)points before the application(t=-3.223,P=0.001),and there was no statistically significant differences among the patients in the 3 campuses(F=0.781,P=0.458).After the application of the management strategy,the overall satisfaction score of the patients in the 3 campus was(98.44±6.22)points,which was higher than(97.98±6.87)points before the application of the management strategy(t=-2.490,P=0.013),and there was no statistical significance among the patients in the 3 campus(F=1.128,P=0.324).The number of banners and letters of commendation received by the 3 campuses increased from 1 661 before the application to 2 190 after the application,with a growth rate of 31.85％.Conclusion Differentiated management in a multi-campus hospital,aiming at homogenized quality through differentiated strategies,is practicable and can significantly improve the patient experience and satisfaction across different campuses.

Objective:To retrieve and obtain relevant evidence of intra-abdominal pressure-oriented enteral nutrition assessment and management in patients with intra-abdominal hypertension, in order to provide evidence-based evidence for clinical medical staff to make enteral nutrition-related clinical decisions for patients with intra-abdominal hypertension.Methods:Systematic retrieval of Chinese National Knowledge Infrastructure, Wanfang, Chinese Biomedical Literature, UpToDate, PubMed, Cochrane Library, BMJ Best Practice and other English data, as well as domestic and foreign guidelines such as American Society for Parenteral and Enteral Nutrition, Scottish Intercollegiate Guidelines Network, etc. All evidence available on the Internet in both Chinese and English on intra-abdominal pressure-guided enteral nutrition strategies in adults with intra-abdominal hypertension, study types including clinical decision-making, systematic reviews/meta-analyses, evidence summaries, expert consensus, guidelines or related to the subject of this study closely related high-quality original research. The retrieval time was from the establishment of the database to November 2021. The literature evaluation tool was selected according to the research type. Two researchers trained in the evidence-based system independently evaluate the quality of the included literature, fully considering the clinical situation and expert opinions, and completed the evidence. Extracted and summarized.Results:Totally 13 articles were finally included, including 5 guidelines, 3 expert consensuses, 1 evidence summary and 4 original studies, and 29 evidence-based practice evidence of enteral nutrition in patients with intra-abdominal hypertension were collected, including the monitoring timing of enteral pressure, the pressure of enteral high pressure and the way of enteral nutrition, the pressure measurement of the abdominal cavity, the setting of abdominal pressure, the temperature conditions for early start of enteral nutrition, the selection of enteral pressure, the temperature setting of enteral nutrition nine aspects such as speed and regulation of internal nutrition and abdominal compartment syndrome prevention.Conclusions:This study summarizes the best evidence of intra-abdominal pressure management and enteral nutrition therapy in patients with intra-abdominal hypertension, and provides evidence-based basis for risk management, standardizing clinical practice, and ensuring treatment safety. In the stage of evidence transformation, clinical medical staff need to comprehensively weigh the benefits and risks of early enteral nutrition, and integrate evidence in combination with clinical practical application scenarios, so as to form a standardized early enteral nutrition management plan suitable for patients with intra-abdominal hypertension.

Objective:To develop and internally validate a fall related injury risk nomogram in of patients in Patients in hospital.Methods:Patients who fall during the hospital stay from a grade-three general hospital of Zhejiang province were recruited. Data were collected from January 2014 to December 2019. Data was collected after patients fall in hospital, including age, sex, and 18 other predictive factors. The LASSO regression model and multivariable logistic regression analysis were applied to build a predicting model. Discrimination and calibration of the predicting model were assessed using the C-index and calibration plot. Internal validation was assessed using the bootstrapping validation.Results:Of the 243 patients included in the study, 70 patients had fall related injury. The fall related injury probability was 28.81%. Predictors contained in the prediction nomogram included age≥60, dysfunction, combined utilization of special drugs, no-escort, hypocalcemia. The model displayed good discrimination with a C-index of 0.823 (95% confidence interval 0.756-0.875) and good calibration. High C-index value of 0.803 could still be reached in the interval validation.Conclusion:This fall related injury risk nomogram in of patients in Patients in hospital incorporating the age≥60, dysfunction, combined utilization of special drugs, no-escort, hypocalcemia could be conveniently used to predict fall related injury risk of patients in hospital.

Objective:To investigate the relationships between severe, diffuse decrease in global brain 18F-fluorodeoxxglucose(FDG)uptake, whole-body total lesion glycolysis(TLG)and short-term death in elderly patients with newly diagnosed stage Ⅳ cancer. Methods:Clinical and 18FFDG PET/CT data of 24 elderly patients newly diagnosed stage Ⅳ cancer showing marked diffuse decrease in global brain FDG uptake(the decreased brain uptake group)were retrospectively enrolled.Sixteen elderly patients with newly diagnosed stage Ⅳ cancer but without decreased global brain FDG uptake(the no decreased brain uptake group)and 25 healthy subjects were enrolled as the control groups.Correlations between brain FDG uptake and whole-body TLG were analyzed.We followed up the final outcomes of all patients and analyzed the short-term prognostic value of these manifestations. Results:The decreased brain uptake group included 17 patients with stage Ⅳ lymphoma and 7 patients with stage Ⅳ malignant tumor of other types[15 males, age: (73±9)years], while the no decreased brain uptake group included 8 patients with stage Ⅳ lymphoma and 8 patients with stage Ⅳ malignant tumor of other types[12 males, age: (65±5)years]and the healthy control group included 25 subjects[13 males, age: (65±6)years]. Patients were older in the decreased brain uptake group than in the no decreased brain uptake group( t=3.8, P=0.001). The global brain SUV means of the decreased brain uptake group and the no decreased brain uptake group were 4.9±1.8 and 10.9±2.0, respectively( t=-9.8, P=0.000). The global brain total glycolysis(TG)values of the two groups were 1786.5±1162.5 and 2868.4±1424.5, respectively( t=-2.6, P=0.012). The whole-body TLG values of the two groups were 6825.5±4776.9 and 2919.5±2031.7, respectively( t=3.6, P=0.001). Pearson correlation analysis showed that brain FDG uptake was adversely correlated with whole-body TLG.We followed up the survival outcomes of the two groups.The median follow-up lengths of the two groups were 6 months and 10 months, respectively( χ2=3.7, P=0.054). Fourteen(14/24)patients died in the decreased brain uptake group while 9(9/16)died in the no decreased brain uptake group( χ2=0.017, P=0.896). However, 8 cases died within 1 month post PET/CT scan in the decreased brain uptake group while none died in the no decreased brain uptake group( χ2=4.7, P=0.029). Conclusions:Severe, diffuse decrease in 18F-FDG PET/CT uptake in the whole cerebral cortex is more common in elderly patients with newly diagnosed stage Ⅳ cancer, whose total tumor load is significantly higher than that of cancer patients without decrease in whole cerebral cortex FDG uptake.This uptake reduction may indicate poor short-term outcome and the probability of short-term death may be high.

Objective:To investigate the diagnostic value of 18F-fluorodeoxyglucose (FDG) PET/CT in detecting N 1 or N 2 metastasis of lymph node (LN) with different densities in patients with non-small cell lung cancer (NSCLC). Methods:A total of 118 patients (68 males, 50 females, age range: 27-87 (65.4±10.8) years) with N 0-N 2 M 0 NSCLC in Beijing Hospital between October 2007 and December 2017 were included in this study. All patients underwent 18F-FDG PET/CT, followed by surgery within 1 month. The pathological findings of the resected hilar mediastinal LN were taken as the gold standard, and ratios of LN metastasis were calculated for different density groups (calcification, partial calcification, hyper density, hypodensity/isodensity). The cut-off values of LN size (short diameter) and the maximum standardized uptake value (SUV max) in the detection of N 1 and N 2 metastases was determined by the receiver operating characteristic (ROC) curve, and the diagnostic efficiencies were calculated. Independent-sample t test, Mann-Whitney U test and χ2 test (partition of χ2) were used for data analysis. Results:A total of 433 LN has the histopathologic results: 365 LN was in stage N 0, 68 LN was in stage N 1-N 2. There were no metastases in calcification group (0/8). The metastatic LN proportions in partial calcification group (28.6%, 8/28), hypodensity/isodensity group (20.3%, 44/217) were significantly higher than that in the hyper density group (8.9%, 16/180; χ2 values: 7.369, 9.945, both P<0.017 (threshold for partition of χ2)). There was no significant difference between the partial group and hypodensity/isodensity group ( χ2=1.021, P>0.017). The SUV max of N 1+ N 2 group was significantly higher than that in N 0 group (6.94 (4.51, 11.36) vs 2.45 (1.93, 3.42); z=-10.388, P<0.01). According to the ROC curve, the cut-off value of SUV max in detecting hilar and mediastinal LN was 3.66. The diagnostic sensitivity, specificity and accuracy for N 1+ N 2 metastasis was 85.3%, 78.9%, 80.0% respectively. The cut-off values of SUV max for hypodensity/isodensity group and hyper density group were 3.66 and 2.79 respectively, and the corresponding sensitivities, specificities, accuracies and positive predictive values (PPV) were 93.2%, 86.7%, 88.0%, 64.1% vs 93.8%, 57.9% ( χ2=10.724), 61.1% ( χ2=7.326, P<0.01), 17.9%( χ2=32.971, P<0.01). The specificity of LN size (1.0 cm)+ SUV max was significantly higher that of LN size or SUV max alone (94.2% vs 80.9%, 86.7%; χ2 values: 14.048, 5.661, both P<0.05) in hypodensity/isodensity group. The specificity and accuracy of LN size (1.0 cm)+ SUV max were significantly higher those of SUV max alone ( χ2 values: 58.043, 37.037, both P<0.01) in hyper density group. Conclusions:18F-FDG PET/CT is useful in diagnosing the N 1+ N 2 metastases in hypodensity/isodensity LN, but has limitation in diagnosing the partial calcification LN. Combination of lymph node short diameter and SUV max cut-off value can improve the diagnostic specificity or accuracy of 18F-FDG PET/CT for hypodensity/isodensity and high density LN.

Objective:To investigate the drugs-sensitivity spectrum of multidrug-resistant tuberculosis (MDR-TB) in China and provide a scientific evidence for the drug selection in clinical therapy and the control of MDR-TB.Methods:A total of 167 strains of MDR-TB were included in this study. Every strain was genotyped by lysX gene sequencing and their sensitivity to 13 different anti-TB drugs was tested by using MicroDST TM and BACTEC TM MGIT 960 TM liquid-culturing method. The association between drug resistance and genotypes as well as cross drug resistance was also analyzed. The results were analyzed by means of the comparison of enumeration data between two groups with χ2 test. Results:The overall resistance rate of 167 MDR-TB strains to 11 anti-TB drugs, except isoniazide and rifampicin, was 95.81%, the rates of pre-extensive drug-resistance (pre-XDR) and extensive drug-resistance were 31.14%(52/167) and 6.59% (11/167), respectively. The streptomycin resistance rate of Beijing genotypes was significantly higher than that of the non-Beijing genotypes ( χ2=30.682, P<0.05), while the pre-XDR proportion in Beijing genotypes was lower than that in non-Beijing genotypes ( χ2=5.332, P<0.05). The resistance rates of Ofloxacin and Pyrazinamide in the modern Beijing genotype were significantly higher than those in classical ones ( χ2=4.105 and χ2=3.912, P<0.05). In addition, the cross-resistance rate to rifampicin and rifabutin was 86.23%. A significant difference in drug-resistance rate to rifabutin was seen among groups with different levels of rifampicin resistance ( χ2=45.912, P<0.05). There was positive correlation not only between ofloxac resistance and moxifloxac resistance, but also between amikacin resistance and kanamycin resistance, with the coefficient of 0.87 and 0.91, respectively. Conclusions:In this study, we observed that there were high incidences of the resistance to 11 anti-TB drugs in 167 clinical MDR-TB strains and the cross resistance phenomena between drugs of the same type were quite serious. The majority of MDR-TB strains belonged to Beijing genotype, which was highly associated with streptomycin resistance.

Objective To evaluate the diagnostic efficacy of the pulmonary perfusion tomography combined with low dose CT scan (Q SPECT/ CT) in detecting acute pulmonary embolism (PE) by compa-ring with pulmonary ventilation/ perfusion (V/ Q) SPECT imaging. Methods A total of 203 patients sus-pected with acute PE (88 males, 115 females, age range 19-94 years) from January 2013 to December 2015 were enrolled in this retrospective study. All patients underwent V/ Q SPECT and low dose CT scan. Final clinical diagnosis was regarded as the gold standard. The diagnostic consistency and diagnostic efficacy of Q SPECT/ CT were compared with those of V/ Q SPECT. χ2 test was used to compare the differences be-tween the two methods. Kappa analysis was used to analyze the agreement of them. Results The coinci-dence rate of Q SPECT/ CT and V/ Q SPECT was 94.09％(191/ 203), Kappa= 0.882, P<0.001. Among the 12 cases with inconsistent diagnosis, 9 were finally diagnosed as chronic obstructive pulmonary disease (COPD). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Q SPECT / CT in the diagnosis of PE were 95. 12％(78/ 82), 80.99％(98/ 121), 77.23％(78/ 101), 96.08％(98/ 102), 86. 70％ ( 176/ 203). The counterpart parameters of V/ Q SPECT were 95. 12％ ( 78/ 82), 90. 91％(110/ 121), 87.64％ (78/ 89), 96.49％ (110/ 114), 92.61％ (188/ 203). Compared with V/ Q SPECT, Q SPECT/ CT had the same sensitivity but lower specificity (χ2 = 4.928, P = 0.026). The positive predictive value, negative predictive value and accuracy of Q SPECT/ CT were lower than those of V/ Q SPECT, but there was no significant difference (χ2 values: 3.491, 0.000, 3.824, all P>0.05). Conclusion In the majority of patients with suspected acute PE, V/ Q SPECT scan can be replaced by Q SPECT/ CT, but it must be careful to select Q SPECT/ CT for patients with COPD history.

Objective To systematically evaluate the optimal dose of early enteral nutrition support in critically ill patients.Methods Systematic search database including PubMed,Web of science,Scopus,CINAHL,CBM,CNKI.RCTs about early enteral nutrition dose selections in critically ill patients were chosen according to include and exclude criteria by two researchers independently.Cochrane system evaluation manual bias risk assessment was used to evaluate quality of literature.RevMan5.3 Meta analysis software was used to analyze the data.Results A total of 1 571 literatures were retrieved and 8 RCT studies were included,2 713 subjects in total.Meta analysis results showed that there were statistically significant differences in mechanical ventilation time,incidence of diarrhea,and utilization rate of gastro dynamic drugs between trophic feeding and full feeding (P＜0.05).There were no statistically significant differences in mortality,length of stay,incidence of nosocomial infections,reflux,vomiting,constipation,etc.(P＞0.05).Conclusions Trophic feeding has familiar effects on mortality,length of hospital stay compared to full feeding,but it can help to shorten ICU mechanical ventilation time,improve the gastrointestinal tolerability.

Objective To detect the consistency of EGFR mutations in pleural effusion in terminal non-small cell lung cancer(NSCLC)patients by amplification refractory mutation system- polymeric chain reaction (ARMS-PCR).Methods Pleural effusion from 44 cases with advanced NSCLC were collected.DNA was extract-ed from a part of pleural effusion,and EGFR gene18,19,20,and 2 l exons mutations were detected by ARMS-PCR amplification. The left part of pleural effusion was used for the pathological microscopic examination of the embedding and to evaluate the feasibility of pleural effusion direct detection.Part of the case results were compared with tissue or pleural effusion at the same time. Results The mutation rate of EGFR detection in pleural effusion was 54.5%,including 19-del(50.0%)and 21-L858R(50.0%);75.0% of pleural effusion sediment was morpho-logically diagnosed with adenocarcinoma and EGFR mutation rate was 27.3% in pleural effusion with no tumor cell. The consistent rate was 72.7% in 22 cases of pleural effusion and tissue and that was 50.0% in 16 cases of pleural effusion and plasma.The comparison between pleural effusion and organizations and plasma test results was statisti-cally significant(P < 0.05).(P < 0.05).Conclusions EGFR gene mutation rate in pleural effusion is lower than that in tumor tissue specimens in terminal NSCLC patients and tumor tissue is still the best test specimens.