Objective:To investigate the changing trends and influencing factors of two kinds of absorbable hemostatic gauze in clinical use based on real-world data,so as to provide a reference for the refined management of absorbable hemostatic gauze.Methods:Data of surgical samples of a total of 34658 pieces of absorbable hemostatic gauzes,whose brand include brand A and brand B,in 27,468 surgeries of the Affiliated Wuxi People's Hospital of Nanjing Medical University between January 1,2015 and December 31,2023 were selected.In them,12729 surgeries used hemostatic gauzes(18,457 pieces)of brand A,and 14,739 surgeries used hemostatic gauzes(16,201 pieces)of brand B.The changing trends of the usage and cost of two kinds of absorbable hemostatic gauzes were compared and analyzed,which correlations of that with the different indicators of workload also were compared and analyzed.Results:The usage amount of absorbable hemostatic gauze of brand B increased annually,which had higher average costs per surgery but lower average usage amount per surgery.Brand B was mainly used in surgery of level-4.Both the usage amounts of brand A(18,457 pieces)and brand B(16,201 pieces)showed a positive correlation with the proportion of patients with difficult and critically ill(r=0.232,0.593,P<0.05),as well as with the proportion of medical consumables expenditure(r=0.334,0.491,P<0.05).Compared to brand A,brand B demonstrated a stronger positive correlation with the proportion of patients with difficult and critically ill,and the proportion of consumables expenditure.However,there was no significant correlation between the usage amount of each brand and the number of inpatients who received surgeries(P>0.05).The usage amount of absorbable hemostatic gauze of each brand was negative correlation with the proportion of pharmaceutical expenditure(r=-0.538,-0.696,P<0.05).Conclusion:The evaluation based on real-world data for clinical use of absorbable hemostatic gauze can reveal that brand B is gradually replacing brand A in clinical application.In clinical practice,the surgery with higher-level more prefers to use brand B.This result can guide management departments to monitor the use of absorbable hemostatic gauze.However,the balance between clinical demand and cost-effectiveness also should be considered,so as to promote the rational use of hemostatic materials,and ensure effective allocation for resource.

Objective:To construct a platform for quality control and performance management of medical equipment based on edge computing architecture,and connect the existing information systems of hospital to achieve interconnection and interworking of bottom layer architecture of medical equipment.Methods:By deeply integrating 5 generation(5G)communication technique and Internet of Things(IoT)technique,and using edge computing architecture,a platform for quality control and performance management of medical equipment was constructed through collected the data of operational log from large-scale medical equipment.A total of 27 medical equipment in clinical use at the Affiliated Wuxi People's Hospital of Nanjing Medical University were selected in the study periods from July to December 2022(pre-implementation phase)and from July to December 2023(post-implementation phase).The accuracy rates of recorded data about equipment's operation were calculated as statistical method before and after the platform was applied.The response times for maintenance,the rates of opening equipment,and frequencies of repairing equipment for computed tomography(CT)equipment were compared between before and after the platform was applied.Results:The platform's primary functions for quality control and performance management of medical equipment mainly encompassed asset ledger,early warning for operation and maintenance,operational dynamics,allocation management,evaluation for usage efficiency,and evaluation for quality control for large-scale medical equipment of hospital.After the platform was applied,the accuracy of recorded data of 27 medical equipment was increased to 97%from 70-80%before the platform was applied.For CT equipment,the average response time and frequency of maintenance after the platform was applied were significantly lower than those before it was applied,while the average rate of opening equipment was significantly higher than that before it was applied,and the differences were significant(t=7.084,3.196,2.537,P<0.05).Conclusion:The platform for quality control and performance management of medical equipment based on edge computing architecture can provide safeguards for the operational quality and safety of large-scale medical equipment,and provide basis for fine using evaluation and rational configuration decisions,and reduce response times and frequency of maintaining equipment,and improve rate of opening equipment,and realize standardization,informatization,and scientificization of the management for large-scale medical equipment.

Objective:To investigate the changing trends and influencing factors of two kinds of absorbable hemostatic gauze in clinical use based on real-world data,so as to provide a reference for the refined management of absorbable hemostatic gauze.Methods:Data of surgical samples of a total of 34658 pieces of absorbable hemostatic gauzes,whose brand include brand A and brand B,in 27,468 surgeries of the Affiliated Wuxi People's Hospital of Nanjing Medical University between January 1,2015 and December 31,2023 were selected.In them,12729 surgeries used hemostatic gauzes(18,457 pieces)of brand A,and 14,739 surgeries used hemostatic gauzes(16,201 pieces)of brand B.The changing trends of the usage and cost of two kinds of absorbable hemostatic gauzes were compared and analyzed,which correlations of that with the different indicators of workload also were compared and analyzed.Results:The usage amount of absorbable hemostatic gauze of brand B increased annually,which had higher average costs per surgery but lower average usage amount per surgery.Brand B was mainly used in surgery of level-4.Both the usage amounts of brand A(18,457 pieces)and brand B(16,201 pieces)showed a positive correlation with the proportion of patients with difficult and critically ill(r=0.232,0.593,P<0.05),as well as with the proportion of medical consumables expenditure(r=0.334,0.491,P<0.05).Compared to brand A,brand B demonstrated a stronger positive correlation with the proportion of patients with difficult and critically ill,and the proportion of consumables expenditure.However,there was no significant correlation between the usage amount of each brand and the number of inpatients who received surgeries(P>0.05).The usage amount of absorbable hemostatic gauze of each brand was negative correlation with the proportion of pharmaceutical expenditure(r=-0.538,-0.696,P<0.05).Conclusion:The evaluation based on real-world data for clinical use of absorbable hemostatic gauze can reveal that brand B is gradually replacing brand A in clinical application.In clinical practice,the surgery with higher-level more prefers to use brand B.This result can guide management departments to monitor the use of absorbable hemostatic gauze.However,the balance between clinical demand and cost-effectiveness also should be considered,so as to promote the rational use of hemostatic materials,and ensure effective allocation for resource.

Objective:To construct a platform for quality control and performance management of medical equipment based on edge computing architecture,and connect the existing information systems of hospital to achieve interconnection and interworking of bottom layer architecture of medical equipment.Methods:By deeply integrating 5 generation(5G)communication technique and Internet of Things(IoT)technique,and using edge computing architecture,a platform for quality control and performance management of medical equipment was constructed through collected the data of operational log from large-scale medical equipment.A total of 27 medical equipment in clinical use at the Affiliated Wuxi People's Hospital of Nanjing Medical University were selected in the study periods from July to December 2022(pre-implementation phase)and from July to December 2023(post-implementation phase).The accuracy rates of recorded data about equipment's operation were calculated as statistical method before and after the platform was applied.The response times for maintenance,the rates of opening equipment,and frequencies of repairing equipment for computed tomography(CT)equipment were compared between before and after the platform was applied.Results:The platform's primary functions for quality control and performance management of medical equipment mainly encompassed asset ledger,early warning for operation and maintenance,operational dynamics,allocation management,evaluation for usage efficiency,and evaluation for quality control for large-scale medical equipment of hospital.After the platform was applied,the accuracy of recorded data of 27 medical equipment was increased to 97%from 70-80%before the platform was applied.For CT equipment,the average response time and frequency of maintenance after the platform was applied were significantly lower than those before it was applied,while the average rate of opening equipment was significantly higher than that before it was applied,and the differences were significant(t=7.084,3.196,2.537,P<0.05).Conclusion:The platform for quality control and performance management of medical equipment based on edge computing architecture can provide safeguards for the operational quality and safety of large-scale medical equipment,and provide basis for fine using evaluation and rational configuration decisions,and reduce response times and frequency of maintaining equipment,and improve rate of opening equipment,and realize standardization,informatization,and scientificization of the management for large-scale medical equipment.

Objective To explore the effect of training mode based on action learning on improving the practicing ability of hospital pharmacists.Methods Thirty pharmacists who received training from September 2022 to December 2023 at Panzhihua Central Hospital were randomly divided into an education reform group(16 cases)and a routine group(14 cases).The education reform group adopted a routine teaching method based on action learning,while the routine group adopted a routine teaching method.The differences between the two groups of pharmacists in theoretical knowledge,practical operation,pharmaceutical services,emergency response,and comprehensive quality were compared.Results The pharmacists in the education reform group were better than the routine group in prescription review,clinical medication analysis,pharmaceutical services,emergency response,andcomprehensive quality.The difference was statistically significant(P＜0.05).Conclusion The teaching model based on action learning can effectively enhance the higher order thinking ability of pharmacists and help them better apply medical knowledge and skills to serve patients and physicians.

OBJECTIVE To investigate the effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical intensive care unit （ICU） patients. METHODS Forty cases of mechanically ventilated non-surgical patients in the ICU of our hospital from February 1st， 2023 to July 31st， 2023 were selected and randomly divided into control group and esketamine （S-K） group using grouping method with opaque envelopes， with 20 cases in each group. Control group was given sufentanil， and S-K group was infused with Esketamine hydrochloride injection at a constant rate of 0.2 mg/（kg·h）+ sufentanil. The treatment period length， analgesic compliance rate， sedation level， analgesic and sedative consumption， and gastric motility indexes were compared between the two groups. RESULTS There was no statistically significant difference in the treatment period length， analgesic compliance rate， sedation level， or the consumption of propofol and midazolam between the two groups （P＞0.05）. The consumption of sufentanil in the S-K group was significantly less than control group （P＜ 0.05）. Compared with 1 h after randomization， the antral contraction frequency， antral contraction amplitude and antral motility index of patients in the S-K group were significantly higher at 72 h after randomization and were significantly higher than control group （P＜0.05）. CONCLUSIONS Esketamine may reduce opioid consumption and improve gastric motility in mechanically ventilated non-surgical ICU patients while ensuring a level of analgesic sedation.

BACKGROUND:Bone mineral density is the clinical gold standard for determining bone strength,but bone mineral density is less sensitive to changes in bone mass,with large changes in bone mineral density only occurring when bone mass is significantly reduced,so bone mineral density has limited ability to predict changes in bone strength and fracture risk. OBJECTIVE:A model of the normal and osteoporotic hip joint was developed to analyze the stresses and deformation in the hip of normal and osteoporotic patients under single-leg standing conditions. METHODS:A healthy adult female volunteer at the age of 36 years was selected as the study subject.The CT data of the hip joint of this volunteer were obtained and saved in DICOM format.The hip joint model was reconstructed in three dimensions,and the material properties were assigned by the gray value assignment method to obtain the normal and osteoporotic hip joint models according to the empirical formula.The same boundary conditions and loads were set to simulate the stresses and deformation in the normal and osteoporotic hip joints in the single-leg standing position. RESULTS AND CONCLUSION:(1)In the finite element model of the normal and osteoporotic hip,the stress distribution was more concentrated in the medial region of the femoral neck.(2)In the hip bone,the stress distribution was mainly concentrated in the upper part of the acetabulum.(3)The stress peaks in the medial femoral neck and upper acetabulum were larger in the normal hip model than in the osteoporotic hip model,probably due to the reduced bone strength of the osteoporotic bone.(4)The peak Von Mises of both normal and osteoporotic hip models were concentrated on the medial femoral neck,and the peak Von Mises of the hip bone was smaller,indicating that the overall effect of osteoporosis on hip bone stresses was relatively small.(5)In terms of deformation in the single-leg standing position,the maximum deformation in the normal hip model was located at the acetabulum and femoral head,and the maximum deformation was located at the upper part of the greater trochanter of the femur.(6)It is suggested that the finite element analysis method to model the values of parameters related to bone tissue in osteoporosis may improve clinical prediction of bone strength changes and fracture risk.It is explained from the biomechanical view that the intertrochanteric femur and femoral neck are good sites for osteoporotic hip fractures.

Objective:To investigate the effect of 3D-printed customized flanged cup in hip revision with severe acetabular bone defects.Methods:Since February 2017, 10 cases of 3D-printed customized flanged cups were used in hip revision with severe acetabular bone defects, including 2 cases of Paprosky type IIIA and 8 cases of Paprosky type IIIB. There were 5 males and 5 females, mean age 73.6±8.1 yrs (range, 62-87 yrs), 5 left and 5 right cases. The preoperative thin-layer CT scan was preformed to reverse reconstruct digital pelvis. Five cases of one-piece flanged cups and 5 cases of decomposed flanged cups, including 3 cases of composite one-piece cups were designed by computer. The surgery was performed strictly according to the plan.Postoperative follow-up was performed to evaluate the Harris score. Operation time,intraoperative bleeding and other complications such as vascular and nerve injury, postoperative infection, and dislocation were counted. Pelvic X-ray was used to assess the height and horizontal position of the center of rotation and the stability of the prosthesis.Results:The surgical procedure was successful, with an average operative time of 147.9±48.3 min (range, 96-212 min) and an average intraoperative bleeding of 730.4±262.6 ml (range, 500-1 300 ml). The mean time of final follow-up was 40.8±18.7 months (range, 16-70 months) after surgery. At the last follow-up, the average Harris score was 83.80±6.73, with 4 cases excellent, 5 cases good, and 1 case fair. The excellent and good rate was 90%. The last Harris score was significantly higher than that before operation 28.60±8.40 ( t=16.84, P<0.001). The height of affected hip joint rotation center decreased from 46.24±7.74 mm before operation to 15.54±2.54 mm after operation with significant difference ( t=14.61, P<0.001). It was slightly higher than the opposite side (13.81±1.48 mm), which had no significant difference ( t=1.83, P=0.100). The horizontal distance of affected hip joint rotation center increased from 33.79±5.27 mm before operation to 40.53±4.50 mm after operation with significant difference ( t=3.62, P=0.006). It had no significant difference ( t=1.28, P=0.232) compared with the opposite side (38.54±3.46 mm). All incisions were healed in one stage without infection, vascular or nerve injury. During the following-up, all prostheses were in satisfied position without loosening, dislocation or screw breaks. Conclusion:Digitally assisted 3D-printed flanged cups can be used in hip revision with severe acetabular bone defect. It can not only improve hip joint function, but also restore the acetabular rotation center and the prosthesis stability, which can achieve good early and mid-term effect.

The authors described the architecture of a real-time platform designed to monitor medical equipments.Three types of data collectors were employed to collect information into the background servers for real-time analysis and presentation.Such a platform can effectively enable the hospital to manage its medical equipments, for their positioning, assets management and risk control.

Objective:Using analytic hierarchy process(AHP)method to construct the risk evaluation of medical equipment.Methods: Combine the professors’ suggestion, data of maintenance and quality control to several medical equipments in different hospitals. Screen six kinds of medical equipment, including infant incubator, high-frequency electrotome, defibrillator, ECG monitor, ventilator and infusion pumps.Results: Ventilator has highest risk and need to be concentrated.Conclusion: The results can guide quality control, patrol, and maintenance.