Performance appraisal of public hospitals have given a guidance for the development of public hospitals at all levels.A Class A tertiary hospital reviewed the problems in the development of the hospital at the present stage and focused on the following four aspects:①insufficient fine management;②No clear orientation of discipline development;③The bottleneck of the improvement of medical operation efficiency;④New challenges in the reform of payment mode.The tertiary hospital launched a fine management practice in May 2022,in order to solve the problems by taking the Department of Surgery as a pilot area,laying the foundation for fine management through information system construction,improving the efficiency of medical operation through management process optimization,improving the overall competitiveness of disciplines through the construction of sub-specialty and Discipline Alliance and adjusting the performance appraisal index system to play the role of performance incentives.The measures effectively improve the overall capacity and efficiency of hospital medical services and help the hospital to achieve high-quality development.

BackgroundThe issue of depression among adolescents is becoming increasingly serious， seriously endangering their healthy development. The issue of sleep disturbances in adolescents with depressive disorder is gradually receiving attention， but there is currently a lack of research on the relationship between sleep quality and suicide risk in this patient population. ObjectiveTo explore the relationship between suicide risk and sleep quality in adolescents with depressive disorders， and analyze the influencing factors of suicide risk， so as to provide references for clinical intervention. MethodsA total of 101 adolescents patients who met the diagnostic criteria for depressive disorder in the International Classification of Diseases， 10th edition （ICD-10） and were hospitalized at Hefei Fourth People's Hospital from June 2020 to February 2023 were selected. The patients were evaluated using the Nurses' Global Assessment of Suicide Risk （NGASR） and Pittsburgh Sleep Quality Index （PSQI）. According to the NGASR score， patients were divided into severe suicide risk group （n=35） and non-severe suicide risk group （n=66）. Pearson correlation analysis was used to examine the correlation between sleep quality and suicide risk in adolescents with depression. Multiple Logistic regression was used to analyze the influencing factors of severe suicide risk in adolescent patients with depression. ResultsStatistically significant differences were found between the two groups in terms of academic pressure， peer relationship and family relationship （t=3.942， 4.378， 6.748， P<0.05）. Moreover， there was a statistically significant difference in PSQI score between two groups （t=7.398， P<0.05）. There was also a statistically significant difference in sleep quality between the two groups （χ²=4.986， P<0.05）. Pearson correlation analysis showed a positive correlation between total PSQI score and NGASR score （r=0.698， P<0.05）. Severe depression （OR=1.628， 95% CI： 1.079~2.457）， high academic pressure （OR=1.118， 95% CI： 1.018~1.228） and poor sleep quality （OR=1.158， 95% CI： 1.033~1.297） were identified as risk factors of severe suicide risk， while good relationships with classmates （OR=0.908， 95% CI： 0.826~0.998） and family （OR=0.904， 95% CI： 0.823~0.993） were protective factors. ConclusionSleep quality in adolescents with depression is negatively correlated with suicide risk and poor sleep quality may be a risk factor for severe suicide risk.

Objective In order to reasonably reduce QY group and improve the accuracy of DRG,we analyzed the data of QY(ambiguity)group in the Diagnosis Related Groups in urology department of a three A and tertiary hospital.Methods Medical insurance settlement statements of urology department of a hospital in the DRG sub-platform of a municipal medical insur-ance bureau were collected from April 1,2022 to November 30,2022,extracting QY cases.The medical records of QY cases were extracted from the digital medical record browser of a hospital.Senior quality control physicians were organized to check medical records,disease classification and medical insurance settlement statements of QY group cases,analyzing the cases.Excel 2010 was used for statistical analysis of the data.Results ① 2 810 copies of medical insurance settlement statements were obtained,of which 43 cases were in the QY groups,accounting for 1.53％.②The cases mainly distributed in urinary system tumors(27.91％),neurogenic bladder(18.60％),prostatic hyperplasia(16.28％),ureteral diseases(11.62％),and ure-thral diseases(11.62％).(3)The total hospitalization cost of patients in QY groups was 731 684.1 yuan,and the average hospi-talization cost was 17 015.91 yuan.The total payment amount of DRG was 419 807.24 yuan,and the average payment amount was 9 762.96 yuan.④The causes of QY groups were as follows:There were 14 cases of DRG grouping rule defect,accounting for 32.56％;There were 29 cases of hospital management defects,accounting for 67.44％.Among the hospital management de-fects,13 cases(30.23％)of the medical insurance settlement statements were defective;There were 8 cases(18.60％)of er-rors in doctors'major diagnoses and major surgical operations.There were 8 cases(18.60％)of coding errors in major diagno-ses and major surgical operations.Conclusion To reasonable reduction QY group,it is necessary to optimize DRG grouping rules and strengthen hospital internal management.Only by paying attention to improve the connotation quality of medical re-cords,accurately classify disease and surgical name,strengthen the management and review of medical insurance settlement state-ments,and establish a long-term mechanism for DRG data quality control,we can further improve the accuracy of DRG and ac-tively promote the reform of medical insurance payment.

The umbrella trial has received increasing attention in the design of clinical trials for oncology drugs in recent years. This trial design categorizes a single disease into multiple sub-types based on predictive biomarkers or other predictive factors, and simultaneously evaluates the efficacy of multiple targeted therapies. When compared with the traditional drug development model of phase Ⅰ, phaseⅡ, and phase Ⅲ randomized controlled trials, umbrella trials are a more scientifically rigorous trial design that can speed up drug evaluation to address the conflict between numerous untested drugs and diseases with a lack of effective treatment options. This article will focus on the concept, main characteristics, eligibility criteria, design and statistical considerations, ethical considerations, and future directions of umbrella trials, with the aim of providing methodological guidance for the design of clinical trials for oncology drugs.

Autologous ozonized blood transfusion(AOBT) is a therapy of re-transfusion of 100-200 mL of autologous blood after shaking and agitation with appropriate amount of oxygen-ozone in vitro. The oxidation of blood through the strong oxidation of ozone can enhance the non-specific immune response of the body, regulate the internal environment and promote health. This therapy has been increasingly applied in clinical practice, while no unified standard for the operation process in terms of ozone concentration, treatment frequency and treatment course had been established. This operation process of AOBT is primarily explored in order to standardize the operation process and ensure its safety and efficacy.

Objective:To explore the current situation of nursing human caring in hospital wards and analyze its influencing factors, so as to facilitate the development of nursing human caring practice.Methods:From July to November 2022, a total of 107 hospitals were surveyed through stratified convenience sampling method, and 4 072 ward nursing managers were recruited to finish the general information questionnaire and the ward nursing human caring status questionnaire. The general information included the region, class and type of the hospital, etc. The ward nursing human caring status questionnaire included 38 items in 5 dimensions of nursing human caring system and process, humanistic quality and training of nursing staff, humanistic environment and facilities, human caring procedures and measures, and human caring quality evaluation and improvement, with a full score of 190 points. Descriptive statistics were used to analyze the general data, independent samples t-test, ANOVA and correlation analysis were used to analyze the factors influencing the current status of nursing human caring in the ward, while multiple linear regression analysis was used to conduct a multivariate analysis. Results:The score of nursing human caring in hospital wards was 156.91±27.78. Whether the hospital had carried out nursing human caring pilot(demonstration) wards, whether the ward had previously been a hospital nursing human caring pilot(demonstration) nursing unit, the type of ward, and whether nursing managers had participated in human caring training were the influencing factors of the implication of nursing humanistic caring in wards( P<0.05). Conclusions:The practice of nursing human caring in hospital wards is at a good level, but needs to be further strengthened. Nursing managers should take systematically strategies to promote the development of nursing human caring practice.

Objective:To explore the psychological experience of front-line nurses combating the COVID-19 epidemic and provide suggestions and evidence for clinical interventions.Methods:From January 25th to 27th, 2020, a semi-structured interview was conducted using phenomenological research methods on 10 front-line nurses combating COVID-19 from a Class Ⅲ Grade A hospital, and Giorgi phenomenological analysis was used to analyze the data.Results:The psychological experience of clinical front-line nurses in this study could boil down to three themes: negative psychological experience (fear, worry, and fatigue) , insufficient ability to cope with public health emergencies (insufficient awareness of disease, and insufficient emergency rescue nursing skills) , and rational understanding of the fight against the epidemic (a sense of mission and confidence) .Conclusions:Clinical front-line nurses have different levels of negative psychological experience and lack the ability to respond to public health emergencies. Hospitals should strengthen psychological assistance and humane care for clinical front-line nurses, promote training for emergency disaster rescue nursing, improve hospital emergency management capabilities, and ensure efficient rescue work.

Recent studies show that resveratrol is characterized with its antioxidative and anti-inflammatory effects, and plays an important role in the prevention and treatment of colorectal cancer through modulating intracellular carbohydrate and ceramide metabolism, activating tumor suppressors such as activator of transcription 3 and peroxisome proliferators-activated receptor γ, down-regulating the expression of kirsten rat sarcoma viral oncogene and inhibiting the epithelial-to-mesenchymal transition process of cancer cells.In addition,resveratrol exhibits its broad application prospects in combination therapy.

Objective To explore the outpatients′experience of caring and provide references for improving their experience of medical care.Methods The phenomenology research method was adopted in this study,and twenty-one outpatients were subject to an in-depth interview to learn their outpatient experiences.Results Ten themes of experience with caring were extracted as follows:passionate and patient,careful and considerate,respect for others,offers to help,encouraging and comforting,apologies and courteously,humor,truthful considerations,conscientious and responsible,and a caring environment setup.Five themes of experience without caring were extracted as follows:impatient communication, careless seeing of outpatients,delayed service,passive reminders,and facilities without enough details. Conclusions The outpatients may have abundant experiences of caring at the outpatient clinic,also lack of caring sometimes as well.Outpatient managers should keep an eye on outpatients′needs and satisfaction of caring from time to time,to improve the quality of outpatient service.

Objective Based on the objective test (A type) results of the 2014 comprehensive clinical course graduation test of 3+2 assistant general practitioners training,this article analyzed the differences between different teaching units,so as to provide objective basis for improving the teaching level of each unit.Method We established a database with EXCEL 2000,and put each question's ID and points,and the score of each student into the computer,so we could get the difficulty coefficient,distinction degree and reliability of the test paper,and calculate the difficulty coefficient and difference of each question.Then we analyzed the difficulty coefficient,the difference and the reliability of the 122 students' testing results,and compared the accuracy to the same question of the 6 teaching units.Result The objective test's (A type) difficulty coefficient is 0.77,distinction degree is 0.19,and reliability is 0.99.The highest score of the 122 students is 47 points,and the lowest score is 28 points,the average score is (38.5 ± 3.9) points.In the 50 questions,3 questions' difficulty coefficient is less than 0.4,14 questions' difficulty coefficient is between 0.4-0.7,33 questions' difficulty coefficient is above 0.7,so the difficulty degree of the paper is relatively low.In the 50 questions,23 questions' distinction degree is less than 0.15,17 questions' distinction degree is between 0.15-0.30,10 questions' distinction degree is above 0.30,so the distinction degree of the paper is relatively high.In the 50 questions,20 questions' accuracy appears larger differences between each unit:9 questions' accuracy has decreased significantly among 1-2 units,4 questions' accuracy decreased significantly among 3 units,3 questions' accuracy decreased significantly among 4 units,only 1 unit has high accuracy among 2 questions,and 2 questions' accuracy decreased significantly among all units.These problems are related to the teachers' teaching ability,the difficulty in mastering the key points of the curriculum,the lack of the concept of the general practitioners training.Conclusion The design of the examination paper is basically in line with the study purpose and the objectives of the training course.This examination paper was highly reliable,and suitable for the professional theory and ability test.There are site differences between each unit,which can provide an objective basis for improving the teaching level of different teaching unit,and we will solve the problems in the form of collective preparation next step.