Objective To explore the application of Plan-Do-Check-Act(PDCA)cycle management to continuously im-prove the service quality of outpatient pharmacy and enhance patient satisfaction.Methods To address the problem of long wait-ing time for patients in outpatient pharmacy,we applied PDCA cycle to investigate the factors affecting patients'waiting time in the process of medicine collection,analyze the current situation,determine the expected goals,formulate the service quality im-provement plan of outpatient pharmacy,implement the improvement plan,follow up and supervise,and summarize and analyse the problems regularly until it was solved.Results After implementing the PDCA cycle in the management,the service quality of outpatient pharmacy was improved,the waiting time was significantly shortened and the satisfaction of medical treatment was in-creased.Conclusion The application of PDCA cycle method is effective in improving the service quality of outpatient pharmacy.Therefore,it is recommended for broader implementation.

Background With the events reporting on odors in drinking water, odorous substances in water have become a hot topic in water quality analysis. Due to the low concentration of the odor threshold and the complexity of the odor components in water, it is difficult to make accurate qualitative and quantitative analysis. So it is necessary to develop a highly sensitive and accurate qualitative and quantitative analysis method. Objective To establish a method for simultaneous determination of four odorous substances, including dimethyl disulfide, dimethyl trisulfide, 2-methylisoborneol, and geosmin in water by purge and trap-gas chromatography-tandem mass spectrometry. Methods A certain amount of water sample was stored in the sample vial of a purge and trapinstrument. Through nitrogen purging, the odorous substances in water were purged out and enriched in the trap. Subsequently, the odorous substances were rapidly released at high temperatures after heating the trap, and then carried by carrier gas into gas chromatograph. After temperature programming, the substances were separated by an Agilent DB-624 capillary chromatographic column (30 m×0.25 mm, 1.4 μm) and determined by tandem mass spectrometry in multiple reaction monitoring modes, with internal standard method for quantification. The current project optimized purge time, sodium chloride concentration in water sample, desorption temperature, desorption time, and split ratio during the experimental process. Under the optimized experimental conditions, the standard curve, detection limit, and quantification limit were validated. Recovery tests with spiking concentrations of 5.0, 10.0, 30.0, 80.0 ng·L⁻¹ and precision tests were conducted on water samples. Finally, the established method was applied to detect odorous substances in source water, finished water, and pipeline water in Deqing County of Huzhou City. Result After the optimization, the purge time was 20 min, the desorption temperature was 280 ℃, the desorption time was 2 min, the split ratio was 10∶1, and no sodium chloride was added during the purge process. Under the optimized experimental conditions, the calibration curves for the four odorous substances showed an excellent linearity in the range of 1 to 100 ng·L⁻¹ (R>0.999), with 0.3 ng·L⁻¹ limit of detection and 1.0 ng·L⁻¹ limit of quantitation. The average recoveries were from 85.5% to 102.4% and relative standard deviations (RSD) from 1.6% to 5.2%. After applying this method to detect local source water, finished water, and pipeline water, it was found that the positive rates of 2-methylisoborneo, and geosmin were relatively high, while the positive rates of dimethyl disulfide and dimethyl trisulfide were relatively low. Only one sample of source water tested positive for dimethyl disulfide, and all samples were negative for dimethyl trisulfide. Conclusion Combined with the superiority of purge and trap and tandem mass spectrometry, the method has the advantages of easy to perform, strong anti-interference ability, good accuracy and precision, which meet the limit requirements of the four odorous substances in the expanded indices and reference indices of Hygienic standards for drinking water (GB 5749-2022). It also provides technical support for water quality assessment and analysis of odorous substances.

Objective:To explore the application effect of adjustable body position protection belt in patients undergoing not painless colonoscopy.Methods:A randomized and controlled trial was used, a total of 180 patients who planned to undergo not painless colonoscopy in the Endoscopy center, the First Hospital of Jiaxing from January to October 2022 were selected as the research objects. They were divided into the experimental group and the control group by the random number table method, with 90 cases in each group. The control group adopted the traditional method of colonoscopy body position placement, and on this basis, the experimental group used the adjustable body position protection belt to assist the patient body position placement. The maintenance rate of body position in colonoscopy, the cecal intubation time, the degree of intraoperative pain and the acceptance rate of re-examinationunder the same operating doctor and nurse were compared between the two groups.Results:The maintenance rate of body position in colonoscopy was 97.78%(88/90) in the experimental group and 58.89%(53/90) in the control group, the difference was statistically significant ( χ2 = 37.84, P<0.05). The cecal intubation time was (7.84 ± 4.39) min in the experimental group and (10.13 ± 5.85) min in the control group, the difference was statistically significant ( t = 2.98, P<0.05). The intraoperative pain score was 2.96 ± 1.39 in the experimental group and 4.28 ± 1.42 in the control group, the difference was statistically significant ( t = 6.31, P<0.05). The acceptance rate for re-colonoscopy was 88.89%(80/90) in the experimental group and 72.22%(65/90) in the control group, the difference was statistically significant ( χ2 = 7.98, P<0.05). Conclusions:Use of adjustable body position protection belt to assist body position placement before the patients undergoing not painless colonoscopy, it can improve the maintenance rate of body position during not painless colonoscopy, shorten the time of cecal intubation, reduce the intraoperative pain degree, and patients also have a higher willingness to undergo colonoscopy again.

Objective:To investigate the clinical efficacy of gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding.Methods:The retrospective cohort study was conducted. The clinical data of 52 patients with cirrhotic portal hypertension combined with gastric variceal bleeding who were admitted to Affiliated Hospital of Jiaxing University between March 2011 and October 2019 were collected. There were 33 males and 19 females, aged (63±9)years, with a range of 41-83 years. Of the 52 patients, 31 undergoing gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization and 21 undergoing laparoscopic splenectomy combined with pericardial devascularization were allocated into sequential group and laparoscopic group, respectively. Observation indicators: (1) surgical situations; (2) complications; (3) changes in gastric varices after treatment; (4) follow-up. Follow-up was performed using telephone interview combined with outpatient examination to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed by the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was analyzed by the Mann-Whitney U test. Count data were expressed as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact probability. Ordinal data was analyzed by nonparametric rank sum test. Results:(1) Surgical situations: patients of sequential group and laparoscopic group underwent surgery successfully. The operation time and volume of intraoperative blood loss of the sequential group were (112±16)minutes and (57±11)mL, respectively, versus (103±14)minutes and (55±9)mL of the laparoscopic group, showing no significant difference in the above indicators between the two groups ( t=0.963, 1.052, P>0.05). (2) Complications: 11 patients in the sequential group had postoperative complications including 1 case with perioperative bleeding, 2 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. There was no death in the sequential group. Sixteen patients in the laparoscopic group had postoperative complications including 2 cases with perioperative bleeding, 6 cases with postoperative gastrointestinal rebleeding, 4 cases with ascites, 4 cases with portal vein thrombosis. Three patients died in the laparoscopic group. There was no significant difference in the cases with perioperative bleeding or cases with ascites between the two groups ( P>0.05) and no significant difference in the cases with portal vein thrombosis or death between the two groups ( χ2=0.082, 0.082, P>0.05). There was a significant difference in the cases with postoperative gastrointestinal rebleeding between the two groups ( P<0.05). Cases with postoperative gastrointestinal rebleeding, cases with ascites, cases with portal vein thrombosis in the sequential group were cured after the treatment of gastroscopy, low salt diet combined with diuretic or low dose warfarin, respectively. Of the 6 patients with postoperative gastrointestinal rebleeding in the laparoscopic group, 3 were cured after the treatment of gastroscopy and 3 died due to failure to rescue in time. Cases with ascites and cases with portal vein thrombosis in the laparoscopic group were cured after the treatment of low salt diet plus diuretic or low dose warfarin, respectively. (3) Changes in gastric varices after treatment: at postoperative 6 months, 31 patients in the sequential group were diagnosed with negative gastric varices; 15 of 21 patients in the laparoscopic group were diagnosed with negative gastric varices, 3 cases were diagnosed with obvious gastric varices and 3 cases were diagnosed with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-3.128, P<0.05). At postoperative 12 months, 29 patients in the sequential group and 13 patients in the laparoscopic group were diagnosed with negative gastric variceal. There were 2 patients in the sequential group diagnosed with obvious gastric varices, and 8 patients in the laparoscopic group diagnosed with gastric varices including 3 cases with obvious gastric varices and 5 cases with severe gastric varices. There was a significant difference in the cases with gastric varices between the two groups ( Z=-2.933, P<0.05). Cases with obvious gastric varices in the sequential group were cured after the treatment of gastroscopy. Cases with obvious or severe gastric varices in the laparoscopic group were cured after the treatment of gastroscopy except 1 died due to massive gastrointestinal hemorrhage. (4) Follow-up: 52 patients were followed up for 1-8 years, with a median time of 4 years. All the 31 patients in the sequential group and 18 ptients in the laparoscopic group survived. Conclusion:Gastroscopic 'sandwich’ injection and sequential laparoscopic splenectomy combined with pericardial devascularization in the treatment of gastric variceal bleeding has low recurrence rate of varicosity and low incidence of rebleeding.

Objective:To evaluate the efficacy of laparoscopic splenectomy plus pericardial devascularization combined with gastroscopic (double endoscopy) treatment of patients with cirrhosis and portal hypertension presenting with bleeding esophagogastric varices.Methods:To retrospectively analyze 108 patients who presented with bleeding esophageal and gastric varices at the First Hospital of Jiaxing from March 2013 to March 2018. Of 108 patients, there were 61 males and 47 females, with an average age of 61 years. According to the disease and desires of patients and family members, 28 patients underwent laparoscopic splenectomy plus devascularization (the laparoscopic group), 43 endoscopic treatment (the endoscopic group) and 37 double endoscopic treatment (the double endoscopic group). The liver function, renal function, hemoagglutination and degrees of recurrence of the three groups were compared after operation.Results:The renal function, coagulation function, HbA1c in the double endoscopic group was significantly better than that in the other two groups ( P<0.05). In the laparoscopic group, there were 4 patients who presented with rebleeding within 36 months, compared with 3 in the endoscopic group, and no patients in the combined group. At 36 months after operation, gastroscopy performed in the laparoscopic group showed mild varices in 8(28.6%) patients, moderate in 9(32.1%), and severe in 11(39.3%). In the endoscopic group, there were 7(16.3%) patients with mild, 26(60.5%) with moderate, and 10(23.2%) with severe. In the double endoscopic group, there were 32(86.5%) patients with mild and 5(13.5%) with moderate. The degrees of recurrence and postoperative esophageal and gastric varices rebleeding in the double endoscopic group were significantly better than those in the laparoscopic group and the endoscopic group ( P<0.05). Conclusion:Laparoscopic combined with endoscopic treatment was more effective in patients with cirrhosis and portal hypertension who presented with bleeding esophageal varices.

Objective To analyze the detection results of TORCH antibodies for further understanding the TORCH infection situation among different groups in Qujing area .Methods The detection results of 3035 cases of TORCH antibodies were retro-spectively analyzed ,and the detection results were grouped into the male group and female group ,juvenile group and adult group , and the positive rate of TORCH antibodies was statistically analyzed .Results (1) In the TORCH-IgG various antibodies detec-tion ,the positive rate of CMV-IgG antibody was highest(84 .78% ) .In the TORCH-IgM various antibodies detection ,the positive rate of RUV-IgM antibody was highest(9 .92% ) .(2)The positive rates of RUV ,CMV and HSVⅠ /Ⅱ-IgG and IgM antibodies in the female group were higher than those in the male group ,and the differences were statistically significant (P<0 .05) ,but the IgM and TOX-IgG had no statistically significant difference between the two groups (P>0 .05) .(3)The positive rates of TOX ,RUV , CMV and HSVⅠ /Ⅱ-IgG antibodies in the adult group were higher than those in the juvenile group ,the differences were statistical-ly significant (P< 0 .05) .The positive rates of TOX ,RUV and HSV Ⅰ /Ⅱ-IgM antibodies in the adult group were higher than those in the juvenile group ,the differences were statistically significant (P<0 .05) ,but the CMV-IgM had no statistically signifi-cant difference between the two groups (P>0 .05) .Conclusion The infection rates of CMV ,RUV ,HSVⅠ /Ⅲ were higher in Qu-jing area .The infection rates are higher in the adult group and female group .Therefore ,TORCH infection should be early found and the infected persons should take some intervention and treatment measures .

Objective To summarize the experience of nursing six patients who showed pitch-off syndrome when the port was implanted and to analyze the causes of pitch-off syndrome so as to guide the nursing and observation of patients who received port implantation.Methods By observing the patients' symptoms and physical signs based on X-ray reports, pitch-off syndrome was diagnosed. Then correct treatment methods were chosen according to the severity of pitch-off syndrome.Results The six patients with pitch-off syndrome were treated based on their severity. The port-cath was removed in two patients since it cracked. The port-cath was removed in two patients who showed level one pitch-off syndrome after two cycles of chemotherapy. And the port-cath of the remaining two patients was also removed to prevent it from cracking since their level one pitch-off worsened to level three.Conclusions Pitch-off syndrome is the most dangerous complication caused by port implantation. Nursing staff should promptly assess and identify the risks of pitch-off syndrome. The port-cath should be used with great caution when the patients suffer from pitch-off syndrome but badly need venous access. In the event of in vivo cath cracks, nursing staff should work together with doctors to remove the port immediately. Pitch-off syndrome prevention is an important measure to reduce cath cracks.

OBJECTIVETo investigate the relationship between the environmental tobacco smoke (ETS) and lung cancer by Meta-analysis.

METHODSWe used "lung cancer/lung neoplasm", "non-smoking/non-smoker", "China/Chinese", "case-control/case control", "risk factor", "environmental tobacco smoke/passive smoking" as key words, to search papers in databases including Chinese BioMedical Literature (CBM), China National Knowledge Internet (CNKI), Wanfang, Vip Citation Databases (VIP), PubMed and Web of Science databases, and collected the case-control studies on ETS and lung cancer among Chinese non-smokers from January 1999 to December 2013. A total of 129 research papers were collected. RevMan 5.2 software was used to calculate combined odds radio (OR) and 95% CI.

RESULTSQualified 18 literatures were included, total cases 6 145 and controls 8 132. Consolidated results showed that ETS exposure could increase the risk of lung cancer, combined OR (95% CI) = 1.52 (1.42-1.64). Stratified analysis showed that ETS exposure was found to be significantly associated with an increasing risk of the lung cancer on non-smoking women and men, and combined OR (95% CI) were 1.58 (1.42-1.75) and 1.34 (1.08-1.65), respectively; the ETS exposure from family or the working environment could increase the risk of lung cancer, and combined OR (95% CI) were 1.48 (1.20-1.82) and 1.38 (1.13-1.69) respectively; childhood exposure and adult exposure were no significant statistical significance, and combined OR (95% CI) were 1.37 (0.98-1.91), and 1.34 (0.97-1.85) respectively.

CONCLUSIONEnvironmental tobacco smoke exposure was a significant risk factor of lung cancer among non-smokers in China.

Objective To investigate the relationship between the environmental tobacco smoke (ETS) and lung cancer by Meta-analysis. Methods We used“lung cancer/lung neoplasm”,“non-smoking/non-smoker”,“China/Chinese”,“case-control/case control”,“risk factor”,“environmental tobacco smoke/passive smoking”as key words, to search papers in databases including Chinese BioMedical Literature (CBM), China National Knowledge Internet (CNKI), Wanfang, Vip Citation Databases (VIP), PubMed and Web of Science databases, and collected the case-control studies on ETS and lung cancer among Chinese non-smokers from January 1999 to December 2013. A total of 129 research papers were collected. RevMan 5.2 software was used to calculate combined odds radio (OR) and 95%CI. Results Qualified 18 literatures were included, total cases 6 145 and controls 8 132. Consolidated results showed that ETS exposure could increase the risk of lung cancer, combined OR(95%CI)=1.52(1.42-1.64). Stratified analysis showed that ETS exposure was found to be significantly associated with an increasing risk of the lung cancer on non-smoking women and men, and combined OR(95%CI) were 1.58(1.42-1.75) and 1.34(1.08-1.65), respectively; the ETS exposure from family or the working environment could increase the risk of lung cancer, and combined OR(95%CI) were 1.48(1.20-1.82) and 1.38(1.13-1.69) respectively;childhood exposure and adult exposure were no significant statistical significance, and combined OR(95%CI) were 1.37(0.98-1.91), and 1.34(0.97-1.85) respectively. Conclusion Environmental tobacco smoke exposure was a significant risk factor of lung cancer among non-smokers in China.

Objective To investigate the relationship between the environmental tobacco smoke (ETS) and lung cancer by Meta-analysis. Methods We used“lung cancer/lung neoplasm”,“non-smoking/non-smoker”,“China/Chinese”,“case-control/case control”,“risk factor”,“environmental tobacco smoke/passive smoking”as key words, to search papers in databases including Chinese BioMedical Literature (CBM), China National Knowledge Internet (CNKI), Wanfang, Vip Citation Databases (VIP), PubMed and Web of Science databases, and collected the case-control studies on ETS and lung cancer among Chinese non-smokers from January 1999 to December 2013. A total of 129 research papers were collected. RevMan 5.2 software was used to calculate combined odds radio (OR) and 95%CI. Results Qualified 18 literatures were included, total cases 6 145 and controls 8 132. Consolidated results showed that ETS exposure could increase the risk of lung cancer, combined OR(95%CI)=1.52(1.42-1.64). Stratified analysis showed that ETS exposure was found to be significantly associated with an increasing risk of the lung cancer on non-smoking women and men, and combined OR(95%CI) were 1.58(1.42-1.75) and 1.34(1.08-1.65), respectively; the ETS exposure from family or the working environment could increase the risk of lung cancer, and combined OR(95%CI) were 1.48(1.20-1.82) and 1.38(1.13-1.69) respectively;childhood exposure and adult exposure were no significant statistical significance, and combined OR(95%CI) were 1.37(0.98-1.91), and 1.34(0.97-1.85) respectively. Conclusion Environmental tobacco smoke exposure was a significant risk factor of lung cancer among non-smokers in China.