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 This study aims to develop and validate a dynamic web-based nomogram for predicting kinetophobia in patients following percutaneous coronary intervention(PCI).Methods A prospective design was employed to selectively enroll 330 PCI patients admitted to a hospital in Hangzhou from December 2022 to July 2023.Single-factor analysis and Lasso regression were utilized to identify independent risk factors for kinesophobia post-PCI.Logistic regression was performed using R software,and a nomogram was constructed.The model was assessed through the area under the receiver operating characteristic curve(AUC)and Hosmer-Lemeshow tests.Results There were 206 cases of kinesiophobia in 330 patients after PCI,and the incidence was 62.4％.Logistic regression analysis identified combined heart failure,emergency surgery,NYHA cardiac function grade,ADL level,sedentary behavior,Chinese version of PROMIS Physical Function Summary Table score,and Chinese version of Perceptive Social Support Scale score as independent influencing factors for kinesophobia after PCI(P＜0.05).The AUC value of the model was 0.821,with a sensitivity of 70.4％and specificity of 82.0％.The Hosmer-Lemeshow fit test yielded a non-significant result(x2=9.350,P=0.314).Calibration and decision curves demonstrated the model's favorable calibration and clinical practicability.The C-index of the nomogram prediction model was 0.778,0.774,and 0.800,respectively,by 5-fold cross-validation,10-fold cross-validation,and the Bootstrap method.Conclusion The dynamic nomogram model developed in this study effectively predicts kinesophobia in patients after PCI.It provides valuable references and support for clinical staff in early identification of high-risk patients,enabling the formulation of individualized health education strategies and exercise rehabilitation plans.

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 analyze the application of Cho peak value and color doppler ultrasound blood flow score in the early diagnosis of breast cancer, and to evaluate the relationship between Cho peak value, blood flow score, TNM stage and prognosis quality.Methods:A total of 82 patients with breast cyst admitted from Jan. 2015 and Dec. 2019 were selected as subjects for the study. ROC curve was used to compare the ability of color doppler flow score and functional magnetic resonance imaging (fmri) in the diagnosis of breast cancer when used alone or in combination. Logistic regression model was used to analyze the factors affecting the prognosis quality and TNM staging of patients.Results:The breast cancer group’s Cho value and blood flow signal score were significantly higher than the benign breast lesion group, and the difference was statistically significant (Cho value: t=43.977, P<0.001; blood flow signal score: t=22.071, P<0.001) ; The sensitivity, specificity and AUC of MRS combined with Doppler ultrasound for differential diagnosis of breast cancer are significantly higher than MRS or Doppler ultrasound alone, and the difference was statistically significant (sensitivity: χ2=4.514, P=0.016; specificity: χ2=4.858, P=0.013; AUC: Z=5.251, P<0.001) ; Cho value of patients with good prognosis group ( t=3.984, P<0.001) and blood flow signal score ( t=4.213, P<0.001) were significantly lower than those in the poor prognosis group; Cho value ( t=3.612, P<0.001) and blood flow signal score ( t=3.835, P<0.001) of TNM stage 0-Ⅱ patients were significantly lower than those of stage Ⅲ-Ⅳ group, the difference was statistically significant; the Cho value of the MRS scan and the patient’s prognosis quality ( OR=1.837, 95% CI=1.210-2.788, P=0.004) and TNM stage ( OR=1.818, 95% CI=1.224~2.702, P=0.003) was significantly positively correlated. The blood flow signal and the patient’s prognostic quality ( OR=1.906, 95% CI=1.105~3.287, P=0.020) and TNM stages ( OR=1.799, 95% CI=1.232-2.626, P=0.002) also showed a significantly positive correlation. Conclusion:The combination of Cho peak value and color doppler ultrasound blood flow score can significantly improve the early diagnosis efficiency of breast cancer, and Cho peak value and blood flow score are independent factors affecting TNM staging and prognosis.

Objective To discuss the predisposing causes and echocardiographic findings of abnormal cardiac calcifications in fetuses.Methods The echocardiographic and pathological data of 12 fetuses with abnormal cardiac calcifications were retrospectively reviewed,and the pregnancy outcome,predisposing cause and echocardiographic features were analyzed.Results Associated maternal positive anti-SSA/SSB antibody was found in 8 fetuses.The echocardiographic findings of these 8 fetuses were extensive hyper-echogenic thickened atrial wall,interatrial septal and atrioventricular roof.Cardiac myocardium dystrophic calcification was found in 3 fetuses with focal or extensive hyper-echogenic of myocardium.Idiopathic infantile calcification with thickening and hyper-echogenic wall of main pulmonary artery and aorta with obvious stenosis of artery were observed in 1 fetus.One fetus with dystrophic myocardium calcification was continued in pregnancy,1 maternal anti-SSA/SSB antibody (+) baby was born,and 10 fetuses were terminated.Conclusion Maternal anti SSA/ SSB antibody (-) is predominantly associated with fetal cardiac calcification.Fetal abnormal cardiac calcification with different predisposing causes have different echocardiographic features.

Objective To investigate the clinical effectiveness and safety of laparoscopic myomectomy in patients with fibroid. Methods Clinical records of 90 patients with diagnosed fibroid in our hospital from January, 2014 to July, 2016 were retrospectively analyzed. Out of them, 45 patients were treated with myomectomy and 45 patients were treated with hysterectomy. The health condition during and after operation as well as during the follow-up in two groups was compared. Results Blood loss during operation in observation group was less than that in control group (P＜0. 05). The duration of operation, anal exhaust time and hospitalization time in observation group were shorter than those in control group(P＜0. 05). The levels of gonadotropin (FSH), luteinizing hormone (LH) and estrogen (E2) in two groups before and after operation did not change significantly. Conclusion Laparoscopic myomectomy in patient with fibroid was minimal invasive, safe and with little postoperative complications. It was worth clinical promotion and application.

Objective To explore the effects of Six-Step standardized communication procedure in improving the communication ability of nurses.Methods C-I-CARE communication procedure was converted into Chinese.The Chinese version of Six-Step standardized communication procedure was Yi Kan,Er Yin,San Gaozhi,Si Wen,Wu Da,Liu Zaijian.The procedure was propagandized by making posters,setting up computer desktop,training nurses by lectures,video and role play.The effects were evaluated by pre and post self-control test among 100 nurses.Results The average score of communication behavior of 100 nurses after applying standardized communication procedure increased from 2.55±0.67 to 4.44±0.59 (t=-23.174,P＜0.001).In 2015,the nursing department received 622 silk banners and commendatory letters for appreciating nursing work,increased by 18.9％ compared to 2014.The discharged patient satisfaction increased from 94.2％ to 96.93％.The satisfaction of doctors to nurses' collaboration was 99.86％.There was no nursing complaint or dispute caused by bad communication.Conclusion The application of procedure and standardized communication method can improve the communication ability of nurses,optimize the relationship between nurses and patients and increase patient satisfaction.

To explore the clinical efficacies of hyperbaric oxygen therapy on the recovery of cognitive function in stroke patients on hemodialysis.Forty stroke patients on hemodialysis were assigned randomly into hyperbaric oxygen therapy (HBO) (n =20 ) and routine therapy groups (n =20).Patients of HBO group received both hyperbaric oxygen therapy and routine therapy.Nerves functions and cognitive function were observed before and after therapy to compare the clinical outcomes.Neuropsychological tests,minimental status examination (MMSE) and activities of daily living (ADL) were used for assessing cognitive function.Then the outcomes were compared with those of the control group.Nerves function and cognitive dysfunction of the treatment group had significant improvement (P ＜ 0.01).Hyperbaric oxygen can significantly improve cognitive dysfunction in stroke patients on hemodialysis.

Objective To explore and compare the mechanism of high-fructose and high-fat diet induced triglyceride excessive accumulation in mice liver and its relationship with endoplasmic reticulum (ER) stress.Methods 45 Adult male C57BL/J6 mice,weight arranged from 25 gram to 30 gram were randomly divided into control group,high-fructose group and high-fat group,15 mice in each group.Common food was fed in control group,high-fructose food was fed in high-fructose group,high-fat food was fed in high-fat group,and the everyday calories consumption in 3 groups was almost equal.Intraperitoneal glucose tolerance test (ipGTT) was performed after feeding for 8 weeks.After mice were sacrificed,triglyceride content,lipogenic enzymes and ER stress markers expression in liver tissues of each group were measured.Results After feeding with different food for 8 weeks,the fat content of epididymis in high-fructose group and high-fat group both was (2.0±0.1) g/100 g (body weight),which was significantly higher than that of control group (1.2 ± 0.1) g/100 g (body weight),P＜0.01).After ipGTT test,the area under curve of blood glucose in high-fructose group and high-fat group was significantly higher than that in control group (P＜0.01).Compared with control group,triglyceride contents of liver tissues in high-fructose group and high-fat group were significantly increased,of those triglyceride contents in high-fructose group increased more obviously,and triglyceride contents in high-fructose group was significantly higher than that of high-fat group (P＜0.01).Compared with control group,the expression of acylCoA carboxylase (ACC),fatty acid synthase (FAS) and stearoyl-CoA desaturase 1 (SCD-1) increased in high-fructose group (P＜0.01),while decreased in high-fat group (P＜0.05) ; meanwhile,the expression of phosphorylated pancreatic ER kinase (p-PERK),inositol requiring enzyme 1 (p-IRE-1/t-IRE-1)and glucose-regulated protein 78 (GRP78) was up-regulated in both high-fructose group and high-fat group (all P＜0.01).Conclusion Both high-fructose diet and high-fat diet can induce fatty liver through different mechanisms.High-frucose diet promotes endogenous lipogenesis while high-fat diet inhibits endogenous lipogenesis.Both dietary factors can induce ER stress,which indicate that ER stress is associated with pathogenesis and development of food factors induced fatty liver.

Objective To compare the effects of pulse high-volume hemofiltration (PHVHF) and continuous veno-venous hemofiltration (CVVH) on severe acute panceatitis (SAP). Method From January 2005 to December 2009, a total of 38 patients with SAP were randomly(random number) divided into PHVHF group ( n = 18)and CVVH group ( n = 20). After hemofiltration for 72 hours, clinical symptoms, APACHE Ⅱ score, biochemical changes and mortality were observed. The levels of TNF-α, IL-6, and IL-10 in plasma were assayed by using ELISA before and after treatment. The doses of dopamine used in shock patients were also observed. Measurement data were expressed in(-x) ± s, and t-test was used for comparison between two groups. Results In both groups ,symptoms were markedly improved after treatment. The APACHE Ⅱ score, serum amylase, creatinine, and white blood cell count were decreased ( P ＜ 0.05). Besides, hypoxemia and acidosis were corrected, and the PHVHF group was superior to the CVVH group especially in heart rate, breathing and APACHE Ⅱ score ( P ＜ 0. 05).The levels of TNF-α, IL-6 and IL-10 decreased in both groups ( P ＜ 0.05), and the PHVHF group was superior to the CVVH group ( P ＜ 0. 01 ). The doses of dopamine used in shock patients also decreased in both groups ( P ＜0. 01 ), and they decreased more in PHVHF group than in CVVH group ( P ＜ 0.05). The mortality was 11.1%in PHVHF group and 25 % in CVVH group. Conclusions PHVHF is obviously superior to CVVH in the treatment of SAP, and can serve as an important adjuvant therapy for SAP, stabilizing the hemodynamics and reducing the levels of pro-inflammatory factors and mortality.