In the present study,we retrospectively analyzed 105382 prescriptions of antipyretic drugs for children(0–14 years of age)in the outpatient and emergency departments of Ningbo Women and Children’s Hospital from Janu...In the present study,we retrospectively analyzed 105382 prescriptions of antipyretic drugs for children(0–14 years of age)in the outpatient and emergency departments of Ningbo Women and Children’s Hospital from January to December 2019.Ibuprofen and acetaminophen are relatively safe and the most commonly used drugs in daily life.Due to different dosage forms,there are acetaminophen suspension drops,acetaminophen oral solution,ibuprofen suspension,and ibuprofen suppositories for children.Through investigation,we found that the age of antipyretic drugs used by children in our hospital ranged from 3 months to 14 years old,which could be divided into two groups:single drug use and alternating use of ibuprofen and acetaminophen,with an alternating use rate of 3.19%.There were differences between the two groups in terms of age,gender,the proportion of emergency departments use,and the amount of single prescription(P<0.05).The age of the alternating use group was younger,and the male proportion,the proportion of emergency departments use,single prescription amount of the alternating use group were higher.In the alternating use group,ibuprofen and acetaminophen of different dosage forms were used alternatively.After pair comparison analysis,they only had an age difference(P<0.008),which was in line with the principle that different dosage forms are suitable for different ages.The method of alternation with ibuprofen and acetaminophen is mainly used in the emergency departments and children of younger age because most of the children have a refractory fever,which is complicated and changes relatively fast.There was no record of adverse reactions about alternation of ibuprofen and acetaminophen in the software system of adverse reactions.However,this study was a retrospective analysis,and there were risks of missing records.Therefore,alternating use of ibuprofen and acetaminophen still couldn’t ignore the risk of adverse reactions.展开更多
Keloids are a notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of r...Keloids are a notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of recurrence;therefore,comprehensive therapy is the better solution.Here,we focused on the management of different medical interventions according to subjective and objective conditions of keloid patients and summarized several clinical comprehensive strategies based on our clinical experience.One original concept of laser combined with radiotherapy was also introduced as a promising method,especially for wide-based pathological scars.展开更多
Objective:To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes.Methods:We conducted an observational cross-sectional study at Children's Hospital 1(CH...Objective:To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes.Methods:We conducted an observational cross-sectional study at Children's Hospital 1(CH1)from July 25,2021,to May 31,2022.All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included.We classified neonates with COVID-19 into 2 groups:mild/moderate and severe for analysis.Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables.Results:This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results.The severity COVID-19 rate among neonatal cases was found to be 13.6%(12/88),with a corresponding mortality rate of 1.1%(1/88).All severe cases showed lung abnormalities as evident on chest X-ray images.In addition to respiratory symptoms,a higher incidence of gastrointestinal manifestations,such as vomiting and diarrhea,was observed in the severe group,indicating a compelling association.The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications.Conclusions:The COVID-19 pandemic has had a substantial impact on the well-being of neonates.The management of COVID-19 in this population presents significant challenges.展开更多
The center was first established in 2013 and affiliated to the Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.In 2015,the center was entitled as 3D Bioprinting Clinical Transformati...The center was first established in 2013 and affiliated to the Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.In 2015,the center was entitled as 3D Bioprinting Clinical Transformation Collaborative Innovation Center.In 2016,the center was renamed as Medical 3D Printing Innovation Research Center of Shanghai Jiao Tong University School of Medicine.Although the center was established in 2013,the clinical application of 3D printing in Shanghai Ninth People’s Hospital can be traced back to the 1990s.As early as 30 years ago,Prof.Kerong Dai had tried to rebuild patients pelvic by manually cutting the foam boards and layering them together based on the theory of 3D printing for preoperative planning model of abnormal skeleton structures and development of personalized prosthesis.That was the first application of 3D printing in the area of medicine in China.Now,The Research Center of 3D Bioprinting in Shanghai Ninth People’s Hospital comprised of subcenters including the outpatient department of 3D printing,medical 3D printing innovation research center and Shanghai key laboratory of orthopedic implant.展开更多
COVID-19 (COVID-19) or COVID-19 is pneumonia caused by the novel coronavirus infection in patients in 2019. COVID-19 pneumonia epidemic is widespread, wide, and deep. To effectively combat the further spread of COVID-...COVID-19 (COVID-19) or COVID-19 is pneumonia caused by the novel coronavirus infection in patients in 2019. COVID-19 pneumonia epidemic is widespread, wide, and deep. To effectively combat the further spread of COVID-19: the overall protocol of the hospital: “three lines of defense” of community prevention and control, fever clinic and face-to-face treatment;grasp the good three-time limits: “2 hours, 12 hours and 24 hours”;do a good job of three key points: key areas and places and groups;carry out four early prevention and control measures: early detection, early reporting, early isolation and early treatment;management of confirmed, suspected, fever, close contact “four types of personnel”;implement l responsibility system;doing all receivable, should be treated, should be checked, should be separated by “four should be”;do investigation, control, supervision, education, and care “five in place”. Through the above methods, the People’s Hospital of Pingchang County has effectively controlled COVID-19.展开更多
Because of the toxic effects of plasticizers, mainly the phthalate DEHP, the Children＇s Hospital Kinderklinik Glanzing in Vienna, Austria started in 2000 replacing PVC-containing medical devices by PVC-free material....Because of the toxic effects of plasticizers, mainly the phthalate DEHP, the Children＇s Hospital Kinderklinik Glanzing in Vienna, Austria started in 2000 replacing PVC-containing medical devices by PVC-free material. After analysis of suspected PVC-containing medical products a PVC input-output balance was established. Through linkage with the consumption data PVC-containing articles could be identified. PVC-free alternatives for medical use were searched as well by literature research as by questioning the manufactures. Then medical producers were asked to confirm PVC free articles. PVC content of invasive medical products could be reduced from 343 kg and 14.6 % weight in 2001 to 178 kg and 7.6% weight in 2010.展开更多
Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enoug...Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.展开更多
Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Backgr...Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Background: The study aims at revealing the level of parental and community awareness and testing the value of a simple measurement in uncovering children who need further assessment when performing an in-hospital BP screening. Methods: BP was measured in 600 children (0 - 17 yr, mean age 5.1 ± 4.3 yr) at a Children’s hospital. Parents were asked to fill in a specially structured questionnaire. Results: In 47.2% of the subjects (40.1% of them were Greeks and 60.6% foreigners), BP had never been checked before (p arterial BP had never been checked before. Surprisingly, a health certificate was issued for school purposes for 81.2% of the schoolchildren of this study, and 75.3% of the enrolled children were allowed to participate in sports clubs without first checking BP. Moreover, parents demonstrated a low level of alertness with respect to paediatric hypertension. Conclusions: Simple arterial BP measurements can ensure early detection and thus early referral to specialists.展开更多
Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospi...Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospitals. Methods: Children’s hospitals that ranked in the top fifty of the 2019-2020 US News and World Report (USNWR) were included in the analysis. The mean and median ranking of children’s hospitals with independent versus a shared EHR was evaluated. The 2019-2020 USNWR rankings of the top twenty adult hospitals in the United States were then evaluated. For each children’s hospital with an associated adult hospital that was both ranked, it was noted as to whether the EHR for the children’s hospital was independent or shared and statistical differences in rankings compared. Results: Among the top 50 children’s hospitals included, the median USNWR ranking for hospitals was statistically different with an independent EHR than with a shared EHR (13 vs. 30.0) (p = 0.002). The 21 top ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. The median ranking for those with an independent EHR was statistically different for those with independent EHR versus shared EHR (7 vs. 28) (p = 0.002). Conclusion: Children’s hospitals with an independent EHR are associated with higher scores on an independent external ranking of hospital quality compared to those which share an EHR with a partner adult hospital.展开更多
Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often ass...Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often associated with a favoring factor. When it is large, it can affect the life expectancy. The objective of our study was to determine the epidemiological, diagnostic and evolutionary aspects of pneumothorax in children aged 0 to 15 years, hospitalized at the Albert Royer National Children’s Hospital in Dakar. This is a retrospective descriptive study of patient records followed at the Albert Royer National Children’s Hospital (CHNEAR) for the management of a pneumothorax during the period from 2020 to 2022. During our study, 15 patients were hospitalized for pneumothorax, with an average annual incidence of 7.5 cases per year. The sex ratio (H/F) was 2.03. The average age was 3.7 years. Chest pain was present in 27% of patients, dyspnea was found in 93%, and cough in 87% of patients. All patients underwent chest radiography and the location of the pneumothorax was predominant on the right in 60% of cases. Thoracic drainage was performed in 93.3% of patients associated with etiological treatment. The average length of hospitalization was 27.8 days with a cure rate of 86.7% and a recurrence rate of 13.3%.展开更多
Objectives: To describe thoracic endovascular aortic repair (TEVAR) outcomes at the Royal Brisbane and Women’s Hospital between 2001-2010. Design: Prospective cohort study. Results: We successfully treated 95 of 97 p...Objectives: To describe thoracic endovascular aortic repair (TEVAR) outcomes at the Royal Brisbane and Women’s Hospital between 2001-2010. Design: Prospective cohort study. Results: We successfully treated 95 of 97 patients for a 98% procedural success rate. Of the treated patients, 68 (72%) were males and mean age was 61 ± 17 years. Average follow up was 3.6 ± 2.0 years. Pathologies treated were: dissection (n = 35), aneurysmal disease (n = 32), traumatic disease (n = 19), coarctation (n = 5) and miscellaneous (n = 4). There was one peri-procedural myocardial infarction. Renal complications occurred in 7 patients (3 with doubling creatinine and 4 requiring temporary renal replacement therapy). Stroke occurred in 2 patients and paresis in 2 patients (permanent in one). Six patients died during index hospitalization and 17 deaths occurred during follow-up, 2 of which were confirmed secondary to aortic pathology. Age (HR 1.08 per year, p < 0.01) and ASA class (HR 2.2 per class, p = 0.02) were independently associated with mortality. There were 25 re-interventions in 22 patients. Eighteen of these re-interventions in 16 patients were related to the management of complications of TEVAR of which 13 were for endoleaks;eight type I, four type II, one type III. Conclusion: TEVAR can be used to treat thoracic aortic pathology but questions remain regarding long-term durability.展开更多
Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The ob...Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The objective of this study is to evaluate the evolutionary profile of the pulmonary pressures of children with congenital heart disease with left-to-right shunt and to identify the factors favoring an evolution towards PAH. This is a retrospective, descriptive and analytical study over a period of four years and six months (from January 1, 2016 to June 30, 2020) at the Center National d’Enfant Albert Royer in Dakar on a series of 87 cases. The hospital frequency was 3.98 per thousand, and the incidence of PAH was 9.44%. The sex ratio of 0.74. The average age was 44.76 months. The average time between the onset of symptoms and the diagnosis of heart disease is 78.81 days. Dyspnea was found in 70.11% of cases, the burst of pulmonary B2 was found in 55%. Global heart failure was noted in 39.08% of cases. Cardiomegaly was found in 89.66% and pulmonary hypervascularization was found in 57.72% of cases. CIV was present in 54.02% of cases, followed by PCA in 21.14% and CAVc in 18.39% of cases. furosemide was used in 97.70% of cases and Captopril in 74.71% of cases. Sildenafil was used in 10.34% of patients, and 12.64% of patients benefited from surgical management. Eisenmenger syndrome was found in 12.64% of patients. PAH in these heart diseases is a formidable and frequent complication, due to an increase in precapillary flow. The major improvement in mortality and morbidity is early surgical management, in the first months of life, to prevent pulmonary vascular disease.展开更多
Objective To investigate the prevalence of nutritional risk, undernutrition, overweight/obesity, and the application of nutritional support among geriatrics so as to provide evidence for whether elderly inpatients wit...Objective To investigate the prevalence of nutritional risk, undernutrition, overweight/obesity, and the application of nutritional support among geriatrics so as to provide evidence for whether elderly inpatients with undernutrition and nutritional risk should receive timely nutritional support. Methods A total of 445 elderly inpatients in the Department of Geriatrics of Peking University People’s Hospital were consecutively enrolled from July 2010 to June 2011. The Nutritional Risk Screening 2002 (NRS 2002) questionnaire was used on the second day after admission. The application of nutritional support was investigated on the 14th day or the discharge day. The relationship between the nutritional risk and nutritional support was analyzed. A NRS 2002 score ≥ 3 was defined as nutritional risk. A body mass index (BMI)< 18.5 kg/m2 was defined as malnutrition, 24.0 kg/m2 ≤ BMI < 28.0 kg/m2 as overweight, and a BMI ≥ 28.0 kg/m2 as obese. Results A total of 445 patients were enrolled and 423 patients (95.1%) completed the NRS 2002. The prevalence of undernutrition and nutritional risk was 4.7% and 13.2%, respectively. Among 230 patients who were overweight/obese, the prevalence of nutritional risk was 6.1%. In total, 15 of the 56 patients (26.8%) with NRS 2002 scores ≥ 3 received nutritional support, and 14 patients (3.8%) with NRS 2002 scores < 3 also received nutritional support. The average PN: EN ratio was 1.6:1. Conclusion A certain proportion of elderly inpatients in the department of geriatrics were experiencing undernutrition or were at nutritional risk. The prevalence of nutritional risk did not increase significantly with age. The current application of nutritional therapy is inappropriate. Evidence-based guidelines are required to improve this situation. The NRS 2002 may not applicable for overweight/obese elderly inpatients.展开更多
Objective:This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers.Materials and Methods:A cross-sectional study was conducted by inte...Objective:This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers.Materials and Methods:A cross-sectional study was conducted by interviewing nurse managers with a questionnaire,including the Rahim Organizational Conflict Inventory-II Form B,used to assess an individual’s approach to conflict management across five styles:cooperating,competing,compromising,obliging,and avoiding.Results:A total of 30 nurse managers participated in this study.The mean scores of the cooperating style were the highest at 4.3±0.4,followed by a compromising style at 3.4±0.5,an avoiding style at 3.1±0.6,an accommodating style at 2.9±0.7,and a competing style at 2.8±0.8(χ^(2)=66.624,P<0.001).The mean scores for avoiding style among bachelor’s degree nurse managers(3.2±0.6)were higher than those of master’s degree nurse managers(2.7±0.6)(P=0.036).Nurse managers over 40 years old,holding a managerial position for≥10 years,and frequent conflict handling rated higher mean scores for the cooperating style than their counterparts(P<0.05).Conclusion:The cooperating style was the most commonly used conflict management style among nurse managers.Factors affecting the conflict management style were age,education level,and experience in management and conflict handling.These findings are useful for developing interventions that enhance the competencies of nurse managers in conflict management.展开更多
Objective: to analyze the causes of critical drug dispensing errors in the drug dispensing process of outpatient and Emergency Pharmacy in our hospital and evaluate the improvement effect of departments to prevent cri...Objective: to analyze the causes of critical drug dispensing errors in the drug dispensing process of outpatient and Emergency Pharmacy in our hospital and evaluate the improvement effect of departments to prevent critical errors. Methods: the causes of drug critical error events in our hospital from January 2019 to January 2021 were reviewed and analyzed. The causes of critical errors were retrospectively evaluated and analyzed. Results: among the 88 cases of critical errors in our hospital, there were 15 cases of dosage form errors, 12 cases of dispensing errors caused by similar packaging, 8 cases of pharmacist’s medication explanation errors, 20 cases of improper compatibility of Chinese and Western drugs, 23 cases of multi-standard dispensing errors of one product and 10 cases of other types of errors. After reviewing the statistical analysis, it was found that the multi regulatory critical error rate of one product was the highest, the improper combination of Chinese and Western medicine was the second, the dosage form was confused, and the dispensing error was in the middle. Critical errors include drug storage problems and drug placement, drug specifications, dosage form factors, external packaging factors, lack of professional quality of dispensing personnel, imperfect management system, nonstandard or wrong input of electronic prescription, careless pre audit of prescription, etc. [1] Conclusion: for the above critical drug errors, the departments summarize and analyze the causes, timely formulate relevant critical drug error management systems, strengthen the training of department personnel, strengthen the level of professional knowledge, take double dispensing and review (24-hour duty), and take the "4 / 3 / 5" dispensing and dispensing steps for dispensing prescriptions, which can significantly reduce the incidence of critical errors. Improve the level of drug management and ensure the service quality of drug distribution.展开更多
3D-printing technology,a leading example of advanced additive manufacturing,has revolutionized the treatment of clinical orthopedic diseases,ushering in a new era of personalized medicine.Since the 1980s,the orthopedi...3D-printing technology,a leading example of advanced additive manufacturing,has revolutionized the treatment of clinical orthopedic diseases,ushering in a new era of personalized medicine.Since the 1980s,the orthopedic team led by Prof.Kerong Dai at Shanghai Ninth People’s Hospital,affiliated with Shanghai Jiao Tong University School of Medicine,has effectively advanced the research,development,and implementation of customized artificial joints through medical collaboration.This work laid the foundation for the application of domestic 3D-printing in orthopedics.Continuous innovations-from fundamental research to clinical practice,from metal prosthesis implantation to customized bioactive bone product replacement,and from the traditional standardized diagnostic and treatment paradigm to the transformation of personalized medical models-underscore the pivotal role of 3D-printing technology.It has promoted personalized medicine,enhanced surgical precision,minimized the risk of infection,and accelerated bone integration.Prof.Yongqiang Hao’s group has further expanded and deepened the application of three-dimensional printing technology in orthopedics.Significant breakthroughs have been achieved in domestic bioactive metals,metal orthopedic implants,and 3D-printed biological implants.The protocols for personalized internal fixation and novel pelvic reconstruction prostheses are now internationally recognized in clinical practice.This study provides a comprehensive overview of the innovative research and applications of personalized and customized 3D-printed orthopedic implants.展开更多
Downregulation of the inwardly rectifying potassium channel Kir4.1 is a key step for inducing retinal Müller cell activation and interaction with other glial cells,which is involved in retinal ganglion cell apopt...Downregulation of the inwardly rectifying potassium channel Kir4.1 is a key step for inducing retinal Müller cell activation and interaction with other glial cells,which is involved in retinal ganglion cell apoptosis in glaucoma.Modulation of Kir4.1 expression in Müller cells may therefore be a potential strategy for attenuating retinal ganglion cell damage in glaucoma.In this study,we identified seven predicted phosphorylation sites in Kir4.1 and constructed lentiviral expression systems expressing Kir4.1 mutated at each site to prevent phosphorylation.Following this,we treated Müller glial cells in vitro and in vivo with the m Glu R I agonist DHPG to induce Kir4.1 or Kir4.1 Tyr^(9)Asp overexpression.We found that both Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression inhibited activation of Müller glial cells.Subsequently,we established a rat model of chronic ocular hypertension by injecting microbeads into the anterior chamber and overexpressed Kir4.1 or Kir4.1 Tyr^(9)Asp in the eye,and observed similar results in Müller cells in vivo as those seen in vitro.Both Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression inhibited Müller cell activation,regulated the balance of Bax/Bcl-2,and reduced the m RNA and protein levels of pro-inflammatory factors,including interleukin-1βand tumor necrosis factor-α.Furthermore,we investigated the regulatory effects of Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression on the release of pro-inflammatory factors in a co-culture system of Müller glial cells and microglia.In this co-culture system,we observed elevated adenosine triphosphate concentrations in activated Müller cells,increased levels of translocator protein(a marker of microglial activation),and elevated interleukin-1βm RNA and protein levels in microglia induced by activated Müller cells.These changes could be reversed by Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression in Müller cells.Kir4.1 overexpression,but not Kir4.1 Tyr^(9)Asp overexpression,reduced the number of proliferative and migratory microglia induced by activated Müller cells.Collectively,these results suggest that the tyrosine residue at position nine in Kir4.1 may serve as a functional modulation site in the retina in an experimental model of glaucoma.Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression attenuated Müller cell activation,reduced ATP/P2X receptor–mediated interactions between glial cells,inhibited microglial activation,and decreased the synthesis and release of pro-inflammatory factors,consequently ameliorating retinal ganglion cell apoptosis in glaucoma.展开更多
Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical p...Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.展开更多
Objective:To explore the application effect of the hospital-community-family model-based combined rehabilitation exercise intervention on middle-aged and elderly patients with chronic kidney disease.Methods:Using the ...Objective:To explore the application effect of the hospital-community-family model-based combined rehabilitation exercise intervention on middle-aged and elderly patients with chronic kidney disease.Methods:Using the convenience sampling method,80 patients in the stable stage of CKD who were treated in the nephrology department of a tertiary hospital from May 2022 to June 2023 were selected as the research subjects.They were divided into the experimental group(40 cases)and the control group(40 cases)by random number table method.The control group received conventional exercise intervention plus telephone follow-up,while the experimental group received combined hospital-community-family modelbased exercise intervention in addition to the control group,using remote medical guidance and monitoring of the application effect of exercise rehabilitation on middle-aged and elderly patients with chronic kidney disease.The glomerular filtration rate,6-minute walking distance,fatigue and social support scores of the two groups of patients were measured before the intervention,4 weeks after the intervention,and 12 weeks after the intervention.Results:Before the intervention,there were no statistically significant differences in glomerular filtration rate,6-minute walking distance,fatigue and social support scores between the two groups(p>0.05).After 12 weeks of intervention,the glomerular filtration rate,6-minute walking distance and social support scores of the experimental group were higher than those of the control group;the differences were statistically significant(p<0.05).The behavioral,emotional,sensory and cognitive scores of the Piper-Fatigue Revised Scale of the experimental group were lower than those of the control group,and the differences were statistically significant(p<0.05).Conclusion:Based on the hospital-community-family model combined rehabilitation exercise,using remote medical guidance for the continuous care of middle-aged and elderly patients in the stable stage of chronic kidney disease can effectively improve the exercise endurance and social support level of patients,improve the fatigue condition,and the implementation effect is positively correlated with the intervention time.展开更多
基金Ningbo Clinical Research Center for Children’s He alth and Diseases(Grant No.2019A21002)Ningbo Medical Science and Technology Project(Grant No.2020Y15)。
文摘In the present study,we retrospectively analyzed 105382 prescriptions of antipyretic drugs for children(0–14 years of age)in the outpatient and emergency departments of Ningbo Women and Children’s Hospital from January to December 2019.Ibuprofen and acetaminophen are relatively safe and the most commonly used drugs in daily life.Due to different dosage forms,there are acetaminophen suspension drops,acetaminophen oral solution,ibuprofen suspension,and ibuprofen suppositories for children.Through investigation,we found that the age of antipyretic drugs used by children in our hospital ranged from 3 months to 14 years old,which could be divided into two groups:single drug use and alternating use of ibuprofen and acetaminophen,with an alternating use rate of 3.19%.There were differences between the two groups in terms of age,gender,the proportion of emergency departments use,and the amount of single prescription(P<0.05).The age of the alternating use group was younger,and the male proportion,the proportion of emergency departments use,single prescription amount of the alternating use group were higher.In the alternating use group,ibuprofen and acetaminophen of different dosage forms were used alternatively.After pair comparison analysis,they only had an age difference(P<0.008),which was in line with the principle that different dosage forms are suitable for different ages.The method of alternation with ibuprofen and acetaminophen is mainly used in the emergency departments and children of younger age because most of the children have a refractory fever,which is complicated and changes relatively fast.There was no record of adverse reactions about alternation of ibuprofen and acetaminophen in the software system of adverse reactions.However,this study was a retrospective analysis,and there were risks of missing records.Therefore,alternating use of ibuprofen and acetaminophen still couldn’t ignore the risk of adverse reactions.
基金This study is supported by the National Nature Science Foundation of China(81101432 and 81272036).
文摘Keloids are a notorious fibroproliferative disorder that may cause cosmetic concerns and life inconvenience.Various methods such as surgery,injection,and laser have been used;however,single treatments are at risk of recurrence;therefore,comprehensive therapy is the better solution.Here,we focused on the management of different medical interventions according to subjective and objective conditions of keloid patients and summarized several clinical comprehensive strategies based on our clinical experience.One original concept of laser combined with radiotherapy was also introduced as a promising method,especially for wide-based pathological scars.
文摘Objective:To evaluate the impact of the severe COVID-19 pandemic on neonates and develop strategies to improve their outcomes.Methods:We conducted an observational cross-sectional study at Children's Hospital 1(CH1)from July 25,2021,to May 31,2022.All neonates who had fever or respiratory symptoms or were born from mothers with COVID-19 and had a positive RT-PCR SARS-CoV-2 result would be included.We classified neonates with COVID-19 into 2 groups:mild/moderate and severe for analysis.Differences between groups were analyzed using Fisher's exact test/Chi-square test for categorical variables and Student's t-test/Wilcoxon Rank Sum test for continuous variables.Results:This study included 88 newborns who had positive RT-PCR SARS-CoV-2 results.The severity COVID-19 rate among neonatal cases was found to be 13.6%(12/88),with a corresponding mortality rate of 1.1%(1/88).All severe cases showed lung abnormalities as evident on chest X-ray images.In addition to respiratory symptoms,a higher incidence of gastrointestinal manifestations,such as vomiting and diarrhea,was observed in the severe group,indicating a compelling association.The administration of anticoagulant and anti-inflammatory drugs in the study group resulted in a satisfactory outcome with no significant complications.Conclusions:The COVID-19 pandemic has had a substantial impact on the well-being of neonates.The management of COVID-19 in this population presents significant challenges.
文摘The center was first established in 2013 and affiliated to the Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine.In 2015,the center was entitled as 3D Bioprinting Clinical Transformation Collaborative Innovation Center.In 2016,the center was renamed as Medical 3D Printing Innovation Research Center of Shanghai Jiao Tong University School of Medicine.Although the center was established in 2013,the clinical application of 3D printing in Shanghai Ninth People’s Hospital can be traced back to the 1990s.As early as 30 years ago,Prof.Kerong Dai had tried to rebuild patients pelvic by manually cutting the foam boards and layering them together based on the theory of 3D printing for preoperative planning model of abnormal skeleton structures and development of personalized prosthesis.That was the first application of 3D printing in the area of medicine in China.Now,The Research Center of 3D Bioprinting in Shanghai Ninth People’s Hospital comprised of subcenters including the outpatient department of 3D printing,medical 3D printing innovation research center and Shanghai key laboratory of orthopedic implant.
文摘COVID-19 (COVID-19) or COVID-19 is pneumonia caused by the novel coronavirus infection in patients in 2019. COVID-19 pneumonia epidemic is widespread, wide, and deep. To effectively combat the further spread of COVID-19: the overall protocol of the hospital: “three lines of defense” of community prevention and control, fever clinic and face-to-face treatment;grasp the good three-time limits: “2 hours, 12 hours and 24 hours”;do a good job of three key points: key areas and places and groups;carry out four early prevention and control measures: early detection, early reporting, early isolation and early treatment;management of confirmed, suspected, fever, close contact “four types of personnel”;implement l responsibility system;doing all receivable, should be treated, should be checked, should be separated by “four should be”;do investigation, control, supervision, education, and care “five in place”. Through the above methods, the People’s Hospital of Pingchang County has effectively controlled COVID-19.
文摘Because of the toxic effects of plasticizers, mainly the phthalate DEHP, the Children＇s Hospital Kinderklinik Glanzing in Vienna, Austria started in 2000 replacing PVC-containing medical devices by PVC-free material. After analysis of suspected PVC-containing medical products a PVC input-output balance was established. Through linkage with the consumption data PVC-containing articles could be identified. PVC-free alternatives for medical use were searched as well by literature research as by questioning the manufactures. Then medical producers were asked to confirm PVC free articles. PVC content of invasive medical products could be reduced from 343 kg and 14.6 % weight in 2001 to 178 kg and 7.6% weight in 2010.
文摘Acute chest syndrome (ACS) is a serious pulmonary complication of sickle cell disease. It is estimated to be responsible for a quarter of deaths in the pediatric sickle cell population. In Senegal, there are not enough pediatric studies in this area. The objective of our study was to determine the epidemiological, diagnostic and evolutionary characteristics of ATS at the Albert Royer National Children’s Hospital (CHNEAR) in Dakar. This was a retrospective study in patients hospitalized at CHNEAR for ATS from January 1, 2021 to March 31, 2022. We included patients hospitalized and diagnosed with ATS. We had collected 102 patients, i.e. a hospital incidence of 2.96%. The average age of the children was 9 years old;the sex ratio was 1.04. The main symptoms on admission were hypoxemia (97.06%), chest pain (77.45%), dyspnea (77.45%) and fever (65.69%). 52.94% of patients had an associated vaso-occlusive crisis (VOC). The chest x-ray was abnormal in 92 patients, a rate of 90.20% and showed images of pneumonia (71%);bronchitis (17.65%) and pleurisy (0.98%). None of the children benefited from a pulmonary ultrasound. The treatment associated with analgesics (100%), broad-spectrum antibiotics (100%), oxygen therapy (100%), hydration (95.09%), transfusion (73.53%), non-ventilation invasive (6.86%), intubation (2.94%) and beta 2 mimetics (12.75%). No patient benefited from incentive spirometry. Almost all of the patients 95.10% (n = 97) had a favorable clinical evolution. However, five children (4.90%) had an unfavorable outcome including one case of complication such as stroke (0.98%) and four (4) cases of death. The average hospital stay was 8 days. ATS is common in children with sickle cell disease in Senegal and its etiologies seem to be dominated by infectious causes in our context.
文摘Arterial hypertension begins in childhood and may continue, without intervention, throughout adulthood with severe health sequelae.The base of timely diagnosis is the systematic blood pressure (BP) measurement. Background: The study aims at revealing the level of parental and community awareness and testing the value of a simple measurement in uncovering children who need further assessment when performing an in-hospital BP screening. Methods: BP was measured in 600 children (0 - 17 yr, mean age 5.1 ± 4.3 yr) at a Children’s hospital. Parents were asked to fill in a specially structured questionnaire. Results: In 47.2% of the subjects (40.1% of them were Greeks and 60.6% foreigners), BP had never been checked before (p arterial BP had never been checked before. Surprisingly, a health certificate was issued for school purposes for 81.2% of the schoolchildren of this study, and 75.3% of the enrolled children were allowed to participate in sports clubs without first checking BP. Moreover, parents demonstrated a low level of alertness with respect to paediatric hypertension. Conclusions: Simple arterial BP measurements can ensure early detection and thus early referral to specialists.
文摘Introduction: To evaluate the correlation between the presence of an independent EHR (compared to a shared EHR system within an adult hospital system) and an externally-derived third party ranking of children’s hospitals. Methods: Children’s hospitals that ranked in the top fifty of the 2019-2020 US News and World Report (USNWR) were included in the analysis. The mean and median ranking of children’s hospitals with independent versus a shared EHR was evaluated. The 2019-2020 USNWR rankings of the top twenty adult hospitals in the United States were then evaluated. For each children’s hospital with an associated adult hospital that was both ranked, it was noted as to whether the EHR for the children’s hospital was independent or shared and statistical differences in rankings compared. Results: Among the top 50 children’s hospitals included, the median USNWR ranking for hospitals was statistically different with an independent EHR than with a shared EHR (13 vs. 30.0) (p = 0.002). The 21 top ranked adult hospitals were associated with 17 children’s hospitals ranked in the top 50. The median ranking for those with an independent EHR was statistically different for those with independent EHR versus shared EHR (7 vs. 28) (p = 0.002). Conclusion: Children’s hospitals with an independent EHR are associated with higher scores on an independent external ranking of hospital quality compared to those which share an EHR with a partner adult hospital.
文摘Pneumothorax is defined by the presence of air between the parietal pleura and the visceral pleura. Most of the child’s pneumothorax is traumatic. The spontaneous pneumothorax (PS) of the child is rare, and often associated with a favoring factor. When it is large, it can affect the life expectancy. The objective of our study was to determine the epidemiological, diagnostic and evolutionary aspects of pneumothorax in children aged 0 to 15 years, hospitalized at the Albert Royer National Children’s Hospital in Dakar. This is a retrospective descriptive study of patient records followed at the Albert Royer National Children’s Hospital (CHNEAR) for the management of a pneumothorax during the period from 2020 to 2022. During our study, 15 patients were hospitalized for pneumothorax, with an average annual incidence of 7.5 cases per year. The sex ratio (H/F) was 2.03. The average age was 3.7 years. Chest pain was present in 27% of patients, dyspnea was found in 93%, and cough in 87% of patients. All patients underwent chest radiography and the location of the pneumothorax was predominant on the right in 60% of cases. Thoracic drainage was performed in 93.3% of patients associated with etiological treatment. The average length of hospitalization was 27.8 days with a cure rate of 86.7% and a recurrence rate of 13.3%.
文摘Objectives: To describe thoracic endovascular aortic repair (TEVAR) outcomes at the Royal Brisbane and Women’s Hospital between 2001-2010. Design: Prospective cohort study. Results: We successfully treated 95 of 97 patients for a 98% procedural success rate. Of the treated patients, 68 (72%) were males and mean age was 61 ± 17 years. Average follow up was 3.6 ± 2.0 years. Pathologies treated were: dissection (n = 35), aneurysmal disease (n = 32), traumatic disease (n = 19), coarctation (n = 5) and miscellaneous (n = 4). There was one peri-procedural myocardial infarction. Renal complications occurred in 7 patients (3 with doubling creatinine and 4 requiring temporary renal replacement therapy). Stroke occurred in 2 patients and paresis in 2 patients (permanent in one). Six patients died during index hospitalization and 17 deaths occurred during follow-up, 2 of which were confirmed secondary to aortic pathology. Age (HR 1.08 per year, p < 0.01) and ASA class (HR 2.2 per class, p = 0.02) were independently associated with mortality. There were 25 re-interventions in 22 patients. Eighteen of these re-interventions in 16 patients were related to the management of complications of TEVAR of which 13 were for endoleaks;eight type I, four type II, one type III. Conclusion: TEVAR can be used to treat thoracic aortic pathology but questions remain regarding long-term durability.
文摘Pulmonary arterial hypertension PAH is a progressive disease characterized by an increase in pulmonary arterial pressure and resistance. It often complicates congenital heart disease with a left-to-right shunt. The objective of this study is to evaluate the evolutionary profile of the pulmonary pressures of children with congenital heart disease with left-to-right shunt and to identify the factors favoring an evolution towards PAH. This is a retrospective, descriptive and analytical study over a period of four years and six months (from January 1, 2016 to June 30, 2020) at the Center National d’Enfant Albert Royer in Dakar on a series of 87 cases. The hospital frequency was 3.98 per thousand, and the incidence of PAH was 9.44%. The sex ratio of 0.74. The average age was 44.76 months. The average time between the onset of symptoms and the diagnosis of heart disease is 78.81 days. Dyspnea was found in 70.11% of cases, the burst of pulmonary B2 was found in 55%. Global heart failure was noted in 39.08% of cases. Cardiomegaly was found in 89.66% and pulmonary hypervascularization was found in 57.72% of cases. CIV was present in 54.02% of cases, followed by PCA in 21.14% and CAVc in 18.39% of cases. furosemide was used in 97.70% of cases and Captopril in 74.71% of cases. Sildenafil was used in 10.34% of patients, and 12.64% of patients benefited from surgical management. Eisenmenger syndrome was found in 12.64% of patients. PAH in these heart diseases is a formidable and frequent complication, due to an increase in precapillary flow. The major improvement in mortality and morbidity is early surgical management, in the first months of life, to prevent pulmonary vascular disease.
文摘Objective To investigate the prevalence of nutritional risk, undernutrition, overweight/obesity, and the application of nutritional support among geriatrics so as to provide evidence for whether elderly inpatients with undernutrition and nutritional risk should receive timely nutritional support. Methods A total of 445 elderly inpatients in the Department of Geriatrics of Peking University People’s Hospital were consecutively enrolled from July 2010 to June 2011. The Nutritional Risk Screening 2002 (NRS 2002) questionnaire was used on the second day after admission. The application of nutritional support was investigated on the 14th day or the discharge day. The relationship between the nutritional risk and nutritional support was analyzed. A NRS 2002 score ≥ 3 was defined as nutritional risk. A body mass index (BMI)< 18.5 kg/m2 was defined as malnutrition, 24.0 kg/m2 ≤ BMI < 28.0 kg/m2 as overweight, and a BMI ≥ 28.0 kg/m2 as obese. Results A total of 445 patients were enrolled and 423 patients (95.1%) completed the NRS 2002. The prevalence of undernutrition and nutritional risk was 4.7% and 13.2%, respectively. Among 230 patients who were overweight/obese, the prevalence of nutritional risk was 6.1%. In total, 15 of the 56 patients (26.8%) with NRS 2002 scores ≥ 3 received nutritional support, and 14 patients (3.8%) with NRS 2002 scores < 3 also received nutritional support. The average PN: EN ratio was 1.6:1. Conclusion A certain proportion of elderly inpatients in the department of geriatrics were experiencing undernutrition or were at nutritional risk. The prevalence of nutritional risk did not increase significantly with age. The current application of nutritional therapy is inappropriate. Evidence-based guidelines are required to improve this situation. The NRS 2002 may not applicable for overweight/obese elderly inpatients.
文摘Objective:This study aimed to describe the conflict management styles and identify factors affecting the conflict management styles of nurse managers.Materials and Methods:A cross-sectional study was conducted by interviewing nurse managers with a questionnaire,including the Rahim Organizational Conflict Inventory-II Form B,used to assess an individual’s approach to conflict management across five styles:cooperating,competing,compromising,obliging,and avoiding.Results:A total of 30 nurse managers participated in this study.The mean scores of the cooperating style were the highest at 4.3±0.4,followed by a compromising style at 3.4±0.5,an avoiding style at 3.1±0.6,an accommodating style at 2.9±0.7,and a competing style at 2.8±0.8(χ^(2)=66.624,P<0.001).The mean scores for avoiding style among bachelor’s degree nurse managers(3.2±0.6)were higher than those of master’s degree nurse managers(2.7±0.6)(P=0.036).Nurse managers over 40 years old,holding a managerial position for≥10 years,and frequent conflict handling rated higher mean scores for the cooperating style than their counterparts(P<0.05).Conclusion:The cooperating style was the most commonly used conflict management style among nurse managers.Factors affecting the conflict management style were age,education level,and experience in management and conflict handling.These findings are useful for developing interventions that enhance the competencies of nurse managers in conflict management.
文摘Objective: to analyze the causes of critical drug dispensing errors in the drug dispensing process of outpatient and Emergency Pharmacy in our hospital and evaluate the improvement effect of departments to prevent critical errors. Methods: the causes of drug critical error events in our hospital from January 2019 to January 2021 were reviewed and analyzed. The causes of critical errors were retrospectively evaluated and analyzed. Results: among the 88 cases of critical errors in our hospital, there were 15 cases of dosage form errors, 12 cases of dispensing errors caused by similar packaging, 8 cases of pharmacist’s medication explanation errors, 20 cases of improper compatibility of Chinese and Western drugs, 23 cases of multi-standard dispensing errors of one product and 10 cases of other types of errors. After reviewing the statistical analysis, it was found that the multi regulatory critical error rate of one product was the highest, the improper combination of Chinese and Western medicine was the second, the dosage form was confused, and the dispensing error was in the middle. Critical errors include drug storage problems and drug placement, drug specifications, dosage form factors, external packaging factors, lack of professional quality of dispensing personnel, imperfect management system, nonstandard or wrong input of electronic prescription, careless pre audit of prescription, etc. [1] Conclusion: for the above critical drug errors, the departments summarize and analyze the causes, timely formulate relevant critical drug error management systems, strengthen the training of department personnel, strengthen the level of professional knowledge, take double dispensing and review (24-hour duty), and take the "4 / 3 / 5" dispensing and dispensing steps for dispensing prescriptions, which can significantly reduce the incidence of critical errors. Improve the level of drug management and ensure the service quality of drug distribution.
基金supported by National Natural Science Foundation of China(Grant No.82273489)National Key Research&Develop-ment Program of China(Grant No.2022YFC2406000)+1 种基金Shanghai Municipal Key Clinical Specialty(Grant No.shslczdzk06701)the Biomaterials and Regenerative Medicine Institute Cooperative Research Project,Shanghai Jiao Tong University School of Medicine(Grant No.2022LHA01).
文摘3D-printing technology,a leading example of advanced additive manufacturing,has revolutionized the treatment of clinical orthopedic diseases,ushering in a new era of personalized medicine.Since the 1980s,the orthopedic team led by Prof.Kerong Dai at Shanghai Ninth People’s Hospital,affiliated with Shanghai Jiao Tong University School of Medicine,has effectively advanced the research,development,and implementation of customized artificial joints through medical collaboration.This work laid the foundation for the application of domestic 3D-printing in orthopedics.Continuous innovations-from fundamental research to clinical practice,from metal prosthesis implantation to customized bioactive bone product replacement,and from the traditional standardized diagnostic and treatment paradigm to the transformation of personalized medical models-underscore the pivotal role of 3D-printing technology.It has promoted personalized medicine,enhanced surgical precision,minimized the risk of infection,and accelerated bone integration.Prof.Yongqiang Hao’s group has further expanded and deepened the application of three-dimensional printing technology in orthopedics.Significant breakthroughs have been achieved in domestic bioactive metals,metal orthopedic implants,and 3D-printed biological implants.The protocols for personalized internal fixation and novel pelvic reconstruction prostheses are now internationally recognized in clinical practice.This study provides a comprehensive overview of the innovative research and applications of personalized and customized 3D-printed orthopedic implants.
基金supported by the National Natural Science Foundation of China,Nos.32271043(to ZW)and 82171047(to YM)the both Science and Technology Major Project of Shanghai,No.2018SHZDZX01 and ZJLabShanghai Center for Brain Science and Brain-Inspired Technology(to ZW)。
文摘Downregulation of the inwardly rectifying potassium channel Kir4.1 is a key step for inducing retinal Müller cell activation and interaction with other glial cells,which is involved in retinal ganglion cell apoptosis in glaucoma.Modulation of Kir4.1 expression in Müller cells may therefore be a potential strategy for attenuating retinal ganglion cell damage in glaucoma.In this study,we identified seven predicted phosphorylation sites in Kir4.1 and constructed lentiviral expression systems expressing Kir4.1 mutated at each site to prevent phosphorylation.Following this,we treated Müller glial cells in vitro and in vivo with the m Glu R I agonist DHPG to induce Kir4.1 or Kir4.1 Tyr^(9)Asp overexpression.We found that both Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression inhibited activation of Müller glial cells.Subsequently,we established a rat model of chronic ocular hypertension by injecting microbeads into the anterior chamber and overexpressed Kir4.1 or Kir4.1 Tyr^(9)Asp in the eye,and observed similar results in Müller cells in vivo as those seen in vitro.Both Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression inhibited Müller cell activation,regulated the balance of Bax/Bcl-2,and reduced the m RNA and protein levels of pro-inflammatory factors,including interleukin-1βand tumor necrosis factor-α.Furthermore,we investigated the regulatory effects of Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression on the release of pro-inflammatory factors in a co-culture system of Müller glial cells and microglia.In this co-culture system,we observed elevated adenosine triphosphate concentrations in activated Müller cells,increased levels of translocator protein(a marker of microglial activation),and elevated interleukin-1βm RNA and protein levels in microglia induced by activated Müller cells.These changes could be reversed by Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression in Müller cells.Kir4.1 overexpression,but not Kir4.1 Tyr^(9)Asp overexpression,reduced the number of proliferative and migratory microglia induced by activated Müller cells.Collectively,these results suggest that the tyrosine residue at position nine in Kir4.1 may serve as a functional modulation site in the retina in an experimental model of glaucoma.Kir4.1 and Kir4.1 Tyr^(9)Asp overexpression attenuated Müller cell activation,reduced ATP/P2X receptor–mediated interactions between glial cells,inhibited microglial activation,and decreased the synthesis and release of pro-inflammatory factors,consequently ameliorating retinal ganglion cell apoptosis in glaucoma.
文摘Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.
基金2024 Annual Medical Science Research Project of Hebei Province,Research on the Rehabilitation Effect of Joint Exercise Intervention Based on Hospital-Community-Family Model for Elderly Patients with Chronic Diseases(Project No.:20240083)。
文摘Objective:To explore the application effect of the hospital-community-family model-based combined rehabilitation exercise intervention on middle-aged and elderly patients with chronic kidney disease.Methods:Using the convenience sampling method,80 patients in the stable stage of CKD who were treated in the nephrology department of a tertiary hospital from May 2022 to June 2023 were selected as the research subjects.They were divided into the experimental group(40 cases)and the control group(40 cases)by random number table method.The control group received conventional exercise intervention plus telephone follow-up,while the experimental group received combined hospital-community-family modelbased exercise intervention in addition to the control group,using remote medical guidance and monitoring of the application effect of exercise rehabilitation on middle-aged and elderly patients with chronic kidney disease.The glomerular filtration rate,6-minute walking distance,fatigue and social support scores of the two groups of patients were measured before the intervention,4 weeks after the intervention,and 12 weeks after the intervention.Results:Before the intervention,there were no statistically significant differences in glomerular filtration rate,6-minute walking distance,fatigue and social support scores between the two groups(p>0.05).After 12 weeks of intervention,the glomerular filtration rate,6-minute walking distance and social support scores of the experimental group were higher than those of the control group;the differences were statistically significant(p<0.05).The behavioral,emotional,sensory and cognitive scores of the Piper-Fatigue Revised Scale of the experimental group were lower than those of the control group,and the differences were statistically significant(p<0.05).Conclusion:Based on the hospital-community-family model combined rehabilitation exercise,using remote medical guidance for the continuous care of middle-aged and elderly patients in the stable stage of chronic kidney disease can effectively improve the exercise endurance and social support level of patients,improve the fatigue condition,and the implementation effect is positively correlated with the intervention time.
