Objective To explore the operation code of main diagnosis and treatment methods of lung cancer.Methods The main diagnostic operations in the field of lung cancer mainly include transbronchial needle aspiration biopsy, transbron chial lung biopsy, transbronchoscope pollution protection brush technology and bronchoalveolar lavage, etc.; while the therapeutic operations mainly include high frequency electric cauterization technology, cryoablation, endotracheal stent implantation, radiofrequency ablation of lung cancer and radioactive particle implantation through bronchoscope, etc. In this paper, we analyzed the clinical knowledge of the aforementioned diagnosis and treatment operations, and then sorted out and summarized the corresponding codes based on the classification principles of ICD-9-CM-3.Results Different diagnosis and treatment methods, operation sites and approaches led to different operation classification codes.Conclusion In order to accurately code and fully express medical record information, coders need to fully understand the latest clinical technologies, master the principles of surgical classification, and review the medical records carefully.

 

Objective To develop a simple random sampling method suitable for researchers at all levels.Methods By using the inherent functions of rank (), rand (), vlookup () and if () of Excel and WPS softwares, the simple random sampling method is designed and the reusable sampling tool is customized.Results The simple random sampling method based on the function design of Excel or WPS can realize the simple random sampling of millions of research population in a few seconds. At the same time, it has the characteristics of simple design and use, short development time and reusability.Conclusion Compared with the sampling tool of Excel, which is only applicable to the data of digital population, the simple random sampling method based on the function design of Excel or WPS can not only realize the sampling of all character types, but also does not need to install add-on items, which is more suitable for health personnel at all levels.

The implementation of the “14th FiveYear Plan” national medical security plan has accelerated the pace of perfecting the multi-tiered medical security system, continuously improved the medical insurance payment mechanism, and announced the implementation of the DRG/DIP payment mode reform three-year action plan in order to improve the quality, reduce the cost and increase the efficiency of the medical insurance funds. Medical insurance payment policy is closely related to performance management of hospitals. Therefore, this paper analyzes the impact of DRG/DIP payment reform on performance management of public hospitals from the perspective of performance management. And from the five aspects of cost accounting and analysis, talent construction, performance evaluation system construction, information construction and culture construction, it explores the performance management path of public hospitals under the background of DRG/DIP payment, and puts forward targeted suggestions for the performance managemet of public hospitals, in order to inject momentum into the high-quality development of public hospitals.

Objective To learn about the pension willingness and factors affecting the choice of home care willingness of the elderly population, and to provide the evidence for improving life status of the elderly population, better providing full cycle services, and promoting healthy aging. Methods Data of the Sixth National Health Service Statistical Survey were used to analyze the nursing situation and pension willingness of the elderly population in different regions, different family conditions, different social demographic characteristics and different disability status, and logistic regression was used to analyze the influencing factors of the elderly population′s choice of homebased care. Results Eleven point eight percent of the elderly needed to be taken care of for their daily life, and daily care was provided 52.5% by spouses and 42.9% by children. And 90.7% of the elderly were inclined to home-based care, urban and rural areas, sex, age, marital status, educational level, family economic status, disability degree, the number of chronic diseases, family size were all influencing factors of elderly pension willingness. The probability of wanting home care was lower in urban areas than in rural areas (OR=0.625,  95%CI: 0.589-0.663); it was higher for men than for wornen(OR=1.122,95%CI:1.062-1.187); and it was higher for 70-79 years old (OR=1.219, 95%CI:1.147-1.296) and 80 years old and above (OR=1.598, 95%CI: 1.433-1.782) than for 60-69 years old; it was lower for unmarried (OR=0.476) and divorce (OR=0.600) than for married; it was lower for the elderly with educational levels of primary school (OR=0.742), junior middle school (OR=0.437), and senior high school or above（OR=0.352）than for those without literacy (P<0.01); it was higher for elderly people not living alone than for those living alone (P<0.01).  Conclusion The elderly with older age, lower educational level, poor family economic status and large family size are more likely to hope for care at home.Combined with the elderly′s pension willingness, in view of the health status, nursing and care needs, it is necessary to establish and improve a service system based on family care, to explore the design of long-term care system, and to protect the health rights and interests of the elderly.

Since 2019, tertiary public hospitals across the country have carried out performance appraisal. Under the new situation of medical reform, how to improve the quality management level is a challenge to the hospital. This paper makes a comprehensive analysis on the relationship between performance appraisal and quality management of tertiary public hospitals and its impact on quality management. And it discusses the strategies to improve the performance assessment of tertiary public hospitals through continuous improvement and prospective management by taking the performance assessment policy of tertiary public hospitals as the work guide, perfecting the quality management system, establishing the quality management database, realizing information management, playing the role of quality control, and improving the hospital performance assessment results through continuous improvement and prospective management.

Objective To explore the relationship between sleep quality and well-being in the elderly and the intermediary effect of state-anxiety between them. Methods One hundred and fifty-five elderly patients with insomnia in the department of psychosomatic medicine of the First Affiliated Hospital of Nanchang University from September 2018 to May 2019 were investigated with Pittsburgh sleeping quality index (PSQI), state-trait anxiety questionnaire (STAI) and memorial university of Newfoundland scale of happiness (MUNSH). Results The STAI score of female patients was higher than that of male patients, and the MUNSH score of patients living alone was lower than that of non-living alone patients (P<0.05). Sleep quality index score was negatively correlated with well-being (r=-0.557, P<0.05), state-trait anxiety was negatively correlated with well-being (r=-0.634, P<0.05), and state-trait anxiety was positively correlated with sleep quality index score (r=0.510, P<0.05). Structural equation model showed that sleep quality had a negative effect on happiness (β=-0.28, P<0.05) and a positive effect on state-trait anxiety (β=0.70, P<0.05), and state-trait anxiety had a negative effect on well-being (β=-0.64, P<0.05). Conclusion State-trait anxiety plays an intermediary role in elderly patients with insomnia. Sleep quality not only directly affects happiness, but also affects the happiness of elderly patients with insomnia through state-trait anxiety.

Objective To provide a fast and rich visualized-template analysis method for the hospital statisticians. Methods The hospital performance data from January 1, 2017 to June 30, 2018 were extracted. After data import, data type conversion, data relationship, and data modeling method, using the builtin visualization template, combined with the actual demand and display effect, the study constructed a series of delicate visualized reports from the overall technical difficulty of medical services, medical efficiency, medical safety, and key specialist capabilities. Results The study produced several reports such as an overview of clinical department data indicators, RW distribution of clinical department, clinical department surgery, and detailed query of clinical department medical records. These reports have the characteristics of high degree of visualization, rich chart, convenient and quick customization. Conclusion Power BI has the characteristics of not relying on IT department, low threshold and a high degree of customization, rich visual template and easy function to understand, and can be used as the preferred tool for hospital statisticians to analyze hospital performance data.

Objective  To explore the drug treatment compliance and its correlated influencing factors of type 2 diabetes mellitus (T2DM), and provided intervention strategy for it.Methods Totally 220 cases with T2DM were investigated with following-up, and theses patients were divided into the good compliance group and the poor compliance group according to the compliance of treatment. The correlated risk factors were screened by multiple factors non-conditional logistic regression method.ResultsThe poor compliance rate of T2DM patients in this study was 37.3% (82/220). Multiple factors analysis result indicated that the factors of high age (OR=2.537，95%CI：1.118～5.417), bad relationship between doctors and patients (OR=3.387，95%CI：1.777～6.455), lack of knowledge of diabetes (OR=3.428，95%CI：1.897～6.196), adverse drug reaction (OR=3.869，95%CI：2.157～6.938), many kinds of drugs (OR=3.209，95%CI：1.741～5.915) and complications (OR=5.523，95%CI：2.760～11.055).Conclusion There is a bad drug compliance of treatment of T2 DM patients. We should enhance health education, followingup and management of the elderly patients, and medication instruction after leaving hospital, and we should also correctly cope with doctorpatient relationship, in order to raise treatment compliance of patients.

Objective To analyze the defective problems existing in the data filling in the front page of medical records of the high rate cases whose cost were more than twice the average cost based on DRGs payment in a hospital, and to put forward improvement measures.Methods The hospital received the high rate cases which were grouped by DRGs and settled expenses between January, 2018 and June, 2018 from the Social Security Bureau's feedback. Combined with DRGs payment mode, under the guidance of the diagnosis operation selection standard announced by the Health Development Planning Commission and the Principles of International Classification of Diseases, selfcheck and retrospective analysis were conducted, and the defects were classified and counted with 6 cases of high rate paying.Results Totally 111 of 526 high rate cases had defect problems related to clinicians and coders, with defective rate 21.11%, and among them, 47, 20, 12 and 29 cases were clinicians' main diagnostic error selection, main operation error selection , main diagnosis and operation error selection, and missing of diagnosis or operation, respectively. The percentage of errors was 42.34%, 18.02%, 10.81% and 26.13% respectively. The coders' main diagnosis coding error and main surgical coding error were 2 and 1 cases respectively, with error rate 1.8% and 0.9% respectively.Conclusion The high rate paying cases caused by the defects of the filling diagnosis and operation and the coding defects on the front page of medical records were closely related to the quality of filling by clinicians and the coding level of coders. Effective measures are to train clinicians to correctly select diagnosis and operation, improve coders' professional skills, and optimize coders' work, so as to reduce high rate cases caused by defective problems.

Data analysis and data visualization has been widely used in various industries. This article introduces the main content of IBCS, Material Design data  visualization design specifications and AntV data visualization specifications, and discusses the key elements of data visualization specifications.

Objective To implement the procedure of distributed lag non-linear model (DLNM) and multivariate meta-analysis in R software.Methods A specific step of two-stage analysis of DLNM and multivariate meta-analysis was carried out in R software through a time series data.Results The two-stage analysis of DLNM and multivariate meta-analysis was successfully implemented in R software.Conclusion R software can be used to construct DLNM and conduct multivariate meta-analysis flexibly and conveniently, and the method can be widely used in environmental epidemiology.

目的 研究影响医院业务收入的因素,为医院管理决策提供依据。 方法用因素分析法对医院门诊和住院业务收入作相关因素分析。 结果业务收入受就诊人次数、出院病人数及相应次均费用和住院天数的影响。 结论医院应着力提高医疗技术、提供优质服务、扩大服务范围、减轻患者负担,实现“优质、低耗、高效”的开源节流型、质量效益型的现代化医院。

目的 探讨多组等级资料的秩和检验及组间两两比较的SAS实现。方法 结合实例介绍多组等级资料Kruskal-Wallis H检验和两两比较Nemenyi检验的计算方法和步骤,通过编制SAS程序一次性完成Kruskal-Wallis H检验和Nemenyi检验。结果 运行SAS程序得到可靠结果。结论编制SAS程序可以有效实现多组等级资料的秩和检验及组间两两比较。

Objective To determine the annual priority improvement indexes of hospitals' quality and safety with delphi method and analytic hierarchy process.Methods Delphi method is used to establish the annual index system for optimization, and AHP is used to establish evaluation index system and check consistency of the judgment matrix.Results Nine hospitals′ annual improvement priority indexes are selectedand consistency check results are good.Conclusion Using Delphi method and AHP to determine the hospitals′ improved indicators is quite scientific and feasible. These two methods are effective tools for hospital management.

Objective To improve the ability of traditional Chinese medicine(TCM) medical service by retrospectively describing and analyzing the clinical diagnosis and treatment characteristics of discharged patients treated mainly by  TCM in a hospital.Methods Discharged patients were divided into the TCM dominant group and the non-TCM dominant group for analysis and comparison, according to the requirement of national performance assessment indicators.Results The differences in population distribution and cost between the two groups were statistically significant (P＜0.05); the number of discharged patients and the proportion of TCM dominant patients were higher for diseases such as posterior circulation ischemia, malignant tumor support treatment and lumbar intervertebral disc herniation; the proportion of DRG group diseases was high, such as alzheimer′s disease or other chronic brain function lesions, coronary atherosclerosis without complications and concomitant diseases.Conclusion Discharged patients treated mainly by TCM had a significant cost advantage, but the average hospitalization days were longer; the diseases with high proportion and high number of TCM dominant discharged patients can be candidate diseases of TCM superiority. It is necessary to actively explore the DRG management scheme in accordance with the characteristics of TCM therapy.

目的 探讨协同护理管理中应用同伴支持对心内科患者自我管理能力的影响。 方法根据是否有亲友被招募为同伴,选取2013年5月~2015年6月入住我院心内科患者60例作为支持组,并选取同期入住患者62例作为管理组,管理组患者实施协同护理管理,支持组患者在协同护理管理的基础上加入同伴支持,调查比较两组患者管理前及管理6个月后的自我管理能力评分、生活质量评分及对护理工作的满意度情况。 结果管理前,两组患者自我管理能力各项指标评分、生活质量各项指标评分差异均无统计学意义(P>0.05)。管理6个月后,两组患者上述各项指标均高于管理前。组间比较,管理后支持组自我管理能力各项指标评分、生活质量各项指标评分均高于管理组,且两组管理前后自我管理能力各项指标评分、生活质量各项指标评分差值对比,差异具有统计学意义(P<0.05)。两组护理满意度比较差异无统计学意义(P>0.05)。 结论协同护理管理可提高心内科患者的管理效果,在此基础上加入同伴支持可进一步提高心内科患者自我管理能力、生活质量,值得临床推广。

Objective To investigate the psychological health status of parents of autistic children, and to explore the influence factors of psychological health of parents of autistic children and the relationship among different factors. Methods Questionnaire survey on the parents of autistic children treated at Zao Zhuang mental health center was conducted, using the psychological test scales (Simplified Mental State Rating Scale Kessler 10 Chinese Version, Simple Coping Style Questionnaire, and Social Support Scale by Xiao Shuiyuan) with high reliability and validity. Results ①The only child, the way of payment, the child′s age, and the illness time had a statistical significance in the mental health of parents of children with autism. ②The time of illness and family month income had a definite effect on social support of parents of autistic children. ③There was a significant negative correlation between social support and mental health of the parents of autistic children, and there was a significant positive correlation between coping inclination and mental health. ④Support had mediating effects on coping style and mental health. Conclusion The mental health of parents of children with autism is affected by many factors, and social support had mediating effect on mental health and coping style.

Objective To investigate the related factors affecting the occurrence of acute illness during root canal treatment. Methods Totally 500 patients who underwent root canal therapy in our hospital from January to January 2019 were enrolled. According to the patients′ EIAE condition, Univariate analysis and multivariate logistic regression analysis were used to analyze differences in age, gender, tooth position, sinus tract, total flushing dose, disinfecting drug, root filling method, and root filling and the influencing factors inducing the occurrence of acute illness during root canal treatment. Results EIAE occurred in 168 of the 500 patients, with an incidence of 33.6%. Univariate analysis found that EIAE patients had differences in sinus tract, total flushing dose, root filling method, and root filling (P<0.05), compared with non-EIAE patients. There was no difference in age, gender, tooth position and disinfection drug (P>0.05). Multivariate logistic regression analysis showed that the risk factors of EIAE were: no sinus tract, 2 mL of total drug washing and below, multiple root filling and overcharging. And the goodness of fit of this model indicated an outstanding fitting (AUC=0.917).Conclusion Thoroughly cleaning the root canal, improving the filling quality, and improving the disposable root canal treatment method can reduce the occurrence of EIAE.

Objective Based on C# language and R language, a software is developed, which is convenient for clinicians to use. It is used to realize the automation of variance analysis of repeated measurement design data. Methods First, the statistical analysis data are imported into the software by C# language, then the R language command script is invoked to complete the ANOVA and the result output of the repeated measurement design data. Finally, the example in the 5th edition of medical statistics published in 2020 is used, combined with the example results and SPSS operation results, to verify the effect of the automation of the software. Results The results of statistical analysis included basic statistical description, repeated measurement ANOVA and result chart of pairwise comparison within the group. Based on the combination of C# language and R language, the running results of the statistical software are completely consistent with the results of manual calculation and analysis of teaching materials and SPSS operation. The operation is simple and the results are intuitive, which greatly surpasses the repeated operation of manual analysis and SPSS menu selection in efficiency; at the same time, the low-level errors in manual analysis and SPSS operation steps are avoided to the greatest extent, and the results are presented automatically, which reduces the errors in judgment and selection of results, and ensures the accuracy and standardization of results. Conclusion The software can automatically realize the single factor, two factor and two / multi-level ANOVA of repeated measurement design data, which is worthy of clinical application.

Objective To introduce the basic principle of 10-fold cross-validation, and use R to show the application of 10-fold cross-validation in the evaluation of the generalization ability of prediction models in an example. Methods The logistic regression model was used with 10-fold cross-validation as the evaluation method to predict the treatment outcome of drug-resistant tuberculosis patients. At the same time, the 5-fold, 10-fold, and leave-one-out cross-validation were used to compare the parameters of evaluation. Results Different divisions of training and test sets have influence on the parameters of evaluation. Compared with other cross-validation methods, the parameters of evaluation from 10-fold cross-validation have a higher stability and efficiency than other numbers of fold. Conclusion In the evaluation of the application effects of machine learning models, the comprehensive performance of 10-fold cross-validation is prominent and the generalization ability of different models can be objectively measured.

Objective To analyze the characteristics, influencing factors and potential risks of adverse drug reactions (ADR) in a tertiary psychiatric hospital, so as to provide reference for clinical prevention and disposal of adverse drug reactions of psychotropic drugs.Methods A retrospective analysis was conducted on 265 ADR case reports due to the use of psychotropic drugs reported by a psychiatric hospital from October 2019 to October 2021.Results Among the 265 reported cases with ADR, 88 were males and 177 were females, with a higher incidence among females. The average age of the patients was (42.23±17.54) years old, with the majority being young and middle-aged. Forty drugs were involved in ADRs reports, of which the number of adverse reaction reports of antipsychotics was the largest, accounting for 66.42%, followed by antidepressants, accounting for 20.38%. The top three drugs in the cumulative number of reported ADR cases were Olanzapine, Quetiapine and Risperidone respectively. The system most affected by ADRs was the digestive system, with 105 cases reported, accounting for 37.23%, followed by the nervous system, with 88 cases reported, accounting for 31.21%.Conclusion The forms of adverse reactions caused by psychiatric drugs are various, and it is difficult to identify them. Clinicians should strengthen the monitoring of the use of psychiatric drugs and use the psychiatric drugs reasonably to ensure the medication safety.

Objective To reconstruct the infant mortality rate from the liberation to the late 1970s in China. Methods According to the time sequence, based on the adjusted infant mortality rate of 1981-1990s and national monitored area infant mortality rate of 1991-2010s, we brought in infant mortality rate of 1949-1980s to establish the relative time series for curve fitting. We preliminary screened the multiple prediction models of infant mortality of 1949-2010s, then secondary screened better dynamic model by using the curve fitting of variance analysis, and at last, we found the best prediction model according to the curve fitting accuracy index, for further retrospective prediction of the infant mortality of 1949-1980. Results Eleven dynamic models of infant mortality rate in China were selected, then we screened out the poor fit models. We found out the exponential form, compound functional, growth functional and logistic curve model, were consistent with the predicted results and the standard error of the estimated value was smallest. They were determined the best prediction model. By prediction the infant mortality rate of 1951, 1956, 1961, 1966, 1971, 1976, and 1980 were 170.5‰,140.7‰, 183.0‰, 95.8‰, 79.1‰, 65.2‰, and 55.9‰ respectively. Conclusion Reconstructed infant mortality rate could not replace the actual level, but more close to the actual level.

目的 对病案整理装订过程中存在的问题进行研究,探讨其改善措施。 方法以我院病案整理装订的现状为例,对遇到的问题及困难逐一分析,根据不同现象做出相应的有效措施。 结果通过一系列有效的措施及方法,病案的整理变得有进有序,病案的装订也更加规范化,错误率明显减少,工作效率大幅提高。 结论对于繁琐的病案整理装订工作,一定要细心严谨,加强培训,完善制度,优化管理。

目的 分析医院门诊患者分布特点以及就医行为特征,为医院管理提供参考。 方法 采用随机抽样的方法对医院门诊患者进行问卷调查,运用K中心聚类法对调查结果进行聚类分析。 结果 患者选择就诊医院主要关注的是医疗水平、知名专家/专科、医疗设备这些反映医院技术实力的3个因素;患者选择就诊医生主要关注的是专业特长、服务态度这2个因素;患者获取医院信息的渠道主要是互联网、微信、电视、院内宣传栏这4个渠道;患者希望医院进一步改善的项目主要是降低收费、提高医疗水平和改善服务态度。 结论 持续提高医院医疗技术水平,重视医生专业特长培养,加强多渠道信息宣传,进一步改善医院薄弱项目,最终提高医院竞争力。

Objective To develop a SAS macro program to sort data about time stratified case-crossover design.Methods An example of data sorting about child's pneumonia incidence, temperature, PM10 and SO2 was used to design and verify the SAS macro program named time stratified (IN_DSN=, OUT_DSN=, DATE_VAR=, LAG_EFFECT=, LAG_VARS=, COUNTS_VAR=).Results Parameters including input data set, output data set, date variable, lag effect, lag effect related variables and frequency variable can be specified respectively in the SAS macro program, and then SAS will sort the data automatically and output the time stratified casecrossover design data set.Conclusion The application of SAS macro program time stratified is simple, convenient, flexible and efficient. It can avoid errors in data sorting process of time stratified casecrossover design and has certain practicality.

Objective  To analyze the dynamic change law of outpatient volume through statistics, and provide reference for hospital decision-making and medical resource allocation.Methods The outpatient volume of a large-scale tertiary general hospital in a certain area from 2013 to 2021 was collected, and the monthly and quarterly outpatient volume were dynamically analyzed by seasonal index.Results The number of outpatients increased year by year. The monthly seasonal index was the highest in December, reaching 115.91%, and the lowest in February, reaching 78.40%. The quarterly seasonal index was the highest in the fourth quarter, reaching 104.99%, and the lowest in the first quarter, reaching 93.53%.Conclusion There are obvious periodicity and regularity in the change of outpatient visits with months and seasons. Hospitals should optimize the allocation of health resources and improve the efficiency of medical services according to the change of outpatient visits.

Objective It is hoped that the risk of 10-year cardiovascular diseases can be calculated quickly by compiling SAS macro program, so as to identify high-risk groups of cardiovascular diseases.Methods The cardiovascular risk was calculated by runningthe macro program on Framingham, UKPDS and ASCVD risk scores using the data of the China Health and Retirement Longitudinal Study.Results Running the SAS macro program to analyze the partial data of the China Health and Retirement Longitudinal Studyin2011,and the Framingham, UKPDS and ASCVD risk predictions of the sample population were 9.5%(95%CI:8.4%～10.6%),7.1%(95%CI:6.3%～7.8%) and 16.4% (95%CI:15.1%～17.7%).Conclusion The SAS macro program we compiled can effectively calculate the prediction of cardiovascular disease risk by Framingham, UKPDS and ASCVD risk scores in large sample population.

Objective To study the compliance of phosphorus control diet and its correlation with disease perception in elderly maintenance hemodialysis patients, and provide guidance for clinical intervention.Methods Elderly patients with end-stage renal disease who received maintenance hemodialysis in a hospital from November 2019 to march 2022 were selected as study objects. The Maintenance Hemodialysis-Related Dietary Compliance Scale and the Brief Illness Perception Questionnaire (BIPQ) in patients with endstage renal disease were used to analyze the patients′ compliance with phosphorus control diet and disease perception status. The Pearson correlation analysis method was used to analyze the correlation between phosphorus control diet compliance and disease perception in maintenance hemodialysis patients.Results The total score of dietary compliance with phosphorus control in 284 elderly patients with end-stage renal disease who underwent maintenance hemodialysis was (48.45±2.16) points, of which 71 cases (25.00%) had high compliance with phosphorus control diet, 111 cases (39.08%) had moderate compliance, and 102 cases (35.92%) had low compliance. The total score of disease perception BIPQ scale of elderly patients on maintenance hemodialysis was（47.49±14.64）points; the Pearson correlation analysis showed that the adherence to phosphorus control diet was significantly negatively correlated with disease perception in elderly patients on maintenance hemodialysis (r=-0.879, P＜0.001).Conclusion The overall compliance of phosphorus control diet in elderly patients on maintenance hemodialysis is at a moderate level, and the compliance of phosphorus control diet is negatively correlated with disease perception.

This article analyzes and elaborates on the connotation of elderly health, the narrow and broad content of elderly health services, as well as safeguard measures. Meanwhile, it combines with long-term practical experience and practice to establish and improve the elderly health service system with a large amount of data and examples. The framework of this system is to establish a comprehensive and continuous elderly health service system covering urban and rural areas, which is based on the "chain-type" medical services and supported by "all-round" health services.

Objective To evaluate the bed efficiency index after correction of each month and each department of a tertiary hospital in 2018, to analyze the reasons for its high efficiency or low efficiency operation, and analyze the influencing factors of the adjusted bed efficiency index, so as to provide reference for the rational allocation of beds in the hospital. Methods The "normalization method" was adopted to calculate the bed efficiency index of each month and each department of a tertiary hospital in 2018, and the CD rate was used for correction.Multiple linear regression method was used to analyze the influencing factors of bed efficiency index after correction. Results For the beds efficiency index in every month, the highest was in July and the lowest was in February.Indexes in every month except that in February were all higher than 0.9.In the adjusted bed efficiency index of all departments, while some department beds were running with high efficiency, there were also some departments with vacant beds. The efficiency index of ICU was the highest (4.06). The linear regression analysis found that the higher the initial number of patients, the number of patients admitted, and the number of patients undergoing two or three types of incision surgery, the higher the emergency admission rate, the higher the bed efficiency index after correction, and the higher the bed efficiency. The more cases of grade 3 and 4 operations, the lower the bed efficiency index. Conclusion Reasonable allocation of hospital beds could be carried out efficiently through administrative intervention and the improvement of medical service mode, and through making use of affecting factors of bed efficiency index.

Objective To reveal the causal relationship between depression and interstitial lung disease (ILD) by using Mendelian randomization method, and to provide new ideas for the prevention, treatment and prognosis of ILD.Methods The genetic loci closely associated with depression were selected as instrumental variables using pooled data from the Genome-Wide Association Study (GWAS). The inverse variance weighting method was used as the primary analysis method, and the weighted median method and MR-Egger regression were used as auxiliary methods to perform two-sample Mendelian randomization analysis; OR values were used to evaluate the causal relationship between depression and ILD, and heterogeneity tests, gene multiplicity tests and sensitivity analyses were performed to assess the stability and reliability of the results.Results Thirty-seven single nucleotide polymorphism (SNP) loci were included as instrumental variables. MR-Egger regression estimated that the risk of lung cancer in patients with depression was 1.21 times that of healthy people (95%CI: 1.075-1.361, P=0.002). The weighted median method also supported a causal effect between depression and interstitial lung disease (95% CI: 1.118-1.564, P=0.001). The heterogeneity test results of the inverse variance-weighted method and MR-Egger regression showed that there was no heterogeneity; MR-Egger regression intercept term and MR-PRESSO method tests showed that the results were less likely to be affected by gene pleiotropism; no non-specific SNPs were found in leave-one-out analysis.Conclusion There may be a positive causal association between depression and ILD.

To analyze the strengths, weaknesses, opportunities and threats of the medical alliance of the provincial specialist hospital in Shandong province. This medical association has its advantages of location, specialty, post and prospect, and is subject to management system, medical insurance policy, the scientific level of hospital management, and many other restrictions. We should make full use of opportunities, deal with various challenges, do a good job of top-level design, information platform construction and personnel training and transportation, so as to gradually set up their own brand, move down high quality medical resources, and truly realize the rational allocation of health resources.

Objective There are more variant subtypes of thyroid papillary carcinoma, which cause difficult coding of thyroid papillary carcinoma and are prone to miscoding. According to the histological classification criteria of thyroid tumors and the ICD-O-3 principle, the coding characteristics of thyroid papillary carcinoma are analyzed to improve the coding accuracy rate. Methods  The hospital medical record information inquiry system was used to retrieve 417 cases of thyroid papillary cancer diagnosed from January 2016 to December 2018 in a hospital. The ICD-O-3 classification rule was used to analyze the morphological coding situation of thyroid papillary carcinoma in a hospital for nearly 3 years. The existing problems were summarized and analyzed. Results There were 159 coding errors and the error rate was 38.13%. Among them, 2 cases of NOS were misclassified in M8000/3 malignant tumor, accounting for 0.48%; 149 cases were misclassified in M8050/3 papillary carcinoma, accounting for 35.73%; the disease classifier was not familiar with the pathological variant subtype of papillary thyroid carcinoma. Pathological diagnosis had given specific subtypes, but was misclassified in M8260/3 papillary adenocarcinoma in 8 cases, accounting for 1.92%; missing morphological morphology was 1 case, accounting for 0.24%.Conclusion Disease classifiers are unfamiliar with the pathological features and variant subtypes of thyroid papillary carcinoma, lack the homepage quality control link, and the coding library is relatively lagging behind clinical development. These reasons are likely to cause coding errors, so disease classification personnel must carefully read the medical records and pathology reports, actively communicate with clinicians and patho logists, update relevant knowledge structures, and continuously improve the accuracy of thyroid papillary cancer coding.

SPSS软件是常用的统计分析重要工具。在SPSS软件中提供了Lilliefors检验、Shapiro-Wilk检验和Kolmogorov-Smirnov检验3种正态性检验方法。对于同一资料使用这3种正态性检验方法进行分析,其分析结果可能会有明显差别,这种分析结果的差别可能与许多因素有关,本文主要探讨了这3种正态性检验方法P值的差别分别与样本含量、变异系数、峰度系数和偏度系数的关系。结果表明这3种正态性检验方法P值的差别分别与样本含量、变异系数和峰度系数存在关联性。由于未见到偏态分布资料变异系数的计算方法,我们尝试提出了偏态分布资料变异系数计算的新方法,这有利于丰富和完善统计学的理论体系。由于关于如何正确选择这3种检验方法,许多SPSS专著的说法不一,容易产生困惑。明确提出了以样本含量2 000作为选择Shapiro-Wilk检验和Lilliefors检验的区分标准,便于实际应用。

Objective To explore the risk factors of nosocomial infections in patients with chronic renal failure (CRF) undergoing hemodialysis, in order to provide reference basis for reducing hospital infection rate. Methods Totally 142 hospitalized CRF patients undergoing hemodialysis were selected as research objects. Thirty-six cases were with hospital infection and belonged to the infection group, and 106 cases were not with hospital infection and belonged to the non-infection group. The common part of infection was numbered. Single factor analysis and logistic analysis were used to analyze relations of hospital infection with 9 factors (sex, age, primary disease, heart failure, length of stay, dialysis age, venous catheter, hemoglobin and blood albumin), in order to identify risk factors. Results The total of infection rate was 25.35%, including 12 cases in respiratory system (33.33%), 9 cases in urinary system (25.00%), 6 cases in vascular access (16.67%), 4 cases in digestive system (11.11%), 3 cases in cyclic system (8.33%) and 2 case in others (5.56%). The differences in age, primary disease (diabetic nephropathy, chronic glomerulonephritis, chronic pyelonephritis, obstructive nephropathy, gouty nephropathy and others), heart failure, length of stay, dialysis age, venous catheter, hemoglobin and blood albumin between the diarrhea group and the non-diarrhea group were statistically significant (P<0.05). The logistic analysis showed that age>60 years (OR:2.746), diabetic nephropathy (OR:2.592), chronic glomerulonephritis (OR:2.527), heart failure (OR:2.578), venous catheter (OR:3.188) and the level of blood albumin<30 g/L (OR:4.744) were the risk factors of nosocomial infections in CRF patients undergoing hemodialysis (P<0.05). Conclusion The risk factors of nosocomial infections in CRF patiets undergoing hemodialysis indicated that active preventive treatment of high-risk groups, strict hemodialysis operation and the strengthening of nutritional support can effectively reduce the ratio of hospital infection.
   

Objective To investigate the use of Analgesics in a hospital from 2017 to 2018 so as to provide reference for standard management and clinic rational use of analgesic drugs.Methods  A retrospective analysis method was used to retrieve the prescription information of analgesic drugs for a medical institution from 2017 to 2018 for drug utilization research (DUR) including the amount of sort analysis, serial number ratio (B/A) analysis, DDDs analysis, DUI and other indicators. The rationality analysis of the use of analgesic drugs in this medical institution in the past two years was analyzed from the macro perspective. Results  The top three drugs in the medical institution from 2017 to 2018 were flurbiprofen, propacetamol and lornoxicam; the top three DDDs were lornoxicam, flurbiprofen, and propaceta, and its DDDs accounted for 93.55% of the total DDDs of all study drugs; lornoxicam′s serial number ratio B/A was the largest, and the smallest was flurbiprofen; most analgesic drugs DUI value was close to 1, among them the largest value was about 1.3 for lornoxicam, indicating that the dosage was a bit large. Conclusion The application of analgesic drugs in this medical institution from 2017 to 2018 is basically reasonable, but there are also some unreasonable drugs. There is still potential in optimizing the utilization of analgesic drugs, which needs further improvement.

Objective To analyze the risk factors of intravenous infusion in outpatients of a tertiary children′s hospital, and to explore related preventive interventions.Methods From June 2017 to October 2018, 486 children who received intravenous infusion treatment in the infusion room of the tertiary children′s hospital were retrospectively analyzed. Retrospective analysis was carried out on the basic data of the children, the incidence rate of transfusion reaction in the course of intravenous infusion was recorded, and the risk factors of transfusion reaction were discussed.Results In 486 cases, 44 cases of infusion reaction occurred during the infusion, and the incidence rate was 9.1%. Multivariate logistic regression analysis showed that children under 7 years old (OR=1.991), infusion volume over 1 000 ml (OR=1.415), low immune function (OR=4.158), pyrogenic source (OR=1.960), drug irritation strong (OR=1.914), past history of allergic disease (OR=5.778), drug deterioration (OR=1.451), particulate contamination (OR=1.765), and infusion speed too fast (OR=1.634) were risk factors for outpatient intravenous infusion reactions. The difference was statistically significant (P<0.05).Conclusion The hospital needs to strengthen the health education of the medical staff on the infusion reaction, strictly grasp the precautions and indications of intravenous infusion, and master the treatment methods of infusion reaction to reduce the occurrence of infusion reaction.