目的 探讨团体体检据实结算的方法，提高体检中心接检人员的工作效率和质量。 方法 采用六西格玛法, 并通过其定义、测量、分析、改进、控制5个步骤，研究并改进团体据实结算的方法，同时对比分析方法改进前后，“清理分检未完”的单次工作量、单次制表时间、单次核实时间以及缺陷发生率。 结果 方法改进后，“清理分检未完”的单次工作量变化无统计学意义（P＞0.05）；单次制表时间由（4.23 ± 0.43）h缩短至（0.06 ± 0.01）h、单次核实时间由（3.18 ± 0.46） h缩短至（1.07 ± 0.01）h、缺陷率从4.83%降至0.69%（P＜0.01）,达到了预期目标。 结论 运用六西格玛法可以发现流程中存在的关键问题,从而提出有针对性的改进措施,提高工作效率和质量。
【摘要】 目的 探讨如何通过流程优化应对体检高峰期。 方法 通过体检高峰期流程优化前后（2008年与2010年）的管理成效对比，评估高峰期流程控制的有效性。 结果 体检高峰期流程优化后，平均候检人数由8人下降至3人、平均侯检时间由11.9 min下降至4.2 min，平均体检时间由175 min下降至130 min。体检者对体检环境、服务态度和服务质量的满意度均高于优化前，差异有统计学意义（Plt;0.05）。 结论 通过流程优化与控制有效地缓解了高峰期体检人员等候时间过长现象，极大地提高了体检者满意度，保障了健康体检工作质量。【Abstract】 Objective To explore how to cope with the peak flow of physical examination through the process optimization. Methods Evaluate the utility of the process control at physical examination peak flow, by contrasting the management effect before and after the physical examination peak flow optimization (2008 and 2010). Results After the process optimization in peak flow, the average number of people waiting to be checked is down to 3 from 8, the consumers′ satisfaction with the medical environment, service attitude and the service quality is higher than before optimization, the difference was significant (Plt;0.05). Conclusion Through the process optimization and control effectively relieve the time for waiting to be examined, greatly enhance the satisfaction of people who take physical examinations and ensure the quality of physical examination.
Objective Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.
In recent years, immune checkpoint inhibitors have begun to be used in targeted cancer therapy. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events. Neuromuscular disease is more common among adverse events involving the nervous system. With the increasing use of immune checkpoint inhibitors, the early recognition and treatment of neuromuscular immune-related adverse events are very important. In this review, we are focused on the epidemiology, pathogenesis, clinical manifestations, evaluation, diagnosis, and treatment of neuromuscular diseases (including peripheral neuropathy, myasthenia gravis, and myositis) caused by immune checkpoint inhibitors, aiming to provide a theoretical basis for improving the diagnosis and treatment ability of users of immune checkpoint inhibitors for such neuromuscular diseases and reducing the disability rate and mortality rate caused by immune checkpoint inhibitors.
Objective To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. Methods Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients’ age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70° (mean, 40.1°). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm × 1.3 cm to 4.0 cm × 2.0 cm. Results After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10° (mean, 1.2°). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. Conclusion Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.
ObjectiveTo evaluate the effectiveness of preputial pedicled flap phalloplasty for repair of severe webbed penis. MethodsBetween May 2011 and May 2015, 23 boys with severe webbed penis were treated. The age ranged from 2 years and 8 months to 8 years and 3 months (mean, 4 years and 8 months). According to El-Koutby & El Gohary classification, 14 cases were rated as grade 3 simple webbed penis and 9 cases as compound webbed penis (2 cases of type 1, 2 cases of type 2, and 5 cases of type 3). The penis length was 2.1-5.4 cm (mean, 3.4 cm), and the penoscrotal angle was 130-160° (mean, 144°). All the glans could not be exposed. No other urinary system diseases and no history of penile surgery were found in children. All cases underwent one stage preputial pedicled flap phalloplasty. ResultsAfter successful correction, the penis length was 3.6-6.4 cm (mean, 4.7 cm); the penoscrotal angle was 90-110° (mean, 97°). Clear skin boundaries were observed at penile and scrotal parts. No web skin or scrotal skin was left on the penis. Primary healing of incision was obtained, with no necrosis of the flap or infection. All cases were followed up 12 to 41 months (mean, 25 months). No penile curvature, abnormal sensation of glans, or recurrence of the penoscrotal angle occurred, and the patients had normal urination. ConclusionPreputial pedicled flap phalloplasty can be used as one stage repair for severe webbed penis. The penis is close to natural state and had satisfactory appearance, avoiding the possibility of long-term edema and penile curvature.