Search

Experience of Improved Surgical Techniques for Thyroid Disease

目的　探讨利用特殊手术器械和相应的手术操作技巧对提高甲状腺外科手术的安全性及质量的作用。方法　借助MPBS系列器械和超声刀的推剥、分离、切割、止血等技术完成甲状腺手术。结果　完成甲状腺部分切除、次全切除或侧叶切除术共468例，手术时间（40±20）min，术中出血量（30±25）ml，住院时间（4±1）d；切口细小，瘢痕平整；术后出现短暂声嘶3例，饮水呛咳2例，局部皮下积液2例。随诊1～3年，平均1.8年，3例复发，1例甲状腺功能低下。无甲状旁腺功能低下和永久性神经损伤病例。结论　利用MPBS器材和超声刀技术在甲状腺疾病外科治疗中的应用安全可靠，具有手术安全、简捷、出血少、时间短、切口小、副损伤少、恢复快的临床效果，值得进一步推广和探讨。

医生助理员对提高门诊工作效率的作用及意义

目的探讨医生助理员在门诊诊断工作中的作用及意义。 方法从2008年8月起，结合医院信息化管理系统（HIS）的启动，为各诊断室医生配备医生助理员，协助完成电子病历、医嘱、处理等录入打印工作。 结果医生助理员的启用，明显提高了医生的工作效率，和病历、处方的合格率，患者侯诊时间也由过去平均 120 min下降至60 min，患者满意度明显提高）。 结论医生助理员的配备，有效地减轻了医生书写医疗文书的工作量，极大地提高了门诊的工作质量和工作效率，值得推荐和推广。极大地提高了门诊的工作质量和工作效率，值得推荐和推广。

Implementation and Effects of Continuous Quality Improvement in the Care of Peripherally Inserted Central Catheter

ObjectiveTo evaluate the clinical effects of continuous quality improvement (CQI) in the care of peripherally inserted central catheter (PICC). MethodsWe retrospectively analyzed the clinical data of 40 patients who received PICC treatment in our hospital between January and December 2011, and then we found out the main problems of PICC catheter care, analyzed the related factors for complications of PICC, and formulated corresponding nursing countermeasures. PICC receivers between January and December 2012 were regarded as controls. Then, we compared the complication incidence and satisfaction of patients between the two groups before and after the implementation of CQI. ResultsAfter the implementation of CQI, complication incidence was significantly lower (P<0.05). The satisfaction degree of patients toward caring rose to 87.8%, which was statistically significant (P<0.05). ConclusionThe implementation of CQI is beneficial to reduce complications of PICC treatment, and patients'satisfaction rate is also significantly increased.

Analysis of the practice and continuous improvement of multi-disciplinary team management mode in the management of multidrug-resistant organisms

ObjectiveTo explore the practical effects of multi-disciplinary team (MDT) management model in the management of multidrug-resistant organisms (MDROs).MethodsIn 2015, the multi-drug resistant MDT was established, and MDT meetings were held regularly to focus on the problems in the management of MDROs and related measures to prevent and control nosocomial infections of MDROs.ResultsThe detection rate of MDROs from 2014 to 2017 was 9.20% (304/3 303), 7.11% (334/4 699), 8.01% (406/5 072), and 7.81% (354/4 533), respectively. The difference was statistically significant (χ2=11.803, P=0.008), in which the detection rates of carbapenem-resistant Acinetobacter baumannii (CRABA), carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae (CRE) changed significantly (χ2=39.022, 17.052, 12.211; P<0.05). From 2014 to 2017, the proportion of multi-drug resistant infections decreased year by year, from 84.54% to 52.82%, and the proportion of multi-drug resistant hospital infections also declined, from 46.05% to 23.16%; the nosocomial infection case-time rate decreased from 0.24% to 0.13% year-on-year; the proportion of multi-drug resistant hospital infections in total hospital infections was 9.07%, 11.17%, 10.47%, and 6.16%, respectively; in the distribution of multi-drug resistant nosocomial infection bacteria, the proportion of methicillin-resistant Staphylococcus aureus, CRABA, CRE hospital infections accounted for the number of MDROs detected decreased year by year. The use rate of antibiotics decreased from 46.58% in 2014 to 42.93% in 2017, and the rate of pathogens increased from 64.83% in 2014 to 84.59% in 2017.ConclusionThe MDT management mode is effective for the management and control of MDROs, which can reduce the detection rate, infection rate, hospital infection rate, and antibacterial drug use rate, increase the pathogen detection rate, and make the prevention and control of MDROs more scientific and standardized.

普外科急诊住院患者术前检查流程优化对治疗的影响

目的　探讨普外科急诊患者术前检查流程优化问题与效果。 方法　2010年1月起，对普外科急诊术前检查流程进行优化，并将其实施优化前后急诊入院的50例患者按就诊流程方式不同分为两组，其中普通组（A组）25例为原就诊流程下治疗患者，优化组（B组）25例为改进就诊流程后治疗患者，比较两组间患者平均住院日、术前等待时间。 结果　流程优化后，患者平均住院日与术前等待时间分别由8.50 d与9.70 h降至4.00 d与6.95 h，差异有统计学意义（P＜0.05）。 结论　结合普外科急诊患者就诊特点，优化后临床流程有助于提高患者的满意度，提升医疗质量指标。

REFORM OF THE PEDICLED ABDOMINAL FLAP AND ITS CLINICAL APPLICATION

Objective To investigate the closing method of wound after removalof the traditional pedicled abdominal flap. Methods Accordingto the design,the pedicled abdominal flaps were cut and lifted, and then the incision were extended from both sides on base of the flap to anterior superior iliac spine, respectively. After separating on superficial fascia, two flaps were obtained. The wound of donor site was closed completely by these two pedicled flaps. Twelvepatients with skin defects on hands or forearms were treated using the reformedmethod of traditional pedicled abdominal flap. Results All of the 12 reformed pedicled abdominal flaps survived, and only one had local necrosis on the distalpart of the abdominal flap, about 1.5 cm ×2.0 cm. Conclusion This new designcould provide a good method to close the abdominal wound after removal of pedicled abdominal flap.

Lean healthcare management in optimizing foreign hospital operating room service process

Objective To analyze the application of lean healthcare management in optimizing services in foreign operating rooms, and provide a theoretical reference for further optimizing service processes in domestic operating rooms with lean healthcare management. Methods PubMed and Web of Science databases were searched literature about lean healthcare management in optimizing foreign hospital operating room service process. The search period was from the establishment of databases to November 2024. The number of publications, publishing institutions, authors, citation frequencies, keywords, the use of lean management tools and the improvement status were analyzed.Results A total of 71 literatures were included. Among them, 17 literatures were published from 2008 to 2014, and the number of related literatures increased significantly since 2015, with 54 literatures published by 2024; 9 literatures were published by universities and 62 literatures were published by hospitals. In terms of the distribution of countries and regions where the literatures were published, there were 34 literatures from the United States, 12 from the United Kingdom, 5 from Italy, 4 from Switzerland, and 3 from Canada. The keywords basically presented the combination ofthemes related to operating room management and lean healthcare management improvement fields, such as lean six sigma, quality improvement, and operating room efficiency. The five lean tools with the highest frequency of occurrence in the 71 included literatures were value stream mapping, fishbone diagram, A3 report, PDCA cycle management, and 5S. Conclusions There is an imbalance in the development of lean healthcare management research, with the number of publications in developed countries being far higher than that in developing countries. Lean healthcare management is conducive to improving surgical safety, work efficiency, and patient-doctor satisfaction. Lean healthcare management should further adapt to the actual situation, unify the lean management indicators in operating rooms, conduct cross-departmental cooperation, maximize the effectiveness of lean improvement tools, and achieve modern medical management.

The Essential Points of Liver Transplantation in China

Application of Continuous Quality Improvement to Reduce the Nursing Record Defects for Blood Transfusion

ObjectiveTo analyze and reduce the defects in nursing records for blood transfusion by continuous quality improvement (CQI) method, in order to prevent blood transfusion related medical disputes. MethodsIn October 2014, CQI team was established to analyze the reason for transfusion record defects and make standardized process and quality monitoring forms for nursing record of blood transfusion. Six months after the implementation of CQI, 40 records were randomly selected before the CQI implementation (April to September 2014) and after the implementation (April to September 2015) for comparison and analysis. ResultAfter 6 months of implementation of CQI, nursing record defects of blood transfusion decreased significantly from 228 to 55 items. ConclusionUsing CQI method can effectively reduce nursing record defects of blood transfusion. CQI can also improve the quality of nursing records and prevent medical disputes caused by blood transfusion.

腓肠内侧动脉穿支带蒂皮瓣手术方法改进

【摘 要】 目的 总结腓肠内侧动脉穿支带蒂皮瓣修复髌前和胫骨上端软组织缺损的临床应用效果，并介绍皮瓣切取手术方法的改进。 方法 2003 年5 月－ 2005 年8 月，在利用腓肠内侧动脉的肌皮穿支带蒂皮瓣修复的基础上，改进穿支皮瓣切取方法治疗16 例髌前或胫骨上端伴骨或肌腱外露软组织缺损的创面。其中男11 例，女5 例；年龄24 ～ 59 岁。髌前区9 例，合并骨折4 例；胫骨上端7 例，合并骨折2 例。软组织缺损范围4.5 cm × 3.0 cm ～ 6.5 cm × 5.5 cm。先从皮瓣近侧显露血管蒂，顺行向下分离至皮瓣的穿支血管，以其为中心切取皮瓣。皮瓣切取范围5.5 cm × 4.0 cm ～ 7.5 cm ×6.5 cm。 结果 术后皮瓣全部成活，14 例伤口Ⅰ期愈合，2 例有小的皮缘表浅感染，经换敷料2 周左右逐渐愈合。全部获随访11 个月～ 3 年半，平均2.1 年。局部骨折均在14 ～ 18 周愈合，皮瓣质地、厚薄及颜色均较好，功能恢复较满意，取得了较满意的治疗效果。供区愈合良好，未见明显功能障碍。 结论 采用顺行法先显露血管蒂再找穿支的方法，较逆行法先切开皮瓣找穿支再显露血管蒂的方法操作更为简便，避免了先切皮瓣对穿支血管的误伤。