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Establishing Medical Risk Monitoring and Early Warning System for Quality Improvement and Patient Safety

The Analysis of Antibacterials Utilization for 400 Outpatients

目的:了解我院门诊部抗菌药物的使用情况,防止临床上滥用抗菌药。方法:随机抽取2008年成人普通处方,每季度100份,共计400份,统计所需分析数据。结果:抗菌药物的品种数占处方用药总品种数的1154%;抗菌药物的总金额占处方总金额的比率为1341%;注射剂使用率为4%;每张处方合并用药品种数269种;处方使用通用名为100%;抗真菌药物的使用率低于1%。结论:门诊患者抗菌药物使用合理。

Surgery for the treatment of low-grade glioma secondary epilepsy−analysis of 45 cases

ObjectiveTo explore the clinical characteristics and surgical effect of low-grade glioma (LGG) secondary epilepsy.Methods45 cases of low-grade glioma secondary epilepsy were retrospectively studied during December 2010 and December 2020.There were 27 males and 18 females in this group. Their ages ranged from 10 to 69 years [mean (42.8±15.61) years]. And the illness duration ranged from 3 months to 5 years [mean (12.5±4.12) months]. The initial manifestation of all LGG was seizure attack.All the patients underwent CT and MRI examination before the operation. The LGG was located in the frontal lobe in 17 cases, temporal lobe in 8 cases, parietal lobe in 4 cases, frontal-temporal lobe in 7 cases, frontal-parietal lobe in 5 cases. Meanwhile the LGG was located in the left side in 31 cases, right side in 14 cases. The long-term video-EEG monitoring showed the epileptogenic lesion was located in the ispilateral frontal lobe in 20 cases, temporal lobe in 8 cases, frontal-temporal lobe in 12 cases, frontal-parietal lobe in 5 cases.All the patients were performed operation under the intra-operative electrocorticography (ECoG) monitoring.If necessary, enlarged epileptogenic cortical resection, cortical coagulation or MST was added.After the operation, all the patients were followed-up for half a year to 10 years [mean (4.7±1.83) years] to observe the surgical effect.Results42 cases of LGG underwent gross total resection and 3 subtotal resection intra-operatively. Anterial temporal lobectomy (ALT) was added in 19 cases whose LGG were invovled with temporal lobe.13 cases were added cortical cogulation and 5 cases MST.The post-operative pathology showed astrocytoma grade Ⅰin 20 cases, astrocytoma grade Ⅱ in 12 cases, oligodendroglioma in 11 cases and dysembryoplastic neuroepithelial tumor (DNET) in 2 cases. The post-operative follow-up showed that 30 cases lived well, 12 cases recurred and received re-operation, 3 cases died. Meanwhile, 42 cases were seizure free and 3 cases had occasional seizure attack during the follow-up.ConclusionsTo the patients with LGG secondary epilepsy, if pre-operative long-term EEG monitoring is in accordance with imaging examination, early LGG resection combined with epileptogenic lesion resection should be performed under the guidance of ECoG monitoring.And the post-operative effect is satisfactory.

重症监护病房呼吸机相关性事件监测结果与分析

目的了解重症监护病房（ICU）呼吸机相关性事件（VAE）的发生状况，为制定干预措施提供参考依据。 方法采用前瞻性监测方法，对2013年4月1日－7月31日所有入住ICU且使用机械通气时间＞2 d、年龄≥18岁的患者进行VAE监测，并与2012年同期呼吸机和相关性肺炎（VAP）监测情况进行比较。 结果监测到有效病例31例，共发生VAE 6例，发生率为19.35%；患者平均住院时间12 d，平均机械通气时间10 d；预后：存活25例，死亡6例，病死率为19.35%；抗菌药物使用率100%。2013年的VAE监测与2012年同期院内VAP目标性监测VAP千日感染率分别为2.83、29.57例/1 000导管日，差异有统计学意义（P＜0.05）。 结论VAE监测及其诊断标准客观量化、简单易行，但是否适用于我国ICU患者VAP的诊断，值得商榷。

Clinical Study of Gastroesophageal Reflux and Gastric Emptying after Esophagectomy with Gastric Replacement Through Esophageal Bed

Abstract: Objective To evaluate the effect on gastroesophageal reflux and gastric emptying in the different route of gastroesophageal anastomosis objectively after esophagectomy for patients with midesophageal carcinoma. Methods Forty patients with midesophageal carcinoma were randomly divided into two groups. Esophageal bed group (n=20): the gastroesophageal anastomosis were performed while the stomach were pulled on through the esophageal bed after esophagectomy; endothoracic group (n=20): gastroesophageal anastomosis were performed while the stomach were pulled on in the thoracic cavity. Ten persons had no disease of digestive system and healthy volunteers were recruited as normal control group. 24-hour esophageal pH monitoring and radioisotope gastric emptying checkup were carried out in all experimental subjects 3 months after operation, so as to observe the changes of gastroesophageal reflux and gastric emptying. Results All of the patients’s operation were success. And no anastomotic leakage and no anastomotic stenosis. Three months after operation, the patients in both operation groups were with different level of reflux. DeMeester total appraise score, the times of regurgitation of gastric juice in 24h, gt;5 min reflux frequency, the longest time of keep reflux, pHlt;4.00 total time and pHlt;4.00 of total time percent, these targets in both operation groups were higher than those in control group (Plt;0.01) DeMeester total appraise score, the times of regurgitation of gastric juice in 24 hours, the longest time of keeping reflux, pHlt;4.00 of total time and pHlt;4.00 of total time percent in esophageal bed group were lower than those in endothoracic group(Plt;0.01). The recent period of gastric emptying percentage (GE) in both operative groups were lower than that in normal control group. GE in esophageal bed group experimental meal in the stomach after entering the 30,60,90,120,180 and 240 min were higher than those in endothoracic group. Conclusion After the operation of esophagogastric anastomosis through esophageal bed in upper aortic site,gastroesophageal reflux and delayed gastric emptying exist objectively, However, the technique is superior to the traditional technique to reduce the extent of gastroesophageal reflux and delayed gastric emptying, its mechanism might be the result of mechanical factors.

超声造影与 MRI 增强扫描在高强度聚焦超声治疗子宫肌瘤中的疗效监测

目的 比较超声造影（contrast-enhanced ultrasound，CEUS）与 MRI 增强扫描在高强度聚焦超声（high intensive focused ultrasound，HIFU）治疗子宫肌瘤中的疗效监测作用。 方法 选取 2013 年 1 月—2014 年 12 月采用 HIFU 治疗的 179 例子宫肌瘤患者（共 234 个肌瘤），对治疗前肌瘤体积及治疗后非灌注区肌瘤消融体积分别采用 CEUS 和 MRI 增强扫描检查。 结果 CEUS 和 MRI 增强扫描在治疗前肌瘤体积对比中差异有统计学意义（P<0.05），在治疗后非灌注区肌瘤消融体积对比中差异无统计学意义（P>0.05）。对治疗后残留两者均可有效检出。 结论 CEUS 和 MRI 增强扫描在 HIFU 治疗前都是治疗必须的检查，两者不可替代；两者均是治疗后疗效评价的有效方法，但 CEUS 比 MRI 增强扫描在治疗中更具灵活性、可重复性，在一定程度上可替代 MRI 增强扫描。

Survey and Analysis of Insulin-treated Type 2 Diabetes Patients’ Self-monitoring of Blood Glucose

目的　了解接受胰岛素治疗的糖化血红蛋白＞7.5%的2型糖尿病患者自我血糖监测现状及存在的问题，为帮助患者建立健康行为提供理论依据。 方法　对2008年12月－2011年2月住院治疗的128例符合纳入标准的患者进行问卷调查。调查内容包括患者一般资料、血糖控制情况、自我监测相关知识及技能等内容。 结果　共发放问卷128份，收回128份，其中有效问卷122份。糖尿病患者血糖自我监测知识获取渠道单一，且相关知识匮乏；不能制定正确血糖自我监测方案，不能对检测结果进行正确记录和汇报；血糖检测操作不正确，检测频率达不到标准要求。 结论　接受胰岛素治疗的2型糖尿病患者自我监测现状并不容乐观，患者自我监测行为缺乏。为此，提高糖尿病患者健康教育水平，帮助其建立并维持健康行为，是糖尿病教育工作的重点和挑战。

Analysis on the Microbial Monitoring Results of Transfusion Service

摘要:目的:回顾我院输血科近年医院感染监测结果,总结经验方法,保障输血生物安全。 方法:收集2001年至今的微生物监测报告,计算合格率。结果:各监测项目的合格率不同,储血冰箱内壁在90次监测中合格率达100%,冰箱空气及储血室空气监测的合格率波动较大。结论:目前的消毒方式可以保障输血科微生物监测合格,杜绝院感发生。Abstract: Objective: To sum up experiences of biosecurity measures in transfusion service of our hospital by retrospect the microbial monitoring results. Methods: Collecting the monitoring reports on microorganism since 2001 and figuring out the percent of pass. Results: The percent of pass are different, the interior of refrigerator is up to 100% while others fluctuate. Conclusion: Current measurements can meet the requirement and provide the guarantee for safe transfusion.

Bedside Accompany Behavior Affecting Video-electroencephalography Monitoring

【摘要】　目的　分析床旁陪护行为对视频脑电图的影响，总结护理指导的意义。　方法　2008年7-9月对214例患者行24 h视频脑电图监测（video EEG，VEEG）监测，每例患者留一床旁陪护。重点观察坐床沿或同睡、用手机、拍打及按摩行为，并比较初次及再次护理指导后上述行为发生情况。　结果　坐床沿或同睡、用手机、拍打、按摩均可影响VEEG，初次指导后以上行为出现率分别为62.6%、55.1%、30.4%、20.1%；再次指导后以上行为分别减少78.4%、75.4%、78.5%、79.1%，VEEG监测质量均有提高。　结论　应将规范床旁陪护行为的指导贯穿于VEEG监测的全过程。【Abstract】　Objective　To assess the impacts of bedside accompany behavior on the quality of video-electroencephalography (VEEG).　Methods　A total of 214 patients underwent 24-hour VEEG monitoring from July to September 2008. Each patient had a bedside-accompany family member. The behaviors of accompany included sitting at the bed, using mobile phone, clapping, and kneading the patients, which were evaluated after the first and second nursing education.　Results　Sitting at the bed, using mobile phone, clapping, and kneading the patients influenced the quality of VEEG. After the first education, the occurrences of the above unfavorable behaviors were 62.3%, 55.1%, 30.4%, and 20.1%. After the second education, the unfavorable behaviors reduced 78.4%, 75.4%, 78.5%, and 79.1% respectively; the VEEG quality improved.　Conclusion　Proper bedside accompany behavior may improve the quality of VEEG monitoring.

Effect of Self-made Urine Volume Record Sheet and Health Education on Urine Volume Monitoring in General Ward

ObjectiveTo explore the effect of self-made urine volume record sheet and health education on urine volume monitoring in general ward. MethodsA total of 110 hospitalized patients between February and July 2015 were selected to be our study subjects. The patients were divided into control group (n=42) and trial group (n=68) according to the time period. The control group used conventional urine volume record and accepted common health education, while the trial group received a self-made urine volume 24-hour record sheet with health knowledge and accepted special health education about urine volume by nurses. Then, we investigated the two groups with a questionnaire about urine volume, and analyzed the acquired data and compared the knowledge of the two groups. ResultsThe knowledge of urine volume and the performance of urine volume record in the trial group were significantly better than the control group (P<0.05). In the control group, the difference in knowledge of aim and singnificance of urine record between the two genders was sigrificant (P<0.05). (the males were better than the females); and was also significant among patients with different educational levels (P<0.05). (the people with college or superior degree was the best, while the ones with primary school education or inferior level was the poorest). ConclusionUsing the self-made urine volume record sheet with health knowledge and strengthening the special health education about urine volume can improve the knowledge awareness of the patients and their families, promote the monitoring of patients’ urine, train patients’ self-care awareness, and improve patients’ prognosis.