专科联盟内慢性伤口患者基层医院就诊体验及卫生服务需求的质性研究

目的了解专科联盟内慢性伤口患者基层医院就诊体验及其对基层医院的卫生服务需求,为基于联盟构建高效的慢性伤口管理模式提供参考。方法对10名慢性伤口患者进行半结构式访谈,通过现象学研究法对资料进行整理和分析,并提炼主题。结果提炼出2个主题:基层医院医疗资源不足,患者缺乏信任感;慢性伤口患者对基层医院支持性医疗服务需求。其中主题二又析出伤口规范化护理需求、卫生资源可及性需求、基础生活护理和健康教育需求、心理支持需求4个次级主题。结论明晰患者就诊体验及卫生服务需求是基于专科联盟构建慢性伤口管理模式的前提,联盟工作的开展应以患者需求为导向,提高联盟内基层医院专业化水平,以满足慢性伤口患者对基层医院多样化的卫生服务需求。     

基于专科联盟的慢性伤口管理模式构建及实施

目的以需求为导向构建基于专科联盟的慢性伤口管理模式,运行并评价其实施成效。方法在实地调研、问卷调查和质性访谈的基础上构建基于专科联盟的慢性伤口管理模式,并将其运用于联盟区域内慢性伤口管理。10个月后从联盟工作开展情况、患者就医成本以及患者基层医院就诊满意度3方面评价管理模式初步实施效果。结果管理模式运行期间牵头单位共对联盟成员医院进行现场技术指导13次,开展远程会诊102次,现场会诊6次,在线教学6次,接收进修人员23人次,培养伤口专科护士57人。慢性伤口患者下转至联盟成员单位后平均经济成本和时间成本显著降低(均P<0.01);管理模式运行后患者对基层医院就诊满意度显著提高(P<0.05,P<0.01)。结论基于专科联盟的慢性伤口管理降低了患者就医成本,提高了患者基层医院就诊满意度,有利于联盟区域内卫生资源整合,从而实现区域内慢性伤口的高效管理。     

北京某医院疝和腹壁外科患者就医意愿影响因素调查研究

目的分析影响疝和腹壁外科患者就医意愿的主要因素,为医院高质量的门诊服务提供参考。 方法采用随机抽样问卷调查法,发放350份问卷,回收有效问卷322份,调查内容包括患者的基本信息、就诊目的、来本院就诊原因、下一步诊疗是否选择本医院及对待互联网医疗的态度等。 结果患者选择本医院的三个最主要的因素为医疗技术、就诊路程和专科影响力三个方面;前来就诊患者中有87.26%的患者会选择在本医院接受下一步诊疗;18.63%的患者为复诊或单纯来医院开药;在互联网就医选择上,患者年龄和教育程度是影响患者是否选择的主要因素,30岁以下和大学以上文化程度患者更容易使用互联网医疗。 结论加大医院医联体建设,将优质的医疗资源服务于疑难疝疾病患者;持续改善患者服务体验,提高患者满意度;持续提高医院医疗技术水平,重视医师专业特长培养,提高医院核心竞争力;扩大互联网医疗的诊疗项目和服务内容,加快互联网医疗的发展。     

医院社区多学科联动慢性伤口居家护理云平台的构建及实施

目的 构建基于互联网的医院-社区慢性伤口多学科联合居家护理服务模式,解决居家慢性伤口患者护理的难点。 方法 构建医院-社区多学科联动慢性伤口居家护理云平台。患者在线申请,医院专科护士和社区护士分阶段整合多学科诊疗意见后联合实施居家伤口护理,社区护士负责后续的居家护理,平台定期随访。 结果 实施6个月,为辖区内的137例患者提供线上咨询服务,其中8例接受了医院-社区联合居家护理服务,社区护士提供后续上门护理服务及随访36例次。 结论 医院-社区多学科联动慢性伤口居家护理云平台整合了医院和社区服务中心资源,一定程度上解决了慢性伤口患者居家服务需求与服务供给矛盾。     

以伤口专科护士为主导的创面修复病房的构建与运行

目的充分发挥伤口专科护士的作用,满足慢性伤口患者护理需求。方法自2018年5月起,建立以伤口专科护士为主导的创面修复病房,成立独立的创面修复护理小组,依托创伤中心医疗组和护理组开展工作。结果 2018年5月至2019年6月创面修复病房收治患者51例,通过创面床准备和负压伤口治疗技术,治愈21例,好转后转科、转院29例,无变化1例。2018年伤口专科护士护理会诊工作量、医疗会诊工作量、门诊工作量及患者对伤口专科护士满意度均高于2017年。结论创面修复病房的建立加强了医护各专科之间联系,充分展示了伤口专科护士的独立性,促进伤口专科护士的自我实现,能够满足慢性伤口患者护理需求。     

基于人工智能的远程医疗在慢性创面管理中的应用

当前,我国创面修复仍处于初期,基层医院从事创面专业的医师较少,为了满足基层慢性创面 患者的诊治需求,辅助并提高基层医院慢性创面的临床诊疗水平,本研究团队开发出一种基于人工智能 （AI）的慢性创面远程管理系统——愈悦,旨在指导慢性创面患者更为便捷、精准地寻求医疗服务,提高 基层医院的诊疗质量,促进二级和三级医院之间的双向转诊流程,使有限的医疗资源得到合理利用。     

“互联网+”居家医疗服务平台应用效果分析

目的 分析“互联网+”居家医疗服平台的应用效果，为优化服务模式提供参考。 方法 对三级医院居家医疗服务平台数据库中2020~2021年服务对象的一般资料、平台使用情况、服务项目等数据，进行回顾性分析。 结果 纳入研究的1 780例次服务中，患者通过医护上门服务App端口获取服务1 683例次，通过互联网医院线上问诊端口获取服务67例次,通过互联网医院医联体服务端口获取服务30例次；提供服务者多为护士（1 451例次），其次为医生（245例次）；服务量排在前3位的项目分别是尿管护理（39.04%）、伤口护理（18.15%）及胃管护理（12.08%）；居家医疗服务比自行前往医院就医更加实惠便捷。 结论 “互联网+”居家医疗服务平台构建了医院-社区-家庭多元联动、医护技药等多学科团队相互协作的新型医疗服务模式，可以为患者提供专业、高效、便捷的医疗服务。但还需进一步完善服务模式，使更多需求者受益。     

基于医联体的区域内母婴连续性照护模式的构建与实施

目的 提升区域内基层医院母婴照护水平，提高孕产妇及照护者照护能力。方法 以医联体新生儿专科护理联盟、远程医疗中心为平台，通过组建母婴照护团队、基线调查、优质护理服务下沉基层医院及母婴关爱行动等举措，在三级医院、二级医院、社区、家庭构建母婴连续性照护模式，为母婴提供全程、连续性的母婴护理。结果 母婴连续性照护模式实施后在区域内形成同质化的母婴护理技术标准；培养产科专科护士72名,儿科专科护士53名；基层医院护理人员母婴照护相关基础技能、重症护理、急救技能得分显著提升（均P<0.01）。结论 母婴连续性照护模式实现了区域内母婴护理技术共享，提升了医联体内基层医院母婴照护水平。     

苏州市三级医院专科护理门诊护理服务现状调查

目的了解苏州市三级医院专科护理门诊护理服务开展现状,为进一步完善管理提供参考。方法自制调查问卷对苏州市14所三级医院的43个专科护理门诊进行调查。结果专科护理门诊中开展最多的是PICC/静疗门诊(14个,32.6%)、糖尿病护理门诊(9个,20.9%)和围生期保健护理门诊(9个,20.9%);9个(20.9%)门诊开设时间≥10年;出诊护士岗位性质以兼职为主(22个,51.2%);每周开诊时间0.5～7.0 d;7个(16.3%)护理门诊免费。服务内涵包括健康咨询、专科护理技术、专科疑难病例处理、并发症筛查等。工作量以PICC/静疗门诊最多,其次为伤口造口门诊。结论苏州市三级医院专科护理门诊服务模式日趋成熟,服务内涵丰富,患者需求量大。但专科护理门诊的质量评价体系和门诊管理机制还需进一步完善。     

糖尿病足患者三级甲等医院专业诊疗中心就诊前的诊治状况及影响因素分析

背景与目的:糖尿病足(DF)是糖尿病患者致残、致死的主要原因之一,而早期诊断和规范治疗不仅可提高疗效、促进溃疡愈合,也是保肢和节省医疗费用的有效途径。本研究探讨DF患者在具有专业DF多学科诊疗团队的三级甲等医院就诊前的诊治现状及相关因素,为DF的规范化诊疗提供相关依据。方法:于2017年10月-11月期间,采用随机整群抽样法,抽取湖南、浙江、上海、四川、广东、河北、黑龙江、澳门的13家具有专业DF诊疗中心的三级甲等医院共326例Wagner 1~5级DF患者行问卷调查与足部检查,以患者就诊于三级甲等医院前伤口清洗液的选择和伤口用药情况为指标评估治疗的规范性,分析可能影响其治疗规范性的因素。结果:在326例DF患者中,误诊率为25.8%,治疗不规范率为72.7%。单因素分析结果显示,患者治疗的规范性与清创人、就诊医院级别、敷料应用人、院前诊治地点、并发症个数和清创地点有关(均P<0.05);Logistic多元回归分析结果表明,医院分级和敷料应用人是DF治疗规范率的独立影响因素(均P<0.05),其中三级医院DF治疗规范率是一级医院的6.707倍,且明显优于二级医院,敷料应用人为伤口/造口治疗师的DF治疗规范率是敷料应用人为患者本人的24.117倍,且明显优于敷料应用人为医生和护士。结论:DF患者在进入具有专业DF多学科诊疗团队的三级甲等医院前存在较多的误诊和治疗不规范的现象。因此,需进一步加强对基层医院医务人员DF多学科规范化诊治的培训,尤其应重视伤口/造口治疗师的培养;完善基层医疗机构和三级医院DF患者双向转诊的标准;鼓励患者主动就医,以减少误诊和不规范诊治现象的发生。     

Thoraco-abdominal wound in gunshot multiple wound

Thoracoabdominal wounding in the shot gun polytrauma was revealed in 56 (25.6%) of injured persons, severe shock of III-IV degree--in 71.4%. Operative intervention on the abdominal cavity organs was done in all injured persons, on the thoracic one--in 92.9%, and on the other anatomical regions--in 55.4%.     

Burn wound coverage and burn wound closure

Early excision and grafting changed dramatically topical wound treatment, but are restricted by difficulty in diagnosing burn depth, by limited donor sites and by technical skills to excise special areas (perineum, face). In addition to the extent of burn and the age of the patient the depth is determinant of mortality, morbidity and of patient's quality of life. It results from the time-temperature relation and is further influenced by local and systemic causes of conversion: dehydration, edema, infection and shock hypoxia, metabolic derangements, peripheral vessels diseases may contribute do deepening of burn wound. Superficial burn on day one appears deep dermal by day three, where spontaneous epithelization lasts much longer than 21 days and results in hypertrophic scarring. To prevent this sequelae deep dermal burn may be treated like full-thickness injury with excision and autografting. Another way is removal of dead layers of corium and using biological or synthetic cover. We have found a more effective way to reach wound closure (not only cover) in the method of "upside-down" application of recombined human/pig skin (RHPS), composed of allogeneic human keratinocytes cultured on cell-free pig dermis. The allogeneic epidermal cells temporarily "take", "close" the excised wound and simultaneously encourage epithelization from adnexa remnants in the wound bed. Thus definitive closure is achieved.     

Titanium wound chambers for wound healing research

Standardized and reproducible animal models are crucial in medical research. Rodents are commonly used in wound healing studies since, they are easily available, affordable and simple to handle and house. However, the most significant limitation of rodent models is that the wounds heal by contraction while in humans the primary mechanisms of healing are reepithelialization and granulation tissue formation. The robust contraction results in faster wound closure that complicates the reproducibility of rodent studies in clinical trials. We have developed a titanium wound chamber for rodent wound healing research. The chamber is engineered from two pieces of titanium and is placed transcutaneously on the dorsum of a rodent. The chamber inhibits wound contraction and provides a means for controlled monitoring and sampling of the wound environment in vivo with minimal foreign body reaction. This technical report introduces two modalities utilizing the titanium chambers in rats: (1) Wound in a skin island model and, (2) Wound without skin model. Here, we demonstrate in rats how the “wound in a skin island model” slows down wound contraction and how the “wound without skin” model completely prevents the closure. The titanium wound chamber provides a reproducible standardized models for wound healing research in rodents.     

Vacuum-assisted wound closure in postoperative spinal wound infection

Combined with antibiotic therapy, vacuum-assisted wound closure may help reduce the need for serial irrigation and debridement surgery, contributing to a decrease in overall hospital stay.     

The molecular biology in wound healing & non-healing wound

The development of molecular biology and other new biotechnologies helps us to recognize the wound healing and non-healing wound of skin in the past 30 years. This review mainly focuses on the molecular biology of many cytokines (including growth factors) and other molecular factors such as extracellular matrix (ECM) on wound healing. The molecular biology in cell movement such as epidermal cells in wound healing was also discussed. Moreover many common chronic wounds such as pressure ulcers, leg ulcers, diabetic foot wounds, venous stasis ulcers, etc. usually deteriorate into non-healing wounds. Therefore the molecular biology such as advanced glycation end products (AGEs) and other molecular factors in diabetes non-healing wounds were also reviewed.     

New techniques in wound management: vacuum-assisted wound closure

Vacuum-assisted wound closure (VAC) is a wound management technique that exposes the wound bed to negative pressure by way of a closed system. Edema fluid is removed from the extravascular space, thus eliminating an extrinsic cause of microcirculatory embarrassment and improving blood supply during this phase of inflammation. In addition, the mechanical tension from the vacuum may directly stimulate cellular proliferation of reparative granulation tissue. Orthopaedic indications for VAC include traumatic wounds after débridement, infection after débridement, and fasciotomy wounds for compartment syndrome. VAC also can be used as a dressing for anchoring an applied split-thickness skin graft. The technique is contraindicated in patients with thin, easily bruised or abraded skin; those with neoplasm as part of the wound floor; and those with allergic reactions to any of the components that contact the skin. Clinical experience with the technique has resulted in a low incidence of minor, reversible irritation to surrounding skin and no major complications. Further experience is required, as well as clinical and basic research, to define optimal indications and benefits compared with traditional methods of wound management.