手术室流程再造对腹腔镜经腹腹膜前腹股沟疝修补术患者院内感染的影响

目的探究手术室流程再造对腹腔镜经腹腹膜前腹股沟疝修补术患者院内感染的影响。 方法以流程再造的方法对南通大学第二附属医院手术室的人员素质、管理制度及手术室硬件等进行再造优化,比较流程再造前后的手术室腹腔镜经腹腹膜前腹股沟疝修补术患者院内感染情况、灭菌合格率及手术满意度情况。 结果手术室流程再造后较再造前手术室医务人员手、无菌物品、空气、物体表面的灭菌合格率明显提高;手术连台间隔时间、首台手术等待时间明显降低;患者的院内感染率（1.14% vs. 8.54%）明显降低;患者的服务满意度明显升高（P均<0.05）。 结论手术室流程再造不仅能强化手术室环境灭菌效果,还能提高医务人员在手术室的工作效率,明显降低腹腔镜经腹腹膜前腹股沟疝修补术患者院内感染的风险,进一步提高了院内感染管理水平。     

Evaluation of Fast Track

This paper is the second of two articles discussing the execution and evaluation of implementing a Fast Track program in a West Australian outer metropolitan hospital Emergency Department. The first paper in the series outlined the implementation process over a 12-month period. This current paper presents the findings of the 12-month evaluation utilising Statistical Process Charts. The object of this evaluation was to undertake analysis of data throughout the change process and demonstrate the effectiveness of implementing Fast Track into the Department. Following the implementation of Fast Track, the Department's "Did not wait" rate decreased over a 12-month period from 10% to 5.4%, without a detrimental impact on treatment times for the patients with serious illnesses and injuries. Furthermore, Fast Track resulted in patients with minor injuries or illnesses being seen, treated and discharged within 2 hours of presentation. Indeed the journey time decreased for all Emergency Department patients. As a result of Fast Track, the Emergency Department waiting area is less congested and staff moral has increased. A further consequence of Fast Track is that nurses are providing more advanced clinical services to patients.     

Understanding cancer patients’ experience and outcomes: development and pilot study of the Cancer Care Outcomes Research and Surveillance patient survey

Goals of work The National Cancer Institute’s Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is conducting a population-based study of newly diagnosed patients with lung and colorectal cancer to describe the experience of persons living with cancer and to understand which barriers present the most significant obstacles to their receipt of appropriate care. The keystone to this effort is the baseline patient survey administered approximately 4 months after diagnosis.Patients and methods We developed a survey to obtain information from patients newly diagnosed with lung and colorectal cancer about their personal characteristics, decision making, experience of care, and outcomes. We conducted a pilot study to evaluate the feasibility of a lengthy and clinically detailed interview in a convenience sample of patients within 8 months of diagnosis (n=71).Main results The median length of the interviews was 75 min for patients with lung cancer (range 43–130) and 82 min for patients with colorectal cancer (range 46–119). Most patients had received some form of treatment for their cancer: 66.1% had undergone surgery, 28.2% had received radiation therapy, and 54.9% were treated with chemotherapy. In addition, 26.7% reported their overall health was less than 70 on a 0–100 scale, demonstrating that patients with substantial health impairment were able to complete the survey.Conclusions A clinically detailed survey of newly diagnosed lung and colorectal cancer patients is feasible. A modified version of this survey is being fielded by the CanCORS Consortium and should provide much needed population-based data regarding patients’ experiences across the continuum of cancer care and their outcomes.     

Evaluation of the performance of pharmacists in terms of providing health assistance at a university hospital

OBJECTIVE: This study aimed to assess the practices of pharmacists in Hospital Care. Method - we interviewed 20 pharmacists from the Pharmacy Division by applying a structured instrument, in September 2005. This instrument addressed aspects related to the main activities at the Hospital Pharmacy, which were assessed according to indicators organized into five areas: sector management, hospital pharmacotechniques, committee activities, information and pharmacotherapeutic follow-up, as well as teaching and research activities. RESULTS: The Pharmacy Division considered all structural aspects under analysis as essential for the good development and application of its services. We found that some essential services, such as the Medication Information Service and Pharmacotherapeutic Follow-up, were absent. Pharmacist professionals were dissatisfied about human resource and physical structure dimensioning, and they presented as not very active in terms of Pharmaceutical Care. CONCLUSION: Results indicate that care is still centered on the drug, with few clinical activities. We suggest reformulations in service management, particularly in the management of pharmacists.     

Process measures facilitate maturation of pediatric enhanced recovery protocols

Background/purpose

The role of process measures used to predict quality in pediatric colorectal surgery enhanced recovery protocols has not been described. The purpose of this study was to demonstrate the feasibility of abstracting and monitoring process measures over protocol improvement iteration.

基于《成人急性枢椎骨折循证临床诊疗指南》的成人急性齿突骨折研究进展和指南更新探讨

正循证临床指南是在广泛收集临床证据的基础上,按照循证医学的方法制定出的临床指导意见,有较强的实用性、科学性和有效性。《成人急性枢椎骨折循证临床诊疗指南》~([1])(以下简称《指南》)是国内首部关于枢椎骨折的循证临床指南,在借鉴国外指南的基础上,特别针对国内脊柱外科的医疗现状,对成人急性枢椎骨折提出了诊疗的基本推荐准则。指南是根据大量循证医学证据形成的。为了使指南具有较高的时效性,其所包含的推荐意见应与     

经皮前路枢椎齿状突螺钉内固定术的并发症分析

目的 :分析经皮前路齿状突螺钉内固定术治疗枢椎齿状突骨折的并发症及相关防治措施。方法 :2006年6月~2013年12月共收治新鲜枢椎齿状突骨折患者122例,其中男79例,女43例,年龄28~73岁(45.6±14.8岁)。根据Anderson-D′Alonzo分型,Ⅱ型88例,浅Ⅲ型34例。均采用经皮颈椎前路枢椎齿状突螺钉内固定术。记录手术时间,术中出血量,螺钉松动及断裂,医源性血管、神经及食管损伤和切口感染等情况。术后及随访时行颈椎正侧位、开口位X线片及CT检查评估螺钉位置和骨折愈合情况,并记录并发症处理措施。结果:皮肤切口长约0.8~1cm,手术时间40.7±12.2min,术中出血量20ml。术中未发生咽后壁、食管、血管和重要神经等邻近组织损伤。共21例患者出现相关并发症,其中3例在置入螺钉过程中产生枢椎前方骨折,1例术中再置入1枚螺钉行双螺钉固定,另2例术后予Halo-Vest架固定治疗后齿状突骨折骨性愈合;1例术后骨折端分离过大,再次行内窥镜下骨折端植骨术而愈合;1例骨折端轻度移位,术后予以支具固定后骨性愈合;9例螺钉钉尾留置过长,但未出现临床症状;1例术后2d出现喉上神经麻痹,经营养神经治疗后恢复正常;1例切口感染,经抗感染治疗后痊愈;2例分别在术后2个月、3个月出现螺钉脱出,均予翻修,1例行前路寰枢关节融合内固定术,另1例行后路寰枢关节融合内固定术;3例纤维连接,齿状突骨折处无移位,内固定无松动,无需佩戴颈围和二次手术。结论:经皮前路齿状突螺钉内固定术是一种方便、安全、微创的手术方式,术后并发症多数经处理后预后良好,整体翻修率低。     

入院流程重组的实施与成效

目的探讨实施护理服务流程重组，对提高护理服务效率，减少患者不必要环节耗时的效果。方法在相同的护理资源条件下采用流程重组设计、系统性整合相结合的方法，对入院流程进行重组，并对实施前后的效果进行比较。结果入院流程重组减少了患者来回询问、寻找院入办理点的环节；在相同的护理人力资源情况下，通过重组，护士工作内容由原来1项提高为目前的5项；患者或家属到达入院处置室耗时由重组前的（4．33±1．17）min减少为（3．63±1．03）min（P〈0．05）。结论护理服务流程重组有利于提高护士主动服务及护理服务效率。     

齿状突骨折并存下颈椎损伤的诊断及治疗

目的 研究齿状突骨折并存下颈椎损伤的机制、临床特点及治疗方法.方法 回顾性分析1999年1月至2004年12月57例经手术治疗的Ⅱ型或浅Ⅲ型齿状突骨折患者的临床及影像学资料.其中并存下颈椎损伤6例,平均年龄54岁,4例同时合并颈椎退行性变或强直性脊柱炎.在下颈椎损伤中,骨折脱位2例,椎间盘、韧带结构损伤4例.6例患者均行上、下颈椎Ⅰ期手术治疗：2例并发脊髓不完全损伤来自于下颈椎损伤,先行下颈椎融合固定;无脊髓损伤4例,其中2例齿状突骨折术前不能复位,先固定齿状突骨折,另2例齿状突骨折术前解剖复位,先固定下颈椎损伤.结果 6例患者术后均获得随访,平均随访10个月,6例齿突骨折及下颈椎损伤均获骨性愈合;未出现与手术直接相关并发症及长期卧床所导致的并发症;2例不完全性脊髓损伤患者术后脊髓功能Frankel分级提高1级.结论 齿状突骨折并存下颈椎损伤的发生率占齿状突骨折的10.5%,多见于合并颈椎退行性变的老年患者,常需MRI检查以明确诊断.手术治疗此类损伤安全有效,可促进康复、减少并发症.对于合并神经功能损伤者,先固定导致神经功能损伤节段;无神经功能损伤者,先处理相对不稳定节段.     

Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures,atlantoaxial distractions and ascending medullary edema

Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20–80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.