Surgical safety checklist and operating room efficiency: results from a large multispecialty tertiary care hospital

Background

The Surgical Safety Checklist (SSC) improves patient safety and outcomes; however, barriers to effective use include the perceived negative impact on operating room (OR) efficiency. The purpose of this study was to determine the effect of SSC implementation on OR efficiency.

Methods

All operations at our large multispecialty tertiary care hospital were reviewed for 1-year pre- and 1-year post-SSC implementation. OR efficiency included operating room time, operation time, first starts on time, same-day cancellations, and OR disposable cost.

Results

A total of 35,570 operations were reviewed: 17,204 pre-SSC and 18,366 post-SSC. There was no difference between groups for operating room time (P = .93), operation time (P = .66), first starts on time (P = .15), and same-day cancellations (P = .57). The mean OR disposable cost was significantly lower ($70/operation) for the post-SSC group (P < .01).

Conclusions

The implementation of an SSC does not negatively impact OR efficiency and should not be considered a barrier to effective use. Our data suggest that SSC use can reduce overall cost per surgical procedure.     

Utilisation de l’activité physique pour la prise en charge thérapeutique de l’épisode dépressif caractérisé chez l’adulte

The impact of exercise has been the subject of significant work for two to three decades. The results of these studies have enabled national and international comities to issue specific recommendations. Their impact on physical health is now well documented. The effect of physical activity on mental health in general, and for the management of major depressive disorder in particular, is the subject of more recent interest. The purpose of this article is first to carry out a review of the literature on this subject in order to identify the level of evidence of the effectiveness of use of exercise in the treatment of major depressive disorder. Secondly, the known data on the impact of physical exercise on physical health are summarized. Finally, the article provides an update on the regulatory framework for its use in France and the methods of use in current practice by the clinician.     

Cost‐effectiveness of treating vascular leg ulcers with UrgoStart® and UrgoCell® Contact

Although chronic wounds have a high socio‐economic impact, data on comparative effectiveness of treatments are rare. UrgoStart^® is a hydroactive dressing containing a nano‐oligosaccharide factor (NOSF). This study aimed at evaluating the cost‐effectiveness of this NOSF‐containing wound dressing in vascular leg ulcers compared with a similar neutral foam dressing (UrgoCell^® Contact) without NOSF. Cost‐effectiveness analysis from the perspective of the German statutory health care system was performed using a decision tree model for a period of 8 weeks. Cost and outcome data were derived from the clinical study ‘Challenge’ suggesting a response rate (≥40% wound size reduction) of UrgoStart^® of 65·6% versus 39·4% for the comparator. In the treatment model, effect‐adjusted costs of €849·86 were generated after 8 weeks for treatment with UrgoStart^® versus €1335·51 for the comparator resulting in an effect‐adjusted cost advantage of €485·64 for UrgoStart^®. In linear sensitivity analyses, the outcomes were stable for varying assumptions on prices and response rates. In an 8‐week period of treatment for vascular leg ulcers, UrgoStart^® shows superior cost‐effectiveness when compared with the similar neutral foam dressing without any active component (NOSF). As demonstrated within a randomised, double‐blind clinical trial, UrgoStart^® is also more effective in wound area reduction than the neutral foam dressing. Wound healing was not addressed in this clinical trial. Follow‐up data of 12 months to allow for reulceration assessment were not generated.     

兼顾效率与公平的中国卫生资源配置:问题发现及政策路径

目的:探讨卫生资源公平且有效率的配置方式,促进居民公平有效分享公共卫生资源。方法:基于我国31个省级区域2010~2014年的数据,通过超效率DEA模型测算各地区卫生资源配置效率,以各地医疗卫生机构获得的人均财政补贴收入来考察卫生资源配置的公平情况,对卫生公平和效率进行静态差异分析和动态固化分析。结果:无论是地区之间还是内部,我国卫生资源公平的差异程度以及固化程度都比效率大,卫生资源存在不公平和不合理两大问题。结论:中央政府应加大卫生资源调节力度,精准扶持那些"低公平、高效率"的地区,并形成稳定的激励机制。     

全膳食中放射性核素的γ能谱测量方法研究

目的 建立一套HP Geγ能谱仪测量全膳食中放射性核素活度浓度的方法。方法 利用"双份饭法"收集全膳食样品后,用BE 5030型宽能HP Geγ能谱仪进行测量。以大米粉标准源验证无源效率刻度的可靠性后,采用LabSOCS软件进行效率刻度,并计算样品中放射性核素的活度浓度和日均摄入量。结果 无源效率刻度验证结果在可接受范围内,所分析样品中均检测出了天然放射性核素²²⁶Ra和⁴⁰K,平均活度浓度分别为0.31和141 Bq/kg（干重）,日均摄入量分别为0.21和95 Bq/d;部分样品检出了²¹⁰Pb和²²⁸Ra;均未检出²³⁸U和人工放射性核素¹³⁷Cs。结论 基于LabSOCS软件的无源效率刻度方法能较好的模拟全膳食样品的探测效率,可以用于全膳食样品的效率刻度。样品中的所检测的放射性核素活度浓度均在国家标准限值内。解决全膳食样品不易混合均匀的制样方法以及"全膳食基质成分库"的建立有待进一步研究。     

抑郁症患者脑结构网络效率属性及与疾病严重程度的相关分析

目的 探讨抑郁症患者与健康对照者脑结构的网络效率及节点效率属性的异同,分析抑郁症患者大脑全局信息处理模式和脑区间信息整合效率的改变,及其与疾病严重程度的关系.方法 对27例抑郁症患者(抑郁症组)和36名健康对照者(对照组)进行弥散张量成像扫描,利用解剖学自动标记模板将整个大脑划分为90个区域,同时对全脑进行确定性纤维追踪,构建脑结构二值化网络.并对所得抑郁症组与对照组脑结构网络的效率属性值进行双样本t检验.结果 (1)2组脑网络分别与相匹配的随机网络比较:网络全局效率均与随机网络相似;网络局部效率均大于随机网络.(2)抑郁症组网络全局效率(0.86±0.01)较对照组(0.87±0.01)下降(t=-2.31;P =0.02).(3)抑郁症组节点全局效率属性值较对照组(右侧额上回眶部:0.41±0.04与0.44±0.02;左侧颞中回颞极:0.31 ±0.02与0.33±0.03)下降(t=-3.52、-3.84;P=0.0008、0.0003;通过多重校正).(4)抑郁症组右侧额上回眶部全局效率属性值与HAMD17总分呈负相关(r=-0.46,P=0.02).结论 抑郁症患者与健康人大脑都具有高效经济的“小世界”式的信息处理模式.抑郁症患者脑区间信息整合的能力已受损,且与疾病严重程度呈负相关.     

595nm脉冲染料激光治疗皮肤血管性疾病的疗效

目的 探讨595 nm脉冲染料激光（pulsed dye laser,PDL）治疗皮肤血管性疾病的疗效和不良反应,并分析与疗效相关的因素.方法 采用595 nm PDL治疗血管瘤、鲜红斑痣、毛细血管扩张、酒糟鼻、蜘蛛痣等各类皮肤血管性疾病572例,对比不同病变的治疗效果及不良反应,分析疗效与患者性别、年龄、病变类型、病灶部位等因素的相关性.结果 治疗疗效与患者年龄、疾病性质、部位等因素相关（P＜0.05）,与性别无明显相关性;治疗后不良反应率为2.27％.结论 595 nmPDL治疗皮肤血管性疾病安全性高,疗效良好,不良反应低,是目前较为理想的治疗方法.     

如何提高农村基层医疗服务的效率和质量——宁夏新农合门诊按人头预付制改革设计与效果

本研究以宁夏回族自治区为案例,针对村医经济激励水平低下,按项目付费引发不恰当诊治行为,系统内缺乏引导供方提高自身服务效率和质量并促进服务与体系整合协调的经济激励等问题,从供方合理激励的角度出发,对新型农村合作医疗支付制度进行改革设计——以乡村为整体对乡镇卫生院和村卫生室提供的门诊服务实施基于绩效的按人头预付制。随后利用配对整群随机试验设计对改革效果进行评估和检验。研究发现,这一支付制度的实施有效降低了农村基本医疗服务中抗生素的使用率,优化了供方的处方行为,对降低村卫生室的单次门诊费用有一定作用,并且促进服务向村卫生室下沉。本文的政策分析和设计思路及严格的政策评估结果可以为我国支付制度的选择和发展提供政策参考和证据支持。     

十二指肠非壶腹部神经内分泌肿瘤内镜下切除的回顾性研究

目的 评价内镜超声检查术（EUS）判断十二指肠非壶腹部神经内分泌肿瘤大小和浸润深度的准确性，并对比内镜黏膜下剥离术（ESD）和改良ESD治疗十二指肠非壶腹部神经内分泌肿瘤的有效性和安全性。方法 以2007年1月至2018年1月于中国人民解放军总医院接受ESD（ESD组）或改良ESD（改良ESD组）治疗的22例十二指肠非壶腹部神经内分泌肿瘤患者为研究对象，回顾性纳入患者临床资料。22例患者中，13例行ESD,9例行改良ESD。对比分析ESD组和改良ESD组整块切除率、R0切除率、手术时间、手术相关并发症发生率等指标。以术后病理结果为金标准，评估术前EUS判定病变大小和浸润深度的准确率。结果 22例十二指肠非壶腹部神经内分泌肿瘤大小为（6.9±1.5）mm。与术后组织病理学结果相对照，内镜超声评估病变浸润深度的准确性为95.5%（21/22）。ESD组和改良ESD组的R0切除率分别为13/13和7/9（100.0% 比77.8%, P=1.000）。改良ESD组在手术时间上显著短于ESD组[（16.0±2.2） min 比 （29.8±4.9）min，P<0.001]。ESD组发生1例术中穿孔和1例迟发穿孔，改良ESD组发生1例迟发出血。术后22例患者均成功进行了随访，随访时间为(30.0±24.8)个月。随访期间无患者发生局部复发或者远处转移。结论 内镜超声可以准确评价十二指肠非壶腹部神经内分泌肿瘤的大小和浸润深度。对于直径≤10 mm，浸润深度局限在黏膜下层的十二指肠非壶腹部神经内分泌肿瘤，改良ESD可以获得与ESD相当的临床治疗效果。