运用PDCA循环持续推进科室质量规范化建设

为了探讨PDCA在科室质量规范化建设中的应用,本研究以科室质量小组为抓手,科学开展Plan、Do、Check、Action阶段管理,通过现状分析进行工作筹划,采用加强管理机制、细化质量活动范畴、加强质量管理宣贯、规范质量改进项目、创新信息化管理等措施,开展质量持续改进工作。以质量监管"大环"运作,带动科室质量"小环"运转。通过一系列整改,医疗质量指标稳步提升,科室规范化发展,形成了一系列制度、流程和规范,安全文化氛围日渐浓厚。医院构建专业化质量管理模式,深化质量管理教育,加大质控信息化建设,可推动医疗质量持续改进。     

The Correlation of Indices in r-TEG with Intra-operative Blood Loss in Neurosurgical Patients

Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography (r-TEG) is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage. Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests (CCTs). Patients' information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman's correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change ofα-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly (P=0.013,r=?0.184), thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased,α-angle decreased, and every 1% loss of estimated blood volume (EBV) led to0.60 degree decrease ofα-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss (P=0.015 and P=0.001, respectively). Conclusions Peri-operative change ofα-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.     

初创社科类英文学术期刊国际影响力提升的探索与实践——以Financial Innovation为例

【目的】 探讨如何在稿源欠缺、显示度低、参与度差的情况下快速有效提升我国初创社科类英文学术期刊的国际影响力。【方法】 结合数据统计分析,结合《金融创新》(Financial Innovation)实际案例,归纳初创英文学术期刊提升国际影响力的途径及方法。【结果】 《金融创新》创刊5年中,跨越式实现从无到有,再到进入SSCI检索并进入学科Q1分区的进步。【结论】 前沿专刊筹措、邮件精准推广、期刊数据库挖掘是初创英文学术期刊在有限资源下取得突破、提升国际影响力的重要路径。     

A Best Practices Approach to Caries Management

Caries management by risk assessment represents best practices and is an evidence-based model that focuses on treating and preventing disease at the patient level rather than a surgical/restorative approach at the tooth level.BackgroundDental caries is a multifactorial, biofilm and pH mediated disease that affects people of all ages and disproportionally affects certain populations at epidemic proportions. Simply restoring cavitated teeth does nothing to resolve the disease. At the heart of the CAMBRA philiosphy is identifying the patient's unique risk level for future caries disease. This can be done by completing a caries risk assessment (CRA). Several easy to use CRA questionnaires are available. Once the patient's unique risk level has been determined, preventive and therapeutic interventions, based on the specific risk level, can then be implemented.MethodsLandmark publications, original research, and systematic reviews are analyzed and reviewed to form the basis for this shift in patient care related to caries disease.ConclusionsCaries management by risk assessment has emerged as the new paradigm in patient care and represents an evidence-based, best practices approach with the potential for significant advantages over traditional methods.     

Decisional Control Preferences,Disclosure of Information Preferences,and Satisfaction Among Hispanic Patients With Advanced Cancer

ContextStudies to determine the decisional control preferences (DCPs) in Hispanic patients receiving palliative care are limited.ObjectivesThe aims of this study were to describe DCPs, disclosure of information, and satisfaction with decision making among Hispanics and to determine the degree of concordance between patients' DCPs and their self-reported decisions.MethodsWe surveyed 387 cancer patients referred to outpatient palliative care clinics in Argentina, Chile, Guatemala, and the U.S. DCPs were measured with the Control Preference Scale, disclosure preferences with the Disclosure of Information Preferences questionnaire, and satisfaction with care with the Satisfaction with Decision Scale.ResultsIn this study, 182 patients (47.6%) preferred shared decisional control, 119 (31.2%) preferred active decisional control, and 81 (21.2%) preferred a passive approach. Concerning their diagnosis and prognosis, 345 (92%) patients wanted to know their diagnosis, and 355 (94%) wanted to know their prognosis. Three hundred thirty-seven (87%) patients were satisfied with the decision-making process. DCPs were concordant with the self-reported decision-making process in 264 (69%) patients (weighted kappa = 0.55). Patients' greater satisfaction with the decision-making process was correlated with older age (P ≤ 0.001) and with a preference for enhanced diagnostic disclosure (P ≤ 0.024). Satisfaction did not correlate with concordance in the decision-making process.ConclusionThe vast majority preferred a shared or active decision-making process and wanted information about their diagnosis and prognosis. Older patients and those who wanted to know their diagnosis seemed to be more satisfied with the way treatment decisions were made.