基于新政府会计制度探究公立医院财务精细化管理

随着社会的高速发展,政府会计制度不断革新,医院是医疗卫生行业的重要构成部分,应当不断适应社会的发展而改革。基于此,该文以公立医院的财务管理作为分析目标,对公立医院财务管理中已有的问题和未来改善措施进行分析探讨,从而为以后的发展提供意见。     

临床路径教学法在ICU新进护士前3个月护理带教中的应用效果观察

目的探讨在ICU新进护士的前3个月护理带教中,采取临床路径教学法的效果。方法选取该院2016年1月—2018年1月ICU新进的60名护士为研究对象,将护士分成两组,即研究组与对照组,每组30名,对照组采取一对一的护理带教模式,研究组则采取临床路径教学法的护理带教模式,观察两组带教效果。结果护理带教后,研究组护士在理论与操作考核成绩上均要显著高于对照组(P<0.05);研究组新进护士对临床实践能力、应急能力、工作能力及学习兴趣的认可率均显著高于对照组(P<0.05)。结论针对ICU新进护士,在前3个月的护理带教中,实施临床路径教学法的带教模式,可显著提高护士理论与操作能力,且护士对护理带教模式的认可度也高。     

Hypothesis of design of biological cell robot as human immunodeficiency virus vaccine

High genetic variability of human immunodeficiency virus (HIV) has been a major intractable challenge to the practical design of vaccines. But a recent pioneer study published in PNAS Xenobots, is likely to revolutionize HIV prevention as it presented the world's first living robot made of cells. In the advent of this discovery, we herein discuss the possibility of using living biological cell robots to target HIV-infected T lymphocytes, and the prospects of this approach being a new HIV vaccine. We capture the current research status and trend of advances in biological cell robots' design as a new HIV vaccine. The key differences between this novel vaccine and other HIV vaccines are highlighted.     

新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估

目的：探索新产程模式下剖宫产和产钳术对持续性枕后位难产孕妇分娩结局的评估。方法:收集2017年至2020年间于浙江省湖州市妇幼保健院收住入院的103例持续性枕后位难产孕妇, 其中以产钳分娩的60例孕妇为研究组，53例以剖宫产术分娩的孕妇为对照组，评估其分娩结局，分析两种分娩方式对孕产妇的影响。采用χ2 检验比较剖宫产及产钳分娩两组的新生儿窒息、产后出血、产时、产后感染、软产道裂伤（包括会阴III度裂伤、阴道裂伤、宫颈裂伤）、切口预后不良的差异。结果：研究组产后出血、产时发热、产后发热发生率[分别为1.66%（1/60）、1.66%（1/60）、3.33%(2/60），χ2 值分别为（4.514 和5.698、4.826，P值分别为 0.040 和 0.020、0.030）]，明显低于对照组[分别为11.32%（6/53）、13.20%（7/53）、15.09%(8/53）]，但是研究组会阴III度裂伤、宫颈裂伤、阴道裂伤、发生率为分别为[15.00%（9/60）、13.33%（8/60））、（11.66%（7/60）），明显高于对照组（1.88%（1/53）、1.88%（1/53）、3.77%（2/53））]，差异有统计学意义（P值均＜0.05）。但研究组的新生儿窒息发生率及切口预后不良的比例分别为[5（8.33%）、4（6.66%）]，略低于对照组[（6（11.32%）、4（7.54%）]，差异无统计学意义（χ2值分别为0.286、0.233，P 值均＞0.05）。结论：新产程标准下持续性枕后位难产孕妇选择产钳分娩可明显降低产时、产后感染及产后出血的发生率，但软产道裂伤发生率较高，差异有统计学意义。所以持续性枕后位难产孕妇选择产钳分娩是相对比较安全的分娩方式，但同时需要注意软产道裂伤的发生。     

Annular versus supra-annular sizing for transcatheter aortic valve replacement in bicuspid aortic valve disease

BackgroundCT measurement of supra-annular area (SA) has been proposed as an alternative to annular area (AA) for sizing of trancatheter valves in biscuspid aortic valves (BAV). This study examines the reproducibility of SA and AA measurements and their potential impact on downstream transcatheter heart valve sizing and clinical outcomes.Methods44 consecutive patients (mean age: 73 ± 15 years, 57% male) undergoing CTA with subsequent SAPIEN 3 valve insertion for severe bicuspid aortic stenosis (AS) were included. AA was measured at the basal ring. SA was measured by generating a circle defined by the intercommisural distance. AA and SA were measured by 2 independent observers. Baseline characteristics, TAVR procedural data, and discharge echocardiography data were collected.ResultsThe SA was significantly larger than the AA (562 ± 146mm2 vs. 518 ± 112mm2,p = 0.013). Interobserver agreement was high using both techniques (ICC AA = 0.98,p < 0.001; SA = 0.80,p < 0.001), but with narrower limits of agreement with AA measurements (mean difference (limits of agreement): AA = −3mm2 (22; 19), SA = −16mm2 (−92; 76)). AA-based device sizing demonstrated substantial agreement with final valve inserted (κ = 0.72,p < 0.001), while SA demonstrated fair agreement (κ = 0.40,p < 0.001). There was no difference in post TAVR gradients, paravalvular leakage or valve success between patients with concordant sizing between AA and SA, and those in whom SA would have suggested an alternate valve size.ConclusionsSupra-annular sizing is less reproducible than annular sizing, with no difference in procedural complication rates in patients in whom supra-annular sizing would have altered the device size used. These results suggest no role for supra-annular sizing in current clinical practice.     

Management of patients with complex perianal fistulas in Crohn's disease: Optimal patient flow in the Italian clinical reality

Perianal fistulizing Crohn’s disease (PFCD) is a common, disabling and aggressive phenotype that negatively impacts on the quality of life of affected patients. Its successful treatment is still a struggle for both physicians and patients. Significant advances in the management of this condition have occurred in the last two decades holding promise for a better future. This culminated into the concept of a collaborative multidisciplinary approach using the latest medical therapies combined with modern surgical and endoscopic techniques. Despite this, PFCD management and treatment have not been standardized yet. Thus the gastroenterologist and surgeon have to be familiar with several approaches and/or techniques. The positioning of each therapeutic option will certainly evolve with new data, but for the time being it should be driven by patient’s characteristics, physician’s preference and/or experience, costs and availability in local practice. Additionally, patient’s perception of benefits and risks of treatment may differ from those of physicians and recognition of this difference is a starting point for difficult clinical decision-making.In this paper, a multidisciplinary group of Italian IBD experts explore and discuss current medical and surgical therapeutic options, highlighting areas of unmet needs in PFCD, with particular focus on the optimal patient flow within the Italian clinical reality.