北京中医药大学东方医院规模发展战略与多院区管理模式浅析

本文以北京中医药大学东方医院创建"一院三区"布局为例,对中医院"一院多区"的组织结构变革、分院区医疗功能定位、成本预算管控、人员绩效与人才培养、多院区一体化信息平台建设等一系列管理上的重点与难点进行分析与解答,通过总结经验,对"一院多区"的管理模式进行有益探索.     

Impacto de la anemia sobre la supervivencia de los pacientes intervenidos de cistectomía radical por tumor vesical

ObjectiveTo evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer.Material and methodsRetrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male < 130 mg/dL, female < 120 mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates.ResultsOverall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA > 2: 54.6 vs. 27.5%; P = .003), ectasia rate previous to RC (41.6 vs. 19.5%; P = .002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P < .001), blood transfusion rate (25.8 vs. 11.5%; P = .015) and pathological stage (pT > 2: 49.4 vs. 33.3%; P = .03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P = .001), cancer-specific survival (89 vs. 61 months; P = .004) and recurrence-free survival (85 vs. 57 months; P = .002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT > 2 and N ≥ 1 were independently associated with overall mortality.ConclusionPreoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.     

Surgical vs non-surgical management of Weber B fractures: A systematic review

BackgroundThe aim of this systematic review was to compare surgical and non-surgical management of Weber B ankle fractures.MethodsA systematic computer-based search was conducted using the MEDLINE (via OvidSP), EMBASE (via OvidSP) and Central databases. Data were extracted regarding functional outcome, radiological union, range of motion (RoM), infection rate and quality of life (QoL).ResultsThere were no significant differences identified between surgical and non-surgical management of Weber B fractures with respect to functional outcome. There is a higher rate of complication following surgical management, including infection, reoperation, thromboembolic events and death. With respect to QoL and ankle RoM, this review identified no differences between surgical and non-surgical management.ConclusionsThere is a need for further published literature evaluating the most efficacious management as there is a poverty of high-level research available. Currently, the available literature does not overwhelmingly favour a particular approach to Weber B ankle fractures.     

新冠肺炎疫情高峰期医院管理和后勤人员的心理压力评估与分析

目的:评估新冠肺炎疫情大流行高峰期中国医院管理和后勤人员的工作状况和心理压力变化。方法:疫情爆发高峰期(2020年3月)随机向全国各级医院管理和后勤人员发放问卷。结果:回收有效问卷673份,大多数受访者(78.5%)认为在COVID-19流行高峰期工作强度有所增加,较多受访者(39.2%)疫情期间心理压力加大。大多数人(89.60%)通过自我调节来缓解压力,有部分受访者(9.66%)通过专业心理咨询介入来缓解压力。结论:新冠肺炎疫情高峰期医院管理和后勤人员的心理压力普遍增大。除一线医务人员外,还应加强关注医院管理和后勤人员的心理压力。     

护士长对临床护士实行考核管理的探索与实践

目的:探索护士长对护士实行考核的临床实践、效果。方法:制定客观量化考核依据,护士长对护士每月考核1次,年终总评成绩,该护士年度考核分=(该护士全年12个月平均分 附加分)-倒扣分。结果:护士综合素质提高,护理质量提高。结论:护士长在临床对护士实行科学、量化考核管理,是科学的人才管理,是提高组织效率的关键。     

儿童自发性脑出血5例报告并文献复习

目的探讨儿童自发性脑出血的病因、临床表现、影像学特点及诊治方法。方法回顾分析2005年1月至2008年4月收治5例儿童自发性脑出血的临床资料。结果3例脑动静脉畸形，1例烟雾病，1例病因不明。痊愈2例，好转2例，死亡1例。4例随访2个月～3年无再出血。结论脑动静脉畸形是儿童自发性脑出血的主要原因。综合CT、MRI／MRA和DSA所见检查可明确儿童自发性脑出血原因。临床表现和治疗因病因不同而有所差异，早期明确诊断及治疗预后良好。     

新护士长在管理工作中值得重视的问题

探讨新护士长在激烈竞争面前和角色转变中，怎样减少波折，加快成熟步伐，提高管理水平。根据自身和经验体会，认为新护士长在管理中值得重视的问题有：取得领导的支持；增强“非权力性影响力”；立足于管理角色；树正气；以人为本，调动下属的积极性；合理安排人力，用人之长；注意协调部门之间的关系．     

Surgical Management of Resistant Priapism

We report a 31 year old patient, presented with painful erection since 48 hours. There was no known predisposing factor on history and examination. Surgery for priapism is rarely indicated nowadays but conservative management failed to achieve detumescence in our case. So Winter’s shunt surgery was done which failed then a formal shunt was created between corpora cavernosa and spongiosum which also failed to achieve detumescence. After 4 days - a formal left side cavernosa saphenous shunt procedure was done and detumescence achieved within 24 hrs .Follow up showed good results.