日间手术治疗模式的效果评价及影响因素分析

日间手术治疗作为一种新型医疗模式,它的发展日益引起人们的关注,但针对日间手术的评价尚不够全面,建议从多维度相关者评价、全面的卫生经济学评价、纳入医生绩效考核3方面建立完善的日间手术评价指标及体系,指出患者、医院和政府成为影响目前日间手术发展的制约因素。     

An ambulatory program for surgical residents and medical students

Teaching in the ambulatory setting is important for medical educators because of the economic, social, and medical trends that are pushing patients into this health care setting. While medical education in the hospital setting maintains its important role, education in ambulatory care demands innovations and new strategies. A pilot program based in a freestanding ambulatory surgery center has been developed as part of a surgical residency training program. In the present article, the author describes the program, outlines its curriculum, and details the daily activities of the residents and medical students. A brief history of ambulatory surgery is given.     

大型综合医院日间手术信息管理平台应用探讨与实践

目的:构建医院日间手术管理平台,实现日间患者集中管理。方法:梳理日间手术业务流程,明确各部门职责,整合HIS、LIS、PACS、EMR、手麻系统等医院业务系统,以达到从门诊的准入、病房的收治、术前麻醉评估、核对宣教、病房预约和手术预约排程到入院后随访计划等日间手术患者全流程管理。结果:平台上线以来,缩短住院日,实现病区床位真正意义上的公共平台式管理,落地了医院日间病房的精细化管理理念。结论:科学的日间手术信息管理平台的应用有助于优化医院日间手术管理水平,促进日间手术管理工作的顺利进行。     

日间手术麻醉新进展

日间手术具有费用低、患者住院时间短等许多优点。日间手术麻醉要求作用迅速、过程平稳,麻醉后苏醒早、恢复快、不良反应少。近年来日间手术逐渐被国内患者接受,手术的种类和麻醉的数量均有较大增长。该文总结了国内外相关的临床经验,从患者的选择与准备、常用的麻醉方法以及术后处理等方面简要介绍日间手术麻醉近几年的进展。     

The evolution of sites of surgery

The shift to ambulatory surgery has taken decades. The history and causation of the move are complex. Key enablers are recounted. The complex interchange of ideas, and physicians, between Belfast and Boston was important in the development of relevant facilitating standards. US and UK governmental and hospital statistics in the increase of ambulatory surgery are presented. The transition of surgery away from hospitals was not all plain-sailing. Insurance companies, governments and hospital administrators hindered and then acquiesced. The shift to ambulatory surgery has not resulted in increased patient morbidity and mortality.     

基于院内网的信息资源库在普外科数字化手术教学中的应用

围绕手术教学的特点,阐述数字化学习理念及其在普通外科手术教学中的独特优势。介绍基于院内网的普外科手术教学信息资源库的构建方案,及其在普外科数字化手术教学中的应用过程及评价方法,并对初步应用效果进行评价,旨在改善普外科手术教学效果。     

基于MDT的小班授课在普通外科住培带教中的应用研究

目的 本研究旨在评估多学科协作诊疗（multi-disciplinary treatment,MDT）模式结合小班授课对普通外科住培医师获取专业知识、掌握临床技能以及整体学习体验的影响。方法 选取2023年1至8月在普通外科轮转的2021级住培医师共60名,分为MDT教学组（n=30）和传统教学组（n=30）。所有住培医师在入科前进行一次理论测试及Mini-CEX技能考核,并比较两组入科前的理论测试成绩及Mini-CEX技能考核成绩。随后进行分组教学,其中MDT教学组针对胃肠道肿瘤采用MDT模式进行小班授课;传统教学组即以传统的“一带一”方式进行日常教学。住培轮转结束时,比较两组住培医师的理论考试成绩、技能操作考核情况以及对教学满意度的评价。采用SPSS 26.0进行统计学分析。结果 两组住培医师在入科前的理论考核成绩及Mini-CEX技能考核成绩差异均无统计学意义（P>0.05）。带教后,MDT教学组理论考试成绩（88.15±3.45）相对于传统教学组（72.25±4.36）更高,差异具有统计学意义（P<0.05）。MDT教学组Mini-CEX技能考核成绩（86.35±2.24）相对于传统教学组（76.28±3.92）更高,差异具有统计学意义（P<0.05）。问卷调查结果显示,MDT教学组住培医师对MDT小班授课教学满意度更高,对教学效果的评价也更好。结论 基于MDT模式的小班授课有利于提高普通外科住培医师胃肠道肿瘤的规范化培训质量,且住培医师的接受度更高,是住培教学有益的尝试。     

现代医学模拟中心的分类及规划

医学模拟实验室是指借助模拟技术和仿真手段营造出一个真实的临床操作环境,为医学生实习、全科医生及专科医生的培训提供一个有效的实践场所.医学模拟实验室分为临床技能实验室、专科技能培训中心、医疗模拟中心和模拟医院,其建立需遵循教学实践,工程施工空间分配,人员配置,资源选用等原则.科学地建立临床模拟试验室需要医学、教育、管理、工程等学科的理论,它为医学教育提供了有效的辅助.     

科学思维在耳鼻咽喉头颈外科教学中的意义和应用

科学思维是医学工作者必备的核心素质.耳鼻咽喉头颈外科是一门多学科交叉、专业性极强的临床学科,医生需要强有力的科学思维能力支撑,因此科学思维训练是其教学中必不可少的重要环节.在耳鼻咽喉头颈外科临床教学中,探索实践了以启发学生发现提出问题为基础的多种教学方法对学生进行系统的科学思维训练,以激发学生科学研究的兴趣,提高学生的...     

Ambulatory Goeckerman treatment of psoriasis: experience with 200 patients.

At a psoriasis day care centre 200 patients were treated with an ambulatory Goeckerman regimen, 25 of them twice, because of recurrence. This treatment consists of the application of a coal tar preparation at home at bedtime, followed the next day by exposure to high-intensity short wavelength ultraviolet radiation (UVB) at the centre. Treatment was given 5 days a week for 1 month. The psoriasis cleared in 86% of the patients after a mean of 21.6 UVB treatment sessions. The mean length of remission was 5.1 months, but at the time of follow-up 15 patients were still free of psoriasis. Compliance with the regimen was good to excellent in 94% of the patients. In our hands ambulatory treatment of psoriasis is much less expensive than hospital treatment and gives better results than photochemotherapy.     

Life satisfaction across treatment methods for patients with end-stage renal failure

After a report which challenged the generally-held view that renal-transplant recipients have a psychological advantage compared with patients who undergo dialysis, we surveyed the quality of life and psychological distress in all patients who were managed by renal transplantation or dialysis at The Royal Newcastle Hospital Renal Unit. A questionnaire was mailed to patients which covered demographic daily illness severity; the quality of life (satisfaction with life in general, general health, and sexual, family and social relationships); a 28-item general-health questionnaire; a life-event schedule; and a locus-of-control scale. The response rate was 88%. Data were obtained on 138 subjects of whom half (69 subjects) were renal-transplant recipients. The other 69 patients were divided between those who underwent haemodialysis at home (24 patients); those who underwent haemodialysis in a hospital centre (24 patients); and those who underwent continuous ambulatory peritoneal dialysis (21 patients). The study showed that while transplant recipients rated highest in the various aspects of quality of life, that of patients who underwent haemodialysis at home was nearly equivalent. Although patients with continuous ambulatory peritoneal dialysis were ranked third in terms of their quality of life, this clearly exceeded that of the group that underwent haemodialysis in a hospital centre, which generally shared very-similar demographic characteristics. Contrary to general expectations, no clear difference was found across the four treatment modalities in the proportion of patients who were disturbed psychologically or who had a history of treatment for "nervous" problems. The results confirm the superiority of renal transplantation in the treatment of end-stage renal disease but highlights the role of continuous ambulatory peritoneal dialysis as a well-tolerated alternative in the treatment of end-stage renal disease.     

An overview of cleft care in Nigeria

This is an overview of the present state of cleft lip and palate care in Nigeria. The aim is to stimulate further discussions on the need to improve standard of care and quality of life in patients with cleft lip and palate deformities. The number of cleft surgeries and surgeons involved in cleft repairs across Nigeria is increasing due to availability of free treatment grants provided by non-governmental organisation; therefore, it has become imperative to assess the quality of surgery and quality of cleft care. It is expected that as the number of repaired cleft lip/palate increases, more patients will require secondary repair, speech therapy, and orthodontics therapy and orthognathic surgery. The following recommendations are made to improve the standard of cleft care in Nigeria: establishment of multidisciplinary team approach, formulation of policy on quality control, establishment of fellowship training in cleft care and establishment of regional specialised cleft care centre.     

The characteristics of training in ambulatory medicine in U.S. residencies

To determine the characteristics of training in ambulatory internal medicine, all internal medicine residency programs in the United States were surveyed in 1981-82. Thirty-eight percent of 477 hospitals responded. Quantitative information was sought regarding the specific features of the ambulatory residency programs, formal teaching conferences, supervision of residents, and evaluation of residents in ambulatory care. According to the responses, the training of the small cadre of primary care residents does emphasize ambulatory medical experience, supervised by an increasing number of faculty members in general medicine. Formal post-clinic conferences, analogous to inpatient attending rounds, are held substantially more often in hospitals with primary care programs than in hospitals without primary care programs. Formal ambulatory teaching conferences stress both traditional topics important in internal medicine and psychosocial issues. However, the authors could detect little effect of these activities in primary care programs on the training of traditional internal medicine residents even within the same hospital.     

应用“标准化病人”对培养医学生医患沟通技能的一点体会

标准化病人（Standardized Patient,SP）在我国临床教学中的应用尚处于起步阶段。本文通过对我院近年来应用SP教学考核实践总结,探讨了应用标准化病人对培养医学生医患沟通技能的经验及存在问题。     

Nurse practitioners in primary care. VI. Assessment of their deployment with the Utilization and Financial Index.

The impact of multidisciplinary teams that incorporate nurse practitioners on total use of health services was measured with the new Utilization and Financial Index (UF-Index). The data from two studies, a randomized controlled trial and a before-and-after study, showed that, in spite of large increases in use of ambulatory services by practice populations served by family physician-nurse practitioner teams, the ultimate effect has been a substantial reduction in total use of health services. The effect was associated with major reductions in hospital care for the same populations. Such economic advantages to society proved feasible within a fee-for-service context and in settings where rigorous evidence demonstrated no concurrent deterioration in health status of patients or in quality of care.     

Unanticipated admission to the hospital following ambulatory surgery

We conducted a case-control study to identify clinical and demographic risk factors for admission to the hospital following ambulatory surgery. Of 9616 adult patients who underwent ambulatory surgery at a university-affiliated hospital between 1984 and 1986, one hundred were admitted. The most common reasons for admission were pain (18), excessive bleeding (18), and intractable vomiting (17). The mean age (+/- SD) of patients who were admitted was 37 +/- 13 years, and 96% had American Society of Anesthesiologists' physical status scores of 1 or 2. Factors that were independently associated with an increased likelihood of admission were general anesthesia (odds ratio, 5.2), postoperative emesis (odds ratio, 3.0), lower abdominal and urologic surgery (odds ratio, 2.9), time in the operating room greater than 1 hour (odds ratio, 2.7), and age (odds ratio, 2.6). Our results indicate that the likelihood of unanticipated admission is related more to the type of anesthesia and surgical procedure rather than to the patient's clinical characteristics.     

浅谈提高外科手术学教学质量

外科手术学教学是医学教学中的一个重要环节,通过外科手术学教学,使学生建立起严格的无菌观念和熟练的手术基础操作,学会外科洗手、穿无菌手术衣和戴无菌手套等基本操作技能,并培养学生在手术过程中的相互协作精神,为临床实习及毕业后的临床工作打下基础。外科手术学教学的内容和方法亟持改革,将外科手术学与临床外科实践相结合,对于培养合格的高素质医学人才具有重要意义。     

Concerns about increasing use of ambulatory care raised at QMA annual meeting.

Quebec Health Minister Dr. Jean Rochon is pushing for a regionalized health care system that favours ambulatory care, day surgery and home care over hospital admissions and acute care in hospital. The Quebec Medical Association is concerned these changes will lower the quality of care in the province.     

Use of the hospital in a randomized trial of prepaid care

Health maintenance organizations (HMOs) achieve their cost savings through lower rates of hospital admissions. To determine whether HMOs selectively avoid discretionary hospitalizations, medical records were reviewed from a randomized trial where families were assigned to either HMO or free-for-service care. Physicians who were blinded to system reviewed 244 medical records and judged the appropriateness both of the hospital setting and of the medical indications for hospitalization. The rate of discretionary surgery was lower in the HMO, while the rate of nondiscretionary surgery was equivalent in the two systems. For medical admissions, rates of discretionary and nondiscretionary admissions were lower in the HMO. There were no observable adverse effects on health from the lower rates of nondiscretionary hospitalization, either because the net effect on health was small or because the HMO substituted appropriate ambulatory services. We conclude that HMO reductions in hospitalization rates do not occur "across the board"; discretionary surgery is selectively avoided.     

加速康复外科理念在胸外科临床实践指导的瑞金医院专家共识

加速康复外科的理念自1997年被提出后,已被广泛应用于胸外科等领域。通过外科、麻醉、护理、康复、营养等多学科协作,基于循证医学证据,采用一系列围手术期优化处理措施,减少患者的生理和心理创伤应激,从而达到缩短住院时间、减少并发症发生、加速术后康复的目的。本文结合多学科专家意见,总结瑞金医院胸外科在ERAS理念下开展的一系列临床实践,以供各位学者参考。