门诊肝病患者就诊需求及管理对策

目的探讨门诊肝病患者就诊需求及管理对策。方法应用自行设计的门诊患者就诊需求调查表对130例肝病患者进行问卷调查。结果门诊肝病患者对就诊流程的满意度不高，41．5％选择一般；对就诊环境和硬件的满意度仅为53．8％；对健康指导的需求度高，为78．5％，且对健康教育方式的需求多种多样。结论门诊肝病患者就诊需求是多方面的，当前的现状未能满足其需求。从患者角度出发，优化就诊流程；改善就诊环境，提升门诊硬件设备；加强门诊护理管理，提高护士素质；进行全方位多角度的健康教育是门诊护理工作的发展方向。     

无接触智慧门诊就诊流程优化及实施效果

目的 探讨优化后的无接触智慧门诊运行效果,为进一步完善就诊流程提供依据.方法 在医院信息系统中的门诊系统基础上优化就诊全流程、全环节,包括线上挂号、择医、预约,智能就诊,集成信息管理等.实施1年后选取其中6个月(2020年7～12月)与优化前同期(2019年7～12月)比较效果.结果 与优化前比较,优化后门诊月均公众号...     

门诊复诊患者分时预约就诊的实践

目的缩短门诊患者候诊的时间,提高护理服务质量。方法在口腔科门诊实施分时预约就诊服务,包括周密计划、广泛宣传,制定流程和制度并实施。结果门诊分时预约服务1年后,患者挂号和候诊时间缩短,满意度显著提高(均P<0.01),护理质量指标提升。结论门诊分时预约就诊,可节省患者候诊时间,提高患者满意度和医疗资源利用率,提高医疗护理质量。     

门诊患者就诊一卡通的应用与管理

目的 探讨门诊就诊一卡通的应用与管理方法.方法 在建立门诊医生站的基础上,由计算机中心与银联合作,建立门诊患者就诊一卡通系统,具有建卡、挂号(包括预约取号)、充值、支付、查询、打印报告等功能.同时,合理布局,科学筹划,建立相应的规章制度和流程,广泛宣传、加强培训,设立试点,启动志愿者服务,加强科室间沟通等管理制度.结果 实施1年后,门诊量、患者满意度及优质护理服务质量显著提升(均P＜0.01).结论 建立门诊患者就诊一卡通,可改善患者的就医环境和就医体验,加快就诊速度,有效提高门诊患者的满意度和服务质量.     

对门诊输液患者健康需求的调查与分析

目的:探讨门诊输液患者对健康知识的需求与护理对策。方法:采用自行设计健康需求内容,对门诊输液患者进行随机问卷调查。结果:100%的患者认为有必要在静脉输液时进行健康教育,对健康宣教的需求多样化。结论:患者对静脉输液知识的缺乏造成不必要的痛苦,不仅要加强对患者静脉输液的健康知识宣传,还要加强采取对患者健康需求的措施。     

整形美容外科门诊的护理管理特色

门诊是重要的服务窗口,整形美容外科门诊护士的整体形象及服务水平直接影响到就诊患者的情绪和接诊质量。如何应对激烈的竞争,留住患者,充分发挥正规医疗单位的设备、技术、人才优势,是对我们护理工作者新的挑战。针对专科门诊护理工作的特点,在以患者为中心的整体护理思路指导     

多次急诊就诊老年患者的家属需求调查分析

目的了解多次急诊就诊老年患者家属的需求现状,更好地推进急诊优质护理服务。方法采用自行设计的急诊家属需求问卷对101名多次急诊就诊的老年患者家属进行调查。结果家属的需求依次为确保患者安全(85.58%),自身舒适(81.93%),获得健康教育(80.14%),获得关心与支持(77.62%)。结论护士应给予家属特殊关注,主动进行心理护理,有针对性地进行健康教育,并指导其关注自身健康,帮助其提高健康意识。     

白内障患者门诊一站式医护接诊服务实践

目的探讨白内障患者门诊一站式护理服务的实践效果。方法改进白内障患者的入院诊疗流程,明确医护工作职责,建立并实施白内障患者一站式医护接诊服务。结果实施一站式医护接诊服务后,患者就诊满意度显著提升,术前住院天数、平均住院日明显下降。结论实施白内障患者门诊一站式医护接诊服务,提高了医护服务质量和患者就诊满意度。     

门诊静脉输液患者的需求调查及护理措施(附880例)

目的:根据对本院门诊部门静脉滴注输液患者采取不同的护理过程,对患者输液过程中的具体需求以及改进措施进行系统的研究与探讨.方法:此次门诊医学护理实验活动选择的研究对象为我院门诊部门2010年6月～2011年6月在我院门诊部进行静脉输液患者为基础数据,从中抽取880例,以其原始门诊病例资料为分析的依据.本次门诊输液护理实验,分为两个时段,将2010年6月～12月定为问题搜集阶段,主要由有关部门针对我院门诊静脉输液现状,精心设计制定出门诊输液调查问卷以及用户满意度调查表,随机抽选调查门诊输液患者440例,分析患者的门诊输液需求,并总结出门诊输液过程中的问题,制定相应整改护理措施.将2011年1月～6月定为整改阶段,根据输液过程中的问题,实施改进护理措施.同时随机抽选调查门诊输液患者440例,在2011年6月份对患者的需求情况以及满意度情况进行重新调查,对两个阶段的调查结果进行对比.结果:搜集阶段组:440例,发生不良反应10例,发生率2.27％,治疗周期平均(7.23±1.34)天,满意度调查优良率80％(352/440);整改阶段组:440例,发生不良反应2例,发生率0.45％,治疗周期平均(5.14±2.15)天,满意度调查优良率97％(427/440).结论:对门诊静脉滴注患者的需求进行详细的分析,找到门诊输液过程中的问题,加以改进,能够有效提高门诊治疗的康复时间,降低不良反应发生率的出现,得到患者的满意,值得推广.     

宫外孕患者延误就诊原因分析及对策

目的了解宫外孕患者延误就诊的原因，提出护理对策。方法采用自设问卷，对49例宫外孕患者进行访谈式调查。结果延误就诊35例（71．4％）。就诊时间与文化程度、居住地、对疾病相关知识的了解程度及对健康的重视程度有关。延误就诊原因依次为对本病知识缺乏（91．4％）、保健意识缺乏（40.0%）、交通不便（28．6％）、基层医生误诊（14．3％）。结论应加强社区育龄妇女的健康教育工作，使更多的人群了解宫外孕的相关知识，定期体检，积极防治妇科慢性炎症，发现不适及时就诊。     

慢性阻塞性肺疾病患者非住院期间用药状况调查

目的对慢性阻塞性肺疾病（COPD）患者非住院期间用药状况进行调查．为提高患者用药依从性及用药安全提供依据。方法采用自设问卷对100例（COPD患者进行问卷调查。结果COPD患者服用最多的药物为抗生素、祛痰、止喘药等．84．0％患者在家能遵医嘱服药．77．0％自患者出现症状自行服药．40．0％患者服药前仔细阅读药物说明书．47．0％患者定期检查药品有效期．51．0％患者用药过程中出现问题时会主动寻求医护人员帮助。结论COPD患者对用药知识了解不全面．存在服药安全隐患。需加强对患者及其照顾者用药知识教育．使其掌握用药自我管理知识．合理正确用药。     

Demands on surgeons of the Infectious Disease Control Act]

The German Infectious Disease Control Act of 2001 includes a modified regulation for reporting infectious diseases and infectious pathogens and new clauses for surveillance and infection control in medical institutions. For the first time, all health care facilities are obliged to conduct surveillance of nosocomial infections and multiresistant pathogens. This legal regulation including mandatory monitoring by local health departments aims at reducing the rates of nosocomial infection and frequency and dissemination of highly resistant pathogens. This article describes the effect of the Disease Control Act on surgical departments. Surveillance of postsurgical wound infection should lead to better understanding of the cause and effect of nosocomial infection and greater acceptance of high-quality hospital hygiene management.     

Diagnosis and Surgical Treatment of Hepatic Hydatid Disease

In this report, 226 patients with hydatid disease admitted to the Surgical Department of Erciyes University (Kayseri) and Şişli Etfal Hospital (Istanbul) in Turkey between 1978 and 1990 were reviewed retrospectively. 102 patients (45.1%) were male and 124 (54.9%) female. The most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). 167 patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). Patients were operated on by various techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5). Main postoperative complications were wound infection (12%) and biliary fistula (2.6%). Total mortality rate was 1.8% in this series.     

Diagnosis and Surgical Treatment of Hepatic Hydatid Disease

In this report two hundred and twenty six patients with hydatid disease were admitted to the Surgical Department of Erciyes University (Kayseri) and Şişli Etfal Hospital (Istanbul) between 1978 and 1990 and reviewed retrospectively. One hundred and two patients (45.1%) were male and 124 (54.9%) female. In the patients with hydatid cysts the most frequent symptom was right upper abdominal pain (66%). The most frequent signs were hepatomegaly (43.8%) and palpable mass (39%). One hundred and sixty seven patients (73.9%) were examined with ultrasonography which has a diagnostic value of 94%. Preoperative complications were infection of cyst (7%), intrabiliary rupture (3.5%) and anaphylactic shock (0.4%). All patients were operated on by using various surgical techniques; omentoplasty (101), external drainage of residual cavity (64), marsupialization (25), capitonnage (15), introflexion (10), pericystectomy (6), and hepatic resection (5).The main postoperative complications were wound infection (12%) and biliary fistula (2.6%). The total mortality rate was 1.8% in this series.     

Etiopathogenesis of Hepatic Osteodystrophy in Wistar Rats with Cholestatic Liver Disease

The pathophysiology of hepatic osteodystrophy (HO) remains poorly understood. Our aim was to evaluate bone histomorphometry, biomechanical properties, and the role of the growth hormone (GH)/insulin-like growth factor-I (IGF-I) system in the onset of this disorder. Forty-six male Wistar rats were divided into two groups: sham-operated (SO, n = 23) and bile duct–ligated (BDL, n = 23). Rats were killed on day 30 postoperatively. Immunohistochemical expression of IGF-I and GH receptor was determined in liver tissue and in the proximal growth plate cartilage of the left tibia. Histomorphometric analysis was performed in the right tibia, and the right femur was used for biomechanical analysis. The maximal force at fracture and the stiffness of the mid-shaft femur were, respectively, 53% and 24% lower in BDL compared to SO. Histomorphometric measurements showed low cancellous bone volume and decreased cancellous bone connectivity in BDL, compatible with osteoporosis. This group also showed increased mineralization lag time, indicating disturbance in bone mineralization. Serum levels of IGF-I were lower in BDL (basal 1,816 ± 336 vs. 30 days 1,062 ± 191 ng/ml, P < 0.0001). BDL also showed higher IGF-I expression in the liver tissue but lower IGF-I and GH receptor expression in growth plate cartilage than SO. Osteoporosis is the most important feature of HO; BDL rats show striking signs of reduced bone volume and decreased bone strength, as early as after 1 month of cholestasis. The endocrine and autocrine–paracrine IGF-I systems are deeply affected by cholestasis. Further studies will be necessary to establish their role in the pathogenesis of HO.     

布加综合征与肝小静脉闭塞病的鉴别

目的总结布加综合征与肝小静脉闭塞病的区别。方法根据国内外有关布加综合征与肝小静脉闭塞病的研究报道,结合笔者经验,对两者的区别进行综述。结果布加综合征与肝小静脉闭塞病均表现为肝后性门静脉高压症状,后期均可发展为肝硬变。临床上根据两种疾病的不同病因和相应的临床特点,大多数病例可以进行初步的判断和确诊。对于诊断不明确的病例,影像学检查（如彩超检查）可以辅助诊断,但最终的确诊需要肝穿刺活检后的病理学检查。结论布加综合征与肝小静脉闭塞病的病因、临床表现及影像学表现存在一定的差别,可利用这些差别进行鉴别诊断。     

Synchronous Rectal and Hepatic Resection of Rectal Metastatic Disease

Background  

The objectives were to determine the feasibility of combined rectal and hepatic resections and analyze the disease-free survival and overall survival.     

Hepatic Gene Expression of Caucasian and African-American Patients with Obesity-Related Non-Alcoholic Fatty Liver Disease

Background/aim  

There is increasing data suggesting that African Americans with NAFLD tend to have less progressive liver disease. The aim of this study is to assess differences in the hepatic gene expression of African-American and Caucasian patients with NAFLD who had undergone bariatric surgery.     

2706例患儿烧伤原因的调查及防护

为了解儿童烧伤的原因及烧伤与患儿年龄,父母职业、文化程度的关系,对2706例烧伤患儿进行了调查,结果患儿中以热液烫伤为最多,占72．28％;1－3岁年龄段烧伤发生率最高,为70．21％;父母为农民、小学以下文化程度者分别占67．15％和73．21％,提出儿童烧伤以预防为主,必须加强父母的安全意识,对儿童进行安全教育,同时采取有效防护措施。     

Seizure Management in the Setting of Hepatic Disease

In the past 20 years, many antiepileptic drugs (AEDs) have been marketed that are not significantly metabolized by the liver, but some patients still require the use of older and more metabolically complex AEDs for optimal seizure control, and current economic and insurance-coverage limitations have forced many patients to switch to less expensive agents, which are often the older AEDs. For the patient with hepatic disease, it is clearly preferable to use medications with little potential to exacerbate their condition. In my practice, I try to use agents with simpler metabolism, especially for patients with multiple medical problems. Doing this can mean using AEDs in monotherapy that are FDA-approved only for adjunctive use. I also find that older agents and hepatically metabolized AEDs can be the most appropriate for particular patients. Selection of the optimal seizure medication requires consideration of multiple factors, only one of which is the impact on liver function. I routinely obtain an executive laboratory panel at least yearly for even the healthiest of patients, to reassure both the patient and myself that the metabolism of their AED regimen is not significantly affected. Occasionally, a change or abnormality in liver function is identified. Certainly hepatic disease can make epilepsy management more difficult, and communication between the neurologist and the other treating physicians is a necessity, although the neurologist and the hepatologist may have differing opinions on how to respond to worsening liver function. Concern about potential liver damage by AEDs may prompt unnecessary discontinuation, sometimes with disastrous consequences for seizure control. Overly complex AED regimens can cause underlying liver problems to worsen. Clinical observation and judgment must complement the data derived from laboratory parameters. Worsening hepatic disease can also result in encephalopathic states that worsen or mimic seizures. The EEG can often be helpful in differentiating these conditions and is crucial in determining appropriate epilepsy therapy.