新生儿科医院感染预防控制的研究进展

医院感染是指入院时不存在、又不处于潜伏期,而是在住院过程中获得的感染,也包括在医院获得感染出院后才出现症状者。新生儿科是医院感染高危区,新生儿由于器官功能发育未完善、免疫功能低下、对疾病的抵抗力较弱,很容易在医院内获得感染性疾病。因此,研究新生儿医院感染的现状及其危险因素,有针对性提出预防和控制措施,将有助于进一步降低新生儿的医院感染率。     

品管圈活动在降低老年创伤患者术后肺部感染中的应用

肺部感染是老年创伤患者术后最常见的并发症,有资料显示多发伤的患者并发肺部感染发生率为21～34％。并发肺部感染后,不仅会加重患者的病情,延长住院时间,浪费卫生资源,甚至导致患者死亡。     

生物检验在医院感染控制中的作用

医院感染在世界各国普遍存在。在医院感染控制中，微生物检验发挥着重要作用：1）对各种临床标本及时做出正确的病原诊断；2）进行细菌耐药性、感染源及易感人群监测；3）通过提高消毒和灭菌质量控制医院感染。     

目标管理在医院感染预防和控制中的应用

目的探讨目标管理在医院感染预防和控制中的应用及效果。方法包括制定目标,落实责任,目标实施,目标结果的考核评价等。结果 2011年采用传统监管办法,医院感染发生率为0.83%,2012年实施目标管理后医院感染的发生率为0.44%,目标管理取得明显效果。结论应用目标管理法能有效预防和控制医院感染的发生。     

医院感染控制的发展

随着现代医学科学技术的不断发展,医院感染管理工作己成为评价医院医疗质量的重要标志之一。发生医院感染不但会增加患者和医院的经济负担,还给患者带来极大的痛苦,甚至危及生命。它严重制约着医疗质量的提高,也是产生医疗纠纷的焦点之一。因此,控制医院感染、加强医院感染管理,是医院管理者及医务人员研究的重要课题。1对医院感染的认识医院感染是指住院病人在医院内获得的感染,包括在住院期间发生的感染和在医院获得出院后发生的感染;但不包括入院前已开始或入院时已处于潜伏期的感染。医院工作人员在医院内获得感染也属医院感染。医院感…     

感染监控管理制度在控制医院感染中的作用

医院感染监控管理是当前医院医疗质量管理的一项重要内容，是一个涉及面宽、影响面大的综合概念。因此，强化医院感染监控管理既要涉及到医院管理的方方面面，包括医院建筑、组织机构建设和制度建设等，又要涉及医院感染监控设备与技术的诸多方面，包括队伍建设、检测设备和业务建设方面。这些监控管理建设的优劣都与医院感染发生关系紧密。     

品管圈活动在心脏外科手术患者护理中的应用效果分析

目的分析品管圈活动在心脏外科手术患者护理中的应用效果。方法选取2015年2月—2016年2月在恩施州中心医院心胸外科行心脏外科手术患者200例,采用随机数字表法分为对照组和观察组。对照组患者采用常规护理,观察组患者采用品管圈活动护理。比较两组护理人员护理质量(护理文书书写合格率、基础操作合格率、常规器械消毒灭菌合格率)、患者护理满意度(住院病房、护理态度、护理服务技术、健康宣教)、护理人员综合能力(团体责任心评分、凝聚力评分、工作积极性评分、沟通能力评分、自信心评分、解决问题能力评分)。结果观察组护理人员护理文书书写合格率高于对照组(P<0.05);两组护理人员基础操作合格率、常规器械消毒灭菌合格率比较,差异无统计学意义(P>0.05)。观察组患者住院病房满意度、护理态度满意度高于对照组(P<0.05);两组患者护理服务技术满意度、健康宣教满意度比较,差异无统计学意义(P>0.05)。观察组护理人员团体责任心评分、凝聚力评分、工作积极性评分、沟通能力评分、自信心评分、解决问题能力评分高于对照组(P<0.05)。结论品管圈活动在心脏外科手术患者护理中的应用效果良好,能有效提高护理人员综合能力和患者满意度。     

品管圈活动在糖尿病护理风险管理中应用探究

目的在降低糖尿病护理风险的管理中,对开展品管圈活动的应用效果进行探讨。方法建立健全品管圈活动小组,活动前,识别和评估糖尿病(diabetes mellitus)是护理风险要素,确立的主题是减少糖尿病(diabetes mellitus)护理风险管理,对有关质量提升工作进行开展。结果开展品管圈活动之后,病室保管胰岛素(insulin)由83.9%的合格率提升至96.8%,医院护理工作人员测定末梢血糖由92.9%的操作合格率提升至99.6%,在考核中,整个医院护理工作人员糖尿病(diabetes mellitus)知识掌握情况显著提升,由73.8%的优秀率提升至92.9%,糖尿病护理不良事件发生数,由2013年6起减少到2014年2起,糖尿病病人知识掌握大幅提高,由2013年8l%的掌握率提升至2014年的9l%。结论品管圈活动在糖尿病护理风险管理中,提高了护理质量,具有推广意义。     

医院感染控制的前瞻性调查

为及时了解和控制医院感染的发生，我院于2002年1月开始对住院病人开展前瞻性调查，即主动、连续不断地观察住院病人中医院感染发生、分布及其影响因素的全过程，并对调查资料进行系统分析，采取有效措施，以达到控制医院感染的目的。     

护理工作与医院感染控制

预防和控制医院感染是保证医疗质量和医疗安全的一项非常重要的工作,是医院护理质量的综合体现,随着医学技术的发展,医院感染防控工作面临越来越多的挑战,新的病原体、多重耐药茵感染的不断增多,侵入性诊疗技术的广泛应用,尤其是抗生素的广泛应用,使医院内感染日趋严重,医院感染的防控及管理已成为医院管理的重中之重,而多数预防医院内感染的措施均贯穿护理行为的全过程,涉及到护理工作的诸多方面,我院重视护理工作管理,注重培养高素质的护理人员,护理工作对预防医院内感染的发生,起到了重要的作用。     

加味四逆泻心汤对胃癌根治术后患者的疗效观察

目的观察中药加味四逆泻心汤预防胃癌根治术后复发转移的临床疗效。方法将52例胃癌根治术后患者随机分为处理组和对照组,处理组治疗采用加味四逆泻心汤合并FOLFOX4方案化疗,对照组采用FOLFOX4方案化疗,观察两组半年、1、2、3年累计生存率及复发转移率。结果处理组2、3年累计生存率均显著高于对照组(P0.05);处理组1、2、3年累计复发转移率均显著低于对照组(P0.05)。结论加味四逆泻心汤可以通过降低胃癌根治术后的复发转移,提高生存率。     

Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations

R a d i c a l g a s t r e c t o m y w i t h a n a d e q u a t e l y m p h-adenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer(GC). A number of randomized controlled trials and meta-analysis provide phase Ⅲ evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomyfor cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.     

Plasma levels of secretory IgA in patients with gastric cancer

Summary The levels of plasma secretory IgA were measured in patients with gastric cancer and found to be slightly higher (9.6±6.2 g/ml) than those in healthy controls (7.0±2.6 g/ml, 0.05<P<0.1). Secretory IgA levels in those with hepatic metastases (19.7±12.2 g/ml) were significantly higher than those in patients without hepatic metastases (P<0.001). In the latter, there was no significant relationship between plasma secretory IgA levels and the deepest layer of cancerous invasion or lymph node metastases. The secretory IgA levels in cases of well differentiated tubular adenocarcinoma were significantly higher than those with poorly differentiated adenocarcinoma (P<0.05). Although there is small diagnostic value in the detection of gastric cancer by measuring the levels of secretory IgA, high levels of secretory IgA in gastric cancer patients may be indicative of the presence of hepatic metastases.     

Laparoscopic vs open total gastrectomy for gastric cancer:A meta-analysis

AIM:To conduct a meta-analysis comparing laparoscopic total gastrectomy(LTG)with open total gastrectomy(OTG)for the treatment of gastric cancer.METHODS:Major databases such as Medline(PubMed),Embase,Academic Search Premier(EBSCO),Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials(CENTRAL)in The Cochrane Library were searched for studies comparing LTG and OTG from January 1994 to May 2013.Evaluated endpoints were operative,postoperative and oncological outcomes.Operative outcomes included operative time and intraoperative blood loss.Postoperative recovery included time to first fatus,time to first oral intake,hospital stay and analgesics use.Postoperative complications comprised morbidity,anastomotic leakage,anastomotic stenosis,ileus,bleeding,abdominal abscess,wound problems and mortality.Oncological outcomes included positive resection margins,number of retrieved lymph nodes,and proximal and distal resection margins.The pooled effect was calculated using either a fixed effects or a random effects model.RESULTS:Fifteen non-randomized comparative studies with 2022 patients were included(LTG-811,OTG-1211).Both groups had similar short-term oncological outcomes,analgesic use(WMD-0.09;95%CI:-2.39-2.20;P=0.94)and mortality(OR=0.74;95%CI:0.24-2.31;P=0.61).However,LTG was associated with a lower intraoperative blood loss(WMD-201.19 mL;95%CI:-296.50--105.87 mL;P<0.0001)and overall complication rate(OR=0.73;95%CI:0.57-0.92;P=0.009);fewer wound-related complications(OR=0.39;95%CI:0.21-0.72;P=0.002);a quicker recovery of gastrointestinal motility with shorter time to frst fatus(WMD-0.82;95%CI:-1.18--0.45;P<0.0001)and oral intake(WMD-1.30;95%CI:-1.84--0.75;P<0.00001);and a shorter hospital stay(WMD-3.55;95%CI:-5.13--1.96;P<0.0001),albeit with a longer operation time(WMD 48.25 min;95%CI:31.15-65.35;P<0.00001),as compared with OTG.CONCLUSION:LTG is safe and effective,and may offer some advantages over OTG in the treatment of gastric cancer.     

Ataxic gait following total gastrectomy for gastric cancer

A 58-year-old woman, who had undergone total gastrectomy for early gastric cancer 9 years previously, visited the outpatient clinic complaining of progressive difficulty in walking for 15 d. Laboratory examinations showed macrocytic anemia and a decreased serum vitamin B12 concentration and increased serum concentrations of folate, vitamin E and copper. Magnetic resonance imaging showed multifocal high signal intensities along the posterior column of the cervical and thoracic spinal cord. Treatment consisted of intramuscular injections of vitamin B12 for 7 d, which increased her serum level of vitamin B12 to normal. This was followed by weekly intramuscular injections of vitamin B12 for another 2 wk and oral administration of vitamin B12 three times per day. After comprehensive rehabilitation for 4 wk, she showed sufficient improvements in strength and ataxic gait, enabling her to return to her normal daily activities.     

Liver function alterations after laparoscopy-assisted gastrectomy for gastric cancer and its clinical significance

AIM: To evaluate the factors associated with liver function alterations after laparoscopy-assisted gastrectomy (LAG) for gastric cancer. METHODS: We collected the data of gastrectomy patients with gastric cancer and divided them into 2 groups: open gastrectomy (OG) and LAG. We also collected the data of patients with colon cancer to evaluate the effect of liver manipulations during surgery on liver function alterations. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin,...     

Subtotal gastrectomy for gastric cancer

Although a steady decline in the incidence and mortality rates of gastric carcinoma has been observed in the last century worldwide, the absolute number of new cases/year is increasing because of the aging of the population. So far, surgical resection with curative intent has been the only treatment providing hope for cure; therefore, gastric cancer surgery has become a specialized field in digestive surgery. Gastrectomy with lymph node (LN) dissection for cancer patients remains a challenging procedure which requires skilled, well-trained surgeons who are very familiar with the fast-evolving oncological principles of gastric cancer surgery. As a matter of fact, the extent of gastric resection and LN dissection depends on the size of the disease and gastric cancer surgery has become a patient and “disease-tailored” surgery, ranging from endoscopic resection to laparoscopic assisted gastrectomy and conventional extended multivisceral resections. LN metastases are the most important prognostic factor in patients that undergo curative resection. LN dissection remains the most challenging part of the operation due to the location of LN stations around major retroperitoneal vessels and adjacent organs, which are not routinely included in the resected specimen and need to be preserved in order to avoid dangerous intra- and postoperative complications. Hence, the surgeon is the most important non-TMN prognostic factor in gastric cancer. Subtotal gastrectomy is the treatment of choice for middle and distal-third gastric cancer as it provides similar survival rates and better functional outcome compared to total gastrectomy, especially in early-stage disease with favorable prognosis. Nonetheless, the resection range for middle-third gastric cancer cases and the extent of LN dissection at early stages remains controversial. Due to the necessity of a more extended procedure at advanced stages and the trend for more conservative treatments in early gastric cancer, the indication for conventional subtotal gastrectomy depends on multiple variables. This review aims to clarify and define the actual landmarks of this procedure and the role it plays compared to the whole range of new and old treatment methods.     

Systematic review and meta-analysis of laparoscopy-assisted and open total gastrectomy for gastric cancer

AIM:To evaluate the safety and efficacy of laparoscopy-assisted total gastrectomy(LATG)and open total gastrectomy(OTG)for gastric cancer.METHODS:A comprehensive search of PubMed,Cochrane Library,Web of Science and BIOSIS Previews was performed to identify studies that compared LATG and OTG.The following factors were checked:operating time,blood loss,harvested lymph nodes,flatus time,hospital stay,mortality and morbidity.Data synthesis and statistical analysis were carried out using RevMan 5.1 software.RESULTS:Nine studies with 1221 participants were included(436 LATG and 785 OTG).Compared to OTG,LATG involved a longer operating time[weighted mean difference(WMD)=57.68 min,95%CI:30.48-84.88;P<0.001];less blood loss[standard mean difference(SMD)=-1.71;95%CI:-2.48--0.49;P<0.001];earlier time to flatus(WMD=-0.76 d;95%CI:-1.22--0.30;P<0.001);shorter hospital stay(WMD=-2.67d;95%CI:-3.96--1.38,P<0.001);and a decrease in medical complications(RR=0.41,95%CI:0.19-0.90,P=0.03).The number of harvested lymph nodes,mortality,surgical complications,cancer recurrence rate and long-term survival rate of patients undergoing LATG were similar to those in patients undergoing OTG.CONCLUSION:Despite a longer operation,LATG can be performed safely in experienced surgical centers with a shorter hospital stay and fewer complications than open surgery.     

Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

AIM: To evaluate the implementation of a clinical pathway and identify clinical factors affecting the clinical pathway for laparoscopic gastrectomy.METHODS: A standardized clinical pathway for gastric cancer (GC) patients was developed in 2001 by the GC surgery team at the Asan Medical Center. We reviewed the collected data of 4800 consecutive patients treated using the clinical pathway following laparoscopic gastrectomy with lymph node dissection for GC involving intracorporeal and extracorporeal anastomosis. The patients were treated between August 2004 and October 2013 in a single institution. To evaluate the rate of completion and risk factors affecting dropout from the clinical pathway, we used a multivariate logistic regression analysis.RESULTS: The overall completion rate of the clinical pathway for laparoscopic gastrectomy was 84.1% (n = 4038). In the comparison between groups of intracorporeal anastomosis and extracorporeal anastomosis patients, the completion rates were 83.88% (n = 1740) and 84.36% (n = 2071), respectively, showing no statistically significant difference. The main reasons for dropping out were postoperative complications (n = 463, 9.7%) and the need for patient observation (n = 299, 6.2%). Among the discharged patients treated using the clinical pathway, the number of patients who were readmitted within 30 d due to postoperative complications was 54 (1.1%). In a multivariate analysis, the intraoperative events (OR = 2.558) were the most predictable risk factors for dropping out of the clinical pathway. Additionally, being male (OR = 1.459), advanced age (OR = 1.727), total gastrectomy (OR = 2.444), combined operation (OR = 1.731), and ASA score (OR = 1.889) were significant risk factors affecting the dropout rate from the clinical pathway.CONCLUSION: Laparoscopic gastrectomy appears to be a good indication for the application of a clinical pathway. For successful application, patients with risk factors should be managed carefully.     

Serious complications after a proximal gastrectomy with a jejunal pouch interposition for gastric cancer

Proximal gastrectomy with jejunal interposition is a common surgical method in Japan, because the procedure has been shown to give a better post-operative quality of life. Some complications are associated with it. However, esophageal candidiasis and linear marginal ulcer along the gastrojejunal anastomosis after the surgical method has never previously been reported. We herein report a case of a patient who developed serious complications after proximal gastrectomy with jejunal interposition. A 68-year-old man underwent proximal gastrectomy with a jejunal pouch interposition for reconstruction for type 1 gastric cancer. Twenty-three months after the procedure, he complained of dysphagia and epigastric pain. Esophagogastroduodenoscopy showed esophageal candidiasis. The patient improved symptomatically following antifungal medication with fluconazole. Eleven months later, the patient developed severe pneumonia. In subsequent days, a melena episode occurred. Esophagogastroduodenoscopy revealed a linear marginal ulcer along three-fourths of the gastrojejunal anastomosis. The ulcer was drug resistant. The patient died of respiratory failure. Jejunal pouch interposition after a proximal gastrectomy can be associated with significant complications. Further studies are required to identify the best condition of the procedure.