临床护理路径在单病种限价中的应用

目的 探讨临床护理路径(CNP)在单病种限价中的作用.方法 以CNP为指导,对30例急性单纯性阑尾炎行阑尾切除患者以及30例胆囊结石行腹腔镜胆囊切除患者(CNP组)实施限价管理,并与实施限价前的上述病例各30例(对照组)进行住院时间、住院费用与患者满意度的比较.结果 CNP组住院时间及住院费用显著短于和低于对照组(P＜0.05,P＜0.01),患者满意度显著高于对照组(均P＜0.010.结论 在实施单病种限价管理中应用合理的CNP,可明显减低医疗费用,提高患者满意度.     

临床护理路径在单病种限价中的应用

目的探讨临床护理路径（CNP）在单病种限价中的作用。方法以CNP为指导，对30例急性单纯性阑尾炎行阑尾切除患者以及30例胆囊结石行腹腔镜胆囊切除患者（CNP组）实施限价管理，并与实施限价前的上述病例各30例（对照组）进行住院时间、住院费用与患者满意度的比较。结果CNP组住院时间及住院费用显著短于和低于对照组（P〈0．05，P〈0．01），患者满意度显著高于对照组（均P〈0．01）。结论在实施单病种限价管理中应用合理的CNP，可明显减低医疗费用，提高患者满意度。     

手术室耗材的信息化闭环管理

目的 探讨信息化闭环管理在手术室高值耗材与低值耗材管理中的应用效果。方法 采用历史对照方法,将2019年5~12月36 737台手术(对照组)使用人工辅助信息化的方式进行耗材管控,将2020年5~12月31 710台手术（观察组）采用信息化闭环管理的方式进行耗材管控,比较两组临床应用效果。结果 观察组一次性高值耗材计费耗时、错收率、漏收率显著低于对照组,低值耗材申领准确率显著高于 对照组,库存占用率显著低于对照组,护士满意度显著高于对照组（均P<0.05）。结论 对手术室耗材实行信息化闭环管理,可有效提高管理效率与精准度,并受到手术室护士的好评与认可。     

护理同行评议结合绩效检查对增强手术室护理路径在腹腔镜阑尾切除术的实施效果

目的探讨护理同行评议结合绩效检查对增强手术室护理路径在腹腔镜阑尾切除术的实施效果。方法选取2017年1月～6月茂名市人民医院104例腹腔镜下阑尾切除术患者,符合入组条件患者按住院号尾数单双号分为观察组和对照组,各52例。对照组给予常规护理干预措施,观察组实施新手术室护理路径(在对照组基础上,加强和强调各个路径方案执行力,将护理细节根据权重不同进行量化)。采用同行评议和绩效检查方法,对阑尾切除术的护理给予打分,对比两组临床指标、并发症、护理差错或问题、医患满意度。结果观察组患者进入手术室到完成手术返回病房时间、总住院时间短于对照组(P0.01,P0.001),观察组手术安全隐患事件发生率低于对照组(P0.05),两组患者发生手术中麻醉意外、脏器损伤及术后感染例数的差异没有统计学意义。结论护理同行评议结合绩效检查能够促进参与者执行手术室护理路径的良好效果,缩短手术室时间,减少差错,提高患者对手术室护理工作的满意度。     

护理同行评议结合绩效检查对增强手术室护理路径在腹腔镜阑尾切除术的实施效果

［摘要］ 目的 探讨护理同行评议结合绩效检查对增强手术室护理路径在腹腔镜阑尾切除术的实施效果。方法 选取2017年1月~6月茂名市人民医院104例腹腔镜下阑尾切除术患者，符合入组条件患者按住院号尾数单双号分为观察组和对照组，各52例。对照组给予常规护理干预措施，观察组实施新手术室护理路径（在对照组基础上，加强和强调各个路径方案执行力，将护理细节根据权重不同进行量化）。采用同行评议和绩效检查方法，对阑尾切除术的护理给予打分，对比两组临床指标、并发症、护理差错或问题、医患满意度。结果 观察组患者进入手术室到完成手术返回病房时间、总住院时间短于对照组（P<0.01，P<0.001），观察组手术安全隐患事件发生率低于对照组（P<0.05），两组患者发生手术中麻醉意外、脏器损伤及术后感染例数的差异没有统计学意义。结论 护理同行评议结合绩效检查能够促进参与者执行手术室护理路径的良好效果，缩短手术室时间，减少差错，提高患者对手术室护理工作的满意度。     

急性细菌性痢疾患者临床护理路径的实施

目的 探讨临床护理路径在急性细菌性痢疾患者中的应用效果,为急性细菌性痢疾单病种实施临床路径提供依据.方法 将176例急性细菌性痢疾患者按随机数字表法分为对照组80例、观察组96例.对照组按常规实施护理,观察组按临床路径实施护理.结果 观察组住院时间显著短于对照组,住院费用显著少于对照组(均P＜0.01).结论 对急性细菌性痢疾患者实施临床路径可提高医疗护理质量,缩短住院时间,降低住院费用.     

泌尿外科手术室医用高值耗材的精细化管理

目的探讨泌尿外科专科手术室医用高值耗材精细化管理的效果。方法对泌尿外科专科手术室医用高值耗材实施精细化管理,包括组建高值耗材管理小组,完善并实施医用高值耗材的管理制度,加强库管员、巡回护士管理及与手术医生沟通等措施。结果实施精细化管理后,专科手术室医用高值耗材保管和使用合格率显著提高,手术医生对耗材供应的满意度显著提高(均P0.01)。结论实施精细化管理,可有效提高泌尿外科专科手术室医用高值耗材的管理质量和手术医生满意度,提升手术室护理管理水平。     

阑尾切除术围手术期舒适护理效果评价

目的探讨阑尾切除术围手术期舒适护理的效果。方法随机将70例接受阑尾切除术的急性阑尾炎患者分为2组,观察组采用围手术期舒适护理,对照组实施常规护理,评价2组的护理效果。结果观察组患者术后下床活动时间、肠功能恢复时间、术后并发症发生率、住院时间及对护理工作满意度均优于对照组(P0.05),差异有统计学意义。结论对阑尾切除术患者实施围手术期舒适护,可明改善治疗效果,提升护理质量。     

急性阑尾炎阑尾切除术围术期整体护理效果观察

目的总结急性阑尾炎阑尾切除术的围手术期整体护理体会。方法随机将行阑尾切除术的70例急性阑尾炎患者分为2组,各35例。对照组实施围术期常规护理,观察组在对照组基础上实施整体护理干预。比较2组的护理效果。结果观察组患者住院时间及术后并发症发生率均优于对照组(P0.05),差异有统计学意义。结论加强急性阑尾炎阑尾切除手术患者的围手术期整体护理,可显著提升护理效果,减少住院时间与并发症发生率,利于患者早期康复。     

儿童手术室护理安全的PDCA管理

目的探讨戴明环管理法在儿童手术室护理安全质量管理中的应用效果。方法选择择期手术患儿80例,随机分为对照组和PDCA组各40例,分别实施手术室护理安全的常规管理和戴明环管理法,比较两组护理安全管理效果。结果实施戴明环管理法后,手术室护理不良事件发生情况得到改善, PDCA组护理安全质量评分显著低于对照组,患儿家属护理满意度显著高于对照组(P0.05,P0.01)。结论应用戴明环管理法,能够提升儿童手术的护理安全质量,保障手术安全,提高家属满意度。     

2015年乳腺癌辅助化疗进展

【摘要】〓乳腺癌是危害我国女性健康的头号杀手,尽管近年来辅助化疗的研究进展突飞猛进,但临床中仍有不少问题未能明确,如辅助化疗的合适人群、化疗的开始时间、蒽环及紫杉类的地位和用法、强化维持治疗的作用、疗效及预后的生物标志物等。本文结合乳腺癌辅助化疗在临床上的常见问题和2015年各大乳腺癌会议阐述乳腺癌辅助化疗的最新进展。     

Alterations in T-Cell Subset Frequency in Peripheral Blood in Obesity

Background: Obesity affects the regulation of immune and inflammatory responses. This study characterizes differences in peripheral blood lymphocyte phenotype in obese humans. Methods: Frequencies of lymphocyte subsets among peripheral blood mononuclear cells were compared between 10 obese (BMI ≥35) and 10 lean subjects, as determined by antibodies directed against cluster differentiation (CD) markers. Results: Obese patients demonstrated an increased frequency of CD3+CD4+ T-cells (mean difference 12%, P=0.004), a decreased frequency of CD3+CD8+ T-cells (mean difference 9.4%, P=0.016) and an increased frequency of CD3+CD8+CD95+ T-cells (mean difference 13.3%, P=0.032). No other differences among T-cell or monocyte subsets were noted. Conclusions: Obesity is associated with alterations in frequencies of peripheral CD4+ and CD8+ T-cells and aberrations in the expression of CD95 among CD8+ T-cells. These data suggest both CD4+ and CD8+ T-cell compartments, as well as the regulation of CD95 expression on CD8+ T-cells, as targets for further study into obesity's effects on the immune system.     

西宁地区烧伤病人动脉血气分析观察

对高海拔地区的27例烧伤病人动脉血气变化进行了分析和观察。结果证明:无论是存活病人还是死亡病人伤后均存在有低氧血症问题。并且在死亡病人和烧伤合并吸入性损伤病人其低氧血症的发生早于单纯烧伤病人。提示:吸入性损伤病人应立即行气管切开术以保障氧气供给,单纯烧伤病人可常规吸氧以维持正常血 PaO_2,ARDS 均发生在合并吸入性损伤的病人,高频喷射通气技术对纠正低氧血症有一定效果。     

Controversies in Fistula in Ano

Managing a complex fistula in ano can be a daunting task for most surgeons; largely due to the two major dreaded complications—recurrence & fecal incontinence. It is important to understand the anatomy of the anal sphincters & the aetiopathological process of the disease to provide better patient care. There are quite a few controversies associated with fistula in ano & its management, which compound the difficulty in treating fistula in ano. This article attempts to clear some of those major controversies.     

β-半乳糖苷酶在体内外成骨细胞中的表达

目的 研究β—半乳糖苷酶(β—gal)在成骨细胞中的表达状况，为阐明MorquioB综合征的发病机制提供依据。方法 裸鼠各器官和骨组织标本行X-gal染色检测。抽取羊和人骨髓行骨髓基质细胞(BMSCs)培养，分为4组：I：Adv-hBMP-2转染组；Ⅱ：Adv—β—gal转染组；Ⅲ：未转染组；Ⅳ：地塞米松诱导组。分别行X-gal染色和RT-PCR检测β—gal的表达。结果 裸鼠骺板两侧、骨膜内面及松质骨的成骨细胞和破骨细胞可见多量β—gal的表达。未转染BMSCs组有少量β—gal的表达，其他3组细胞的β—gal表达增高。结论成骨细胞和破骨细胞可表达多量β—gal，该两种细胞的β—gal缺乏可能是MorquioB综合征骨骼异常的直接原因。     

Smoking-Attributable mortality in Spain in 2016

IntroductionSmoking-attributable mortality (SAM) is a valuable indicator that can be used to characterize the course and health burden of the smoking epidemic. The aim of this paper was to estimate SAM in Spain in 2016 in the population aged 35 and over, using the best available evidence.MethodsA smoking prevalence-dependent analysis based on the estimation of population-attributable fractions was performed. Smoking prevalence (never, former, and current smokers) was calculated from a combination of the Spanish Health Survey (2016) and the European Health Survey (2014); the relative risk of death among current and former smokers was taken from the follow-up of various cohorts; and mortality rates were obtained from National Center for Statistics data. SAM estimates are presented globally, and by sex, age groups, and major disease categories: cancer, cardiometabolic diseases and respiratory diseases.ResultsIn 2016, 56,124 deaths were attributed to tobacco consumption, 84% in men (47,000), and 50% in the population aged over 74 (27,795). Overall, 50% of SAM was due to cancer (28,281), 65% of which was lung cancer. One in 4 attributable deaths (13,849) occurred before the age of 65.ConclusionsOne in 7 deaths in Spain in 2016 were attributable to smoking. This estimation of SAM clearly highlights the great impact of smoking on mortality in Spain, mainly due to lung cancer and chronic obstructive pulmonary disease.     

MicroRNAs in hepatic pathophysiology in diabetes

MicroRNAs(miRNAs or miRs) are small approximately 22 nucleotide RNA species that are believed to regulate diverse metabolic and physiological processes.In the recent past,several reports have surfaced that demonstrate the role of miRNAs in various biological processes and numerous disease states.For a disease as complex as diabetes,the emergence of miRNAs as key regulators leading to the disease phenotype has added a novel dimension to the area of diabetes research.On the other hand,the liver,a metabolic hub,contributes in a major way towards maintaining normal glucose levels in the body as it can both stimulate and inhibit hepatic glucose output.This equilibrium is frequently disturbed in diabetes and hence,the liver assumes special significance considering the correlation between altered hepatic physiology and diabetes.While the understanding of the mechanisms behind this altered hepatic behavior is not yet completely understood,recent reports on the status and role of miRNAs in the diabetic liver have further added to the complexities of the knowledge of hepatic pathophysiology in diabetes.Here,we bring together the various miRNAs that play a role in the altered hepatic behavior during diabetes.     

Fluid-phase transcytosis in the primate epididymis in vitro and in vivo

Ligated tubules from the corpus epididymidis of men and monkeys were incubated in medium containing horseradish peroxidase (HRP) as a marker for fluid-phase endocytosis. HRP was localized by light and electron microscopy after 0, 15, 30 and 60 min of incubation. Movement between the cells was prevented by tight junctions, but bypass of this barrier was apparently achieved by an intracellular vesicular mechanism leading to a time-dependent appearance of HRP in the lumen. Uptake of HRP into basal cells and capture by the lysosomal apparatus of principal cells were also observed. HRP-filled vesicles also appeared in the basal, mid and apical cytoplasm of epithelial cells in the caput 1 h after injection of the tracer into the epididymal circulation of the monkey, suggesting that this pathway also operates in vivo.     

Surgical management of ductal carcinoma in situ in Australia in 1995

Background: In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow. Methods: Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case. Results: Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women . Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.