85例腹腔镜胆囊切除手术的护理配合心得

目的：对腔镜手术的护理配合方法进行探讨,并总结配合体会。方法：对85例腔镜手术的护理配合方法及效果进行回顾性分析。结果：手术的术中护理配合默契的,术中出血、手术时间及手术效果等均有所提高。结论：应加强腔镜手术的护理配合,从而有效减少手术并发症、减少手术时间,提高患者的治疗效果。     

腰椎内固定手术围术期间麻醉和手术的护理配合

目的：探讨行腰椎内固定术时手术室护士与麻醉医生与手术医师的护理配合。方法：回顾研究总结2014年3月-2016年2月在我院治疗的90例腰椎内固定术患者的围手术期护理配合,包括术前后心理护理、手术器械物品准备、巡回、洗手护士术中配合,术后护理等。结果：90例患者采取围手术期护理配合,麻醉和手术均成功,术后未出现不良反应及并发症。结论：针对全身麻醉和腰椎手术的特点,做好围手术期的护理配合,做到与麻醉和手术医生的密切配合是手术成功的关键之一。     

腔镜下甲状腺叶切除的手术护理配合

目的：研究腔镜下甲状腺叶切除的手术护理配合方法。方法：选取2013年5月到2014年5月间我院收治甲状腺叶切除术患者100例，观察和分析手术护理配合经验。结果：手术效果较为圆满，术后患者愈合情况较为理想。结论：手术配合的熟练性有助于提高手术效果，降低术中出血率，减少术后并发症的产生，因此手术配合非常重要。     

无缝隙护理在低温等离子扁桃体切除术中的应用

目的：探讨低温等离子手术治疗慢性扁桃体炎围手术期的护理方法。方法：对我院2010年1月至10月行低温等离子手术治疗的87名患者采用无缝隙护理进行护理并对护理措施进行总结。结果：患者均未出现护理并发症。结论：在围手术期根据患者具体情况进行护理,对患者围手术期间的配合及康复产生积极影响     

腹腔镜下胆囊摘除术的手术配合

目的：探讨腹腔镜下胆囊摘除术的手术配合及护理措施.方法：对2013年2年-2014年2月本院开展腹腔镜胆囊摘除术的90例患者,做好术前心理护理、物品准备以及术中熟练地配合.结果：80例经腹腔镜胆囊摘除的患者均治愈出院,无中转开放手术,术后无不良并发症发生. 结论：对行腹腔镜胆囊切除术的患者实施术前心理护理、规范的术前准备以及术中熟练地配合等护理措施,能缩短手术时间,提高腹腔镜胆囊切除患者治愈率和护理质量,减少并发症的发生,值得临床应用.     

舒适护理在剖宫产术患者中的应用研究

目的：探讨在妇科剖宫产术患者中运用舒适护理模式的效果。方法：将120例行剖宫产术患者随机分为实验组（舒适护理模式）与对照组（常规护理模式）,并对两组患者的手术效果进行统计学分析。结果：实验组的各项手术效果指标均优于对照组。结论：舒适护理模式有助于患者消除心理障碍并积极配合手术和护理,提高了手术质量和患者的满意度。     

自我管理干预对肺癌手术患者的影响

目的：探讨自我管理干预对肺癌手术患者的影响。方法：将100例肺癌患者随机分为观察组和对照组各50例,两组均按常规护理方式对患者进行术前、术后访视及手术配合,观察组在常规护理基础上进行自我管理干预。比较两组患者术前生命体征、焦虑状态、肺癌知识的掌握、手术依从性及对护理满意度。结果：观察组采用自我管理干预后,患者术前生命体征、焦虑状态、肺癌知识的掌握、手术依从性及对护理满意度均明显优于对照组（P〈0．05）。结论：通过自我管理干预,能充分发挥肺癌患者参与手术的主观能动性,积极配合一系列治疗、护理,从而促进手术成功,是护理理念和方法上的革新,值得在肺癌手术患者中推广应用。     

70例小儿手术麻醉的护理配合

由于小儿好哭易动,自控能力差,手术期间不易配合,做好小儿手术患者的麻醉护理,对于确保手术成功十分重要。现将笔者对70例小儿手术麻醉的护理配合体会介绍如下：     

宫腔镜黏膜下子宫肌瘤切除围手术期的护理体会

目的：探讨宫腔镜黏膜下子宫肌瘤切除围手术期的护理。方法：随机抽取我院在2011年1月—2013年12月治疗的60例子宫肌瘤患者,均使用宫腔镜黏膜下子宫肌瘤切除术进行治疗,对患者进行术前护理、术中配合、术后护理观察。结果：通过手术证实,患者的子宫肌瘤平均是（4.41±0.36）cm,均一次手术成功,成功率达到了100%,2例患者出现并发症,并发症发生率为3.3%。结论：宫腔镜手术不仅减少了患者的术中出血量,而且缩短了患者的住院时间,在配合围手术期的护理,大大提高了子宫肌瘤患者的手术疗效。     

心脏外伤手术的临床手术室护理配合体会

目的：总结心脏外伤手术的临床手术室护理配合经验。方法：2011年2月～2015年2月,医院共采用手术治疗心脏创伤患者14例,采用心脏修补术治疗,4例连台手术,巡回护士做好术前准备、麻醉护理配合、体位摆放、术中配合、术后处理,器械护士做好术前准备、术中配合。结果：所有患者开胸后,均痊愈治愈,抢救成功率达到100.0%。结论：心脏外伤手术的临床手术室要求巡回、器械护士都具有丰富的心脏外科手术经验,了解心脏外伤手术治疗目的与基本操作,提高配合质量。     

额部扩张皮瓣修复鼻缺损的护理

目的：探讨额部扩张皮瓣修复鼻缺损术的观察及护理方法。方法：对16例行额部扩张皮瓣修复鼻缺损的患者进行有针对性的心理护理，重点做好术前准备，术后作好术区护理、扩张器植入后、注水期、皮瓣转移及断蒂术后的各期护理。结果：本组16例患者术后跟踪随访3-12月，无并发症发生，外形恢复良好，手术效果满意。结论：额部皮瓣扩张法修复鼻缺损是一种历时较长、难度较大的手术，手术的成功不仅取决于手术者高超的技术还取决于患者良好的心态以及术前术后精心护理，重点观察皮瓣血运，及时采取相应的护理措施尤为重要，在很大程度上提高了手术效果。     

How Does Degree of Rurality Impact the Provision of Surgical Services at Rural Hospitals?

ABSTRACT:  Context: Rural residents frequently have decreased access to surgical services. Consequences of this situation include increased travel time and financial costs for patients. There are also economic implications for hospitals as they may lose revenue when patients leave the area in order to obtain surgical services. Rural communities vary in size and distance from more populated centers. Since rural hospitals are located in varying types of rural communities, they likely differ with regard to the provision of surgical care. Purpose: To describe the differences between hospitals located in smaller versus larger rural areas regarding the provision of surgical care. Methods: A 12-item survey instrument based on one previously used in a pilot study was mailed to a national random sample of rural hospital administrators (n = 233). Rural location was determined using rural-urban commuting area codes. Findings: One hundred and eleven surveys were received, yielding a 48% response rate. Hospitals in larger rural areas had an average of 9 surgeons compared to 1 at hospitals in smaller rural areas. More administrators at hospitals located in larger rural areas viewed the ability to provide surgical care as very important to the financial viability of their hospital. Conclusions: Among rural hospitals located in communities of varying sizes there are significant differences in how surgical services are delivered and the financial importance of providing surgical care. Administrators at hospitals located in larger rural areas, more than in smaller ones, report financial reliance on their ability to offer surgical care and have significantly more resources available to do so.     

Are Grampian general practitioners good gatekeepers for access to emergency general surgical care?

BACKGROUND: Direct admission from primary care is the predominant emergency general surgical referral route in north-east Scotland. Recent primary and secondary care reconfiguration has increased resources necessary to support the current system, therefore alternative models are proposed. We seek to analyse frequency and accuracy of provisional diagnosis by general practitioners within our current admission system. METHOD: Presence of referral letter, provisional diagnosis, discharge diagnosis and management were prospectively recorded for all emergency general surgical admissions to Aberdeen Royal Infirmary over three weeks. RESULTS: One hundred and sixty three primary care admissions: 69.3% from patient's own practice and 30.7% from the out-of-hours service. Of these patients 98.1% came with a referral letter, 86.1% including a provisional diagnosis, which was correct in 43.6% of cases. Fourteen patients (8.6%) were transferred to another ward for treatment. DISCUSSION: General practitioners provide written provisional diagnoses with most referrals, accurate in almost half of cases, with only a minority of patients requiring transfer for management of presenting problems. This is despite limited investigations, clinical isolation, restricted facilities for examination and limited time for assessment. We believe Grampian general practitioners are good gatekeepers to emergency general surgical care and support the current direct admission pathway.     

Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.

OBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization. DESIGN: Surveillance and cohort study. SETTING: A 470-bed tertiary trauma-referral community hospital. PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization greater than or equal to 48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for greater than or equal to 72 hours during the epidemic period who had no X maltophilia-positive culture). RESULTS: Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk = 1.3, p = .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient's room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel's hands. Related environmental and clinical isolates were serotype 10. CONCLUSIONS: Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.     

Assessment of the quality of breast cancer care: a single institutional study from Saudi Arabia.

OBJECTIVE: To evaluate the quality of operable breast cancer care in a tertiary care institution. DESIGN: A retrospective analysis of all breast cancer patients seen in our institution between 1995 and 2000. Data were abstracted from the charts of these patients. Indicators were based on an international consensus conference and other publications. SETTING: A tertiary care health care institution. MAIN MEASURES: We evaluated the charts and calculated the percentage for which the internationally accepted quality care indicators were followed during the continuum of care. We also reviewed the histopathological reports to evaluate conformation with the accepted indicators. RESULTS: Charts of 75 patients (four exclusions, three metastatic, and one male), diagnosed to have breast cancer during the study period were reviewed. Only 28 (37%) patients had triple assessment before a definitive surgical procedure. Pre-operative staging including a CT and bone scan was performed in 58 (77.3%). Among the 50 patients who had definite surgical intervention, the majority had mastectomy (44/50, 88%) whereas axillary dissection was performed in 46 (46/50, 92%). Estrogen and progesterone receptor status was reported in only four (4/50, 8%) and the exact tumor size in 24 (24/50, 48%) of the histopathological reports. Adjuvant chemotherapy was used in accordance with the international standards but radiotherapy was under-utilized. CONCLUSION: Our study demonstrated that the quality of breast cancer care in this institution was below the accepted international standards. This study may be used to make interventions for improvement of quality in similar institutions all over the kingdom.     

Comparing patients' telephone calls after medical and surgical abortions

OBJECTIVE: The purpose of this study is to monitor the content, timing of and response to telephone calls from medical and surgical abortion patients in order to improve the counseling and nursing care and allay patient's concerns. METHODS: There were 43 calls from a possible 626 surgical patients and 100 calls from a possible 671 medical patients. Calls were considered preventable in 67% of the medical patients and 46.5% of the surgical patients. Women who were having their first abortion were more likely to place preventable calls. CONCLUSIONS: Calls could be reduced by explaining variations in normal bleeding and how to use analgesics and providing this information in diagrammatic form on an information sheet.     

实施全程心理护理对普外科手术安全性和术后康复的影响

目的：探讨实施全程心理护理对普外科手术安全性和术后康复的影响。方法：对2009-2011年住院患者实施外科常规护理,加强了心理护理及心理咨询。结果：通过精心护理,患者情绪稳定,保持了最佳的心理状态,减少了手术并发症,提高了普外科手术安全性和术后康复能力。结论：实施全程心理护理可提高患者对手术的耐受,减少术后并发症,对患者的术后康复具有重要的作用。     

人性化护理在手术室中的应用与探索

目的：探索手术患者人性化护理的细节和要点,开展全方位的人性化护理,提高患者及家属的满意度。方法：通过对2012年1月-2012年12月的17000余例手术患者通过术前访视、术中关爱、术后回访等方法对手术患者实施了全方位的人性化护理。结果：手术患者及家属对手术室的满意度由原来的90%提高到99.5%,确保了手术患者的安全和舒适。结论：通过对手术患者实施全方位的人性化护理,患者术前紧张、焦虑、恐惧、陌生、孤独感减少,战胜疾病的信心加强,配合手术积极主动;护理人员的责任心加强,工作、学习积极性提高。     

Validating risk-adjusted surgical outcomes: chart review of process of care.

OBJECTIVE: The primary purpose of this study was to validate risk-adjusted surgical outcomes as indicators of the quality of surgical care at US Department of Veterans Affairs (VA) hospitals. The secondary purpose was to validate the risk-adjustment models for screening cases for quality review. DESIGN: We compared quality of care, determined by structured implicit chart review, for patients from hospitals with higher and lower than expected operative mortality and morbidity (hospital-level tests) and between patients with high and low predicted risk of mortality and morbidity who died or developed complications (patient-level tests). SUBJECTS: 739 general, peripheral vascular and orthopedic surgery cases sampled from the 44 VA hospitals participating in the National VA Surgical Risk Study. MAIN OUTCOME MEASURES: A global rating of quality of care based on chart review. RESULTS: Ratings of overall quality of care did not differ significantly between patients from hospitals with higher and lower than expected mortality and morbidity. On some of the secondary measures, patient care was rated higher for hospitals with lower than expected operative mortality. At the patient level of analysis, those who died or developed complications and had a high predicted risk of mortality or morbidity were rated higher on quality of care than those with a low predicted risk of adverse outcome. CONCLUSIONS: The absence of a relationship between most of our measures of process of care and risk-adjusted outcomes may be due to an insensitivity of chart reviews to hospital-level differences in quality of care. Site visits to National VA Surgical Risk Study hospitals with high and low risk-adjusted mortality and morbidity have detected differences on a number of dimensions of quality. The patient-level findings suggest that the risk-adjustment models are useful for screening adverse outcome cases for quality of care review.