Cardiac transplantation--first year experience in a community hospital: a three year follow-up

This is a report of ten consecutive patients with end-stage cardiac disease treated with orthotopic cardiac transplantation in a community hospital, during the first year of its heart transplantation program. All patients were followed for a minimum of 33 months and a maximum of 45 months with 100% survival at two years and 90% at three years. All survivors are presently in N.Y.H.A. Class I or II. The entire group of patients received the same triple immunosuppressive therapy. The incidence of infection and rejection during the first three months post-transplantation was 0.3 and 0.6 episodes per patient respectively. Every patient developed some degree of deterioration in renal function and 80% of the patients now receive treatment for systemic hypertension. The in-hospital institution cost for the transplant admission varied from $25,084 to $74,164. To date, 30 patients have undergone heart transplantation in our program and 26 are long-term successes. This study again proves that renal insufficiency and hypertension remain the major side effects of Cyclosporine therapy. We further conclude from our experience that cardiac transplantation can be successfully and cost effectively performed in a community hospital even with a somewhat lower caseload.     

Prospective Study on the Morbidity Profile of Recruits over one year in three large Regimental Training Centres

Keeping in view the lack of prospective epidemiological data on the incidence of major causes of morbidity specifically among recruits, the present study was undertaken among recruits of three large regimental training centres in a particular cantonment. The study period extended over exactly one training year, from 01 July 2001 to 30 June 2002. Successive batches of recruits entering the training centres during this period were followed up prospectively for hospitalisation in the local military hospital, till they completed their training. The study revealed that the major causes of morbidity were chickenpox and training injuries, including stress fractures. The major causes of invalidments were injuries, pulmonary tuberculosis and mental disorders. The findings have been compared and certain recommendations for preventing / reducing the incidence of major causes of morbidity have been submitted.Key Words: Incidence data, Military recruits, Morbidity     

日间手术在小儿外科开展的可行性及其意义

通过回顾分析我院小儿外科开展日间手术30年的体会,探讨小儿外科日间手术实施的可行性及意义。日间手术在小儿外科开展是安全可行的,可以有效缓解“看病难、看病贵”,缩短住院日数、降低医疗费用,符合当前医疗改革的目标。     

Cancelled Primary Care Appointments: A Prospective Cohort Study of Diabetic Patients

Patients scheduled for primary care appointments often cancel or no show. For diabetic patients, nonattendance can affect continuity of care and result in higher emergency department (ED) and hospital use. Nonattendance also impacts appointment scheduling, patient access, and clinic work load. While no show has received significant attention, little research has addressed the prevalence and impact of appointment cancellation. Data on 46,710 appointments for 7586 adult diabetic patients was used to conduct a prospective cohort study examining primary care appointment behavior. The independent variable was the status of the INDEX appointment, which was attended, cancelled, or no showed. Dependent variables included the dates of (1) the last attended appointment, (2) scheduling the NEXT appointment, (3) the next attended follow-up appointment, and (4) ED visits and hospitalizations within six months of the INDEX. Cancellation was more prevalent than no show (17.7% vs 12.2%). Of those who cancelled and scheduled a next appointment, 28.8% experienced over 30 days delay between the INDEX and NEXT appointment dates, and 59.9% delayed rescheduling until on or after the cancelled appointment date. Delay in rescheduling was associated with an 18.6% increase in days between attended appointments and a 26.0% increase in ED visits. For diabetic patients, cancellation with late rescheduling is a prevalent and unhealthy behavior. Although more work is necessary to address the health, intervention, and cost issues, this work suggests that cancellation, like no show, may be problematic for many clinics and patients.     

Student audit of clinical teaching: a three year study

An audit of teaching to junior clinical students in the University of Birmingham organised by students identified several surgical and medical firms on which they received little clinical teaching. Consultants spent an average of four and a half hours a week teaching junior students on the wards, arrived about 10 minutes late for that teaching, but missed less than 10% of teaching sessions. Junior students missed less than 10% of consultant teaching sessions and found them useful, though not always stimulating. Audit organised by students is an acceptable method of monitoring the informal teaching received by clinical students.     

腹腔镜在妇科日间手术中心的应用分析

目的探讨腹腔镜在妇科日间手术中心应用的可行性。方法选择合适的病例作为研究组（日间手术组,不孕症患者及卵巢囊肿患者100例）,选择同类非日间手术患者110例作为对照组,比较两组患者的住院费用、住院时间及用药费用,病情康复情况。结果日间手术患者的住院治疗总费用平均为（3840±53）元,用药费用平均为（331±18）元,平均住院天数为（2.63±0.26）d;而同类非日间手术患者的住院治疗总费用平均为（5410±96）元,用药费用平均为（575±37）元,住院天数平均为（10.30±0.35）d;两组间以上指标差异有统计学意义（P〈0.01）。结论选择合适的病例进行腹腔镜日间手术安全可行,该医疗方式可显著减少患者的医疗费用及减少药物费用。     

耳鼻咽喉头颈外科学临床教学改革初探

目的针对耳鼻咽喉头颈外科学教学中存在的问题,为提高教学质量,对临床教学进行初步改革。方法改革现有教学模式,调整教学计划,强化学生主体作用;建立有利于临床诊疗思维能力、创新精神培养和综合素质提高的教学体系;科学化大班理论课,优化见习小班课,细化临床实习,增加小班案例课教学和大班讨论课;广泛采用授课与自学相结合、讲解与讨论相结合、理论与实践相结合、传统教学手段与现代教学手段相结合等方法。结果改革取得了良好效果,学生成绩及能力明显提高,学生不仅具备一定的专业知识和较强的临床能力,而且学习兴趣明显增强,毕业后愿意从事该专业的学生逐年增多,教学督导组及管理干部评价极高。结论初步的教学改革是成功的,对以后深化教学改革具有借鉴价值。     

Pre-operative testing for pregnancy in Dublin Day Surgery Units

Background

The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients’ pregnancy status prior to elective surgery.

Aims

This study aims to evaluate practices in Ireland with regard to methods used to exclude pregnancy in premenopausal women attending for day surgery.

Methods

Postal questionnaires were sent to all consultants in Gynaecology and General Surgery. E-mail questionnaires were sent to all registrar trainees in both specialties. Letters were sent to nine Dublin teaching hospital day surgery units and followed up by telephone consultations.

Results

The overall response rate was poor at 34.3 %. Eighty per cent of respondents in the gynaecology specialty have encountered a preoperative patient with a positive pregnancy test at least once during their career versus 28.6 % in the surgical specialty. Only 35 % of gynaecology respondents would routinely inform female reproductive age patients of the need to avoid pregnancy prior to surgery versus 14.3 % in the surgical specialty. On the day of elective surgery, 90 % of gynaecologists would determine the LMP (last menstrual period) versus 35.7 % of surgeons. The policy at all nine Dublin teaching hospitals is to perform a urinary HCG preoperatively but, their policies vary as to whether the patient’s LMP, age and medical history are considered when performing a urinary HCG test.

Conclusion

It is important that, female patients are counselled appropriately regarding the importance of using adequate contraception or, abstinence in order to avoid pregnancy prior to elective surgical procedures. Our survey shows that, gynaecologists are more likely to give this advice compared to our surgical colleagues. Nevertheless, the number of gynaecologists who do this is surprisingly low (35 %). Urinary HCG is still the standard test used in most units to exclude pregnancy.     

新型医用头灯在耳鼻喉、头颈外科的使用和维护

目的 介绍新型医用头灯在耳鼻喉、头颈外科的使用和维护.方法 比较传统医用头灯和新型医用头灯在耳鼻喉、头颈外科中的使用和维护,可以得出,新型医用头灯采用人体工学设计的头带,结构精巧,无任何外接连线;灯头方向可调且定位稳定,配置有双目放大镜,可清晰放大物象,使用非常简便.结果 经过临床使用,新型医用头灯更加能够满足耳鼻喉、头颈手术的需要.结论 新型医用头灯非常适合在大多数医疗应用.     

首诊于耳鼻咽喉头颈外科神经纤维瘤病的诊疗体会

目的：探讨首诊于耳鼻咽喉头颈外科神经纤维瘤病（N F ）的诊断和治疗方法。方法回顾性分析23例N F患者的临床资料,结合文献探讨该病的临床表现、诊断及治疗方法。结果术前病理证实8例,术后病理确诊为神经纤维瘤20例。经过28月（2月～10年）随访,死亡4例,1例神经纤维瘤伴恶性神经鞘瘤死于全身转移,1例双侧听神经瘤死于第二侧术后继发性脑干出血,另2例死于神经纤维瘤恶变伴全身转移;健在19例中复发3例,其中恶变1例。结论对于表浅皮肤型的NF无须治疗,但应定期随访;位于耳鼻咽喉头颈部较大肿块或孤立性神经纤维瘤,且有局部压迫症状或影响功能及美容者,应采取手术切除;如局部发生恶变须采取广泛切除,术后予规范放化疗。     

结膜松弛症手术治疗的护理观察

目的寻求安全、有效的结膜松弛症手术的护理方法,优化治疗方案。方法对手术治疗的132例（196眼）结膜松弛症患者进行手术前后系统护理观察、症状评估、泪河观察、BUT测定、尝味试验及病人满意度测定。结果196只眼中,162眼症状改善（82．6％）;松弛结膜消除者168眼（85．7％）;泪河恢复正常者155眼（79．1％）;BUT〉10秒者143眼（72．9％）;氯霉素尝昧试验阳性者119眼（60．7％）,术后病人满意率93．9％。结论针对结膜松弛症手术特点进行术前术后眼部护理及生活指导是术后顺利康复的重要保证。