内镜技术在消化道梗阻中的应用

内镜可以直接进入消化道,明确梗阻性质、解除梗阻状态,发挥其特有的微创与精准优势,内镜技术在消化道梗阻中可发挥诊断作用、引流作用,还可置入支架姑息治疗或术前辅助治疗以及解除狭窄问题.     

腹腔镜胃癌根治手术中的团队配合

目的探讨团队配合在腹腔镜胃癌根治手术中的重要性及技巧。方法对2008年1月-2008年10月32例腹腔镜胃癌根治临床的临床资料进行分析。主刀医生及扶镜助手,第一助手在相应的手术区域,采用基本固定的配合模式,分别完成胃结肠韧带、脾胃韧带、肝胃韧带的离断,小网膜囊的完整切除及各组淋巴结的清扫,并在体腔外完成病灶的切除,消化道的重建。结果32例均在腹腔镜下完成手术,远近端胃癌根治性切除术时间250-390 min,平均325 min。全胃根治性切除300-450 min,平均347min。术中出血量：远、近端胃癌根治性切除术50-250 ml,全胃根治性切除术60-350 ml,术中均未输血。所有标本切缘均阴性,清扫淋巴结13-35枚,平均21枚。术后排气时间24-72 h,平均38 h。进流质时间2-5 d,平均2.8 d。27例术后随访1-8个月,未见复发和转移,未发生切口和穿刺口种植。结论密切的团队配合是顺利完成腹腔镜胃癌根治手术的必要条件,对缩短手术时间,减少术中出血及保证根治效果具有重要意义。     

Evaluating Teamwork in a Simulated Obstetric Environment

Background: The National Confidential Enquiry into Maternal Deaths identified "lack of communication and teamwork" as a leading cause of substandard obstetric care. The authors used high-fidelity simulation to present obstetric scenarios for team assessment.

Methods: Obstetric nurses, physicians, and resident physicians were repeatedly assigned to teams of five or six, each team managing one of four scenarios. Each person participated in two or three scenarios with differently constructed teams. Participants and nine external raters rated the teams' performances using a Human Factors Rating Scale (HFRS) and a Global Rating Scale (GRS). Interrater reliability was determined using intraclass correlations and the Cronbach [alpha]. Analyses of variance were used to determine the reliability of the two measures, and effects of both scenario and rater profession (R.N. vs. M.D.) on scores. Pearson product-moment correlations were used to compare external with self-generated assessments.

Results: The average of nine external rater scores showed good reliability for both HFRS and GRS; however, the intraclass correlation coefficients for a single rater was low. There was some effect of rater profession on self-generated HFRS but not on GRS. An analysis of profession-specific subscores on the HFRS revealed no interaction between profession of rater and profession being rated. There was low correlation between externally and self-generated team assessments.     

Teamwork, communication, and anaesthetic assistance in Scotland

Teamwork involves supporting others, solving conflicts, exchanging information, and co-ordinating activities. This article describes the results of interviews with anaesthetic assistants (n=22) and consultant anaesthetists (n=11), investigating the non-technical skills involved in the effective teamwork of the anaesthetic assistants in the operating theatre. Anaesthetic assistants most commonly saw themselves as either being part of a theatre team or an anaesthetic subgroup and most commonly described the senior theatre nurse as their team leader. Examples of supporting others included the following: checking equipment, providing equipment, being a second pair of eyes, providing emotional and decision support, and supporting trainee anaesthetists. Of the 19 anaesthetic assistants who were asked if they would speak up if they disagreed with a decision in theatre, only 14 said that they would voice their concerns, and the most common approach was to ask for the logic behind the decision. The WHO checklist was described as prompting some anaesthetists to describe their anaesthetic plan to the anaesthetic assistant, when previously the anaesthetist would have failed to communicate their intentions in time for equipment to be prepared. The prioritization of activities to achieve co-ordination and the anaesthetic assistants becoming familiar with the idiosyncrasies of their regular anaesthetists were also described by anaesthetic assistants.     

手助腹腔镜胃癌 D2根治术的团队配合

目的：探讨手助腹腔镜胃癌D2根治术的团队配合技巧及重要性。方法对我中心2010年12月～2013年6月180例手助腹腔镜胃癌D2根治术的临床资料进行回顾性总结。术者及助手相对固定,只需术者及扶镜手两人相互配合,就能完成肿瘤的根治性切除及淋巴结清扫。结果180例均在手助腹腔镜下完成手术,全胃切除术84例,远端胃切除术81例,近端胃切除术15例。手术切口长度（6．9±0．5）cm;术中出血量（226．1±127．0）ml;手术时间（172．2±34．1）min;病检获淋巴结数（17．3±5．0）枚;术后住院时间（9．3±2．0） d。围手术期死亡1例,手术残端癌残留2例。手术相关并发症率6％（11／180）。术后随访1～24个月,失访12例（失访率7％）,同时性肝转移4例,异时性淋巴结转移2例,局部复发1例,未发生切口和穿刺口种植。结论良好的团队配合是保证手助腹腔镜胃癌D2根治术的必备条件,对肿瘤的根治程度、手术时间及术后并发症的发生起着至关重要的作用。     

Teamwork and communication in surgical teams: implications for patient safety

BACKGROUND: As part of a national program in the Department of Veterans Affairs to improve communication within the health-care environment, the Medical Team Training questionnaire was developed to assess organizational culture, communication, teamwork, and awareness of human factors engineering principles. STUDY DESIGN: The Medical Team Training questionnaire was pilot tested with 300 health-care clinicians. The final version of the Medical Team Training questionnaire was administered to an interdisciplinary group of 384 surgical staff members in 6 facilities as part of the Medical Team Training pilot project in the Department of Veterans Affairs. RESULTS: The results revealed a pattern of discrepancies among physicians and nurses in which surgeons perceive a stronger organizational culture of safety, better communication, and better teamwork than either nurses or anesthesiologists do. CONCLUSIONS: The Medical Team Training questionnaire was helpful in identifying hidden problems with communication before formal team training learning sessions, and it will be useful in focusing efforts to improve communication and teamwork in the operating room.     

急诊护理管理中团队精神的培养

目的 探讨急诊护理管理中团队精神培养的有效方法及作用.方法 建立良好的沟通氛围,对急诊科护理人员实施护理质量分层目标管理,运用有序的学习竞争,开展团队技能训练等措施培养团队精神.结果 急诊科护理人员在医院组织的竞赛活动中取得一、二、三等奖,并被评为全院优质服务示范科室.结论 团队精神培养有利于满足护士爱及归属的需要,强化护士的团队责任感、进取精神、协作精神,促进护士的个人发展,提高护理团队整体综合素质,提升护理服务质量.     

急诊护理管理中团队精神的培养

目的探讨急诊护理管理中团队精神培养的有效方法及作用。方法建立良好的沟通氛围，对急诊科护理人员实施护理质量分层目标管理，运用有序的学习竞争，开展团队技能训练等措施培养团队精神。结果急诊科护理人员在医院组织的竞赛活动中取得一、二、三等奖，并被评为全院优质服务示范科室。结论团队精神培养有利于满足护士爱及归属的需要，强化护士的团队责任感、进取精神、协作精神，促进护士的个人发展，提高护理团队整体综合素质，提升护理服务质量。     

Observational Assessment of Surgical Teamwork: A Feasibility Study

Background Teamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings. Method We observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS (Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co-operation, co-ordination, shared-leadership and monitoring. Results Ratings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one-eighth of the cases and delays or changes occurred in over two-thirds of the cases. Conclusions This study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However, for these measures to be used for formal assessment, more research is needed to make them robust and standardized.     

社区护理学教学中合作学习模式的实施

目的探讨社区护理学教学中小组合作学习模式的实施效果。方法将护理本科生162人根据年级分组,2004级82人为对照组,2005级80人为实验组。对照组按传统方法实施社区护理学教学;实验组在社区护理学教学中实施小组合作学习模式。采用综合考核方法和问卷调查了解教学效果。结果实验组实践成绩与综合能力显著优于对照组（P〈0．05,P〈0．01）,实验组护生对合作学习模式的认可度为72．50%～95．00%。结论合作学习模式为护生创设了主动参与的学习环境和教学情景,教学效果优于单一授课法,且有利于激发护生的学习兴趣．提高护生的综合素质。     

荧光显像技术在消化外科中的应用进展

近红外荧光显像技术可运用特殊分子的荧光特性增强显示人体重要解剖结构和组织血流灌注。笔者总结荧光显像技术原理、常用荧光分子特性和荧光显像设备特点,探讨荧光显像技术在胃食管外科、肝胆外科、结直肠外科及腹膜恶性肿瘤等外科实践中的应用价值。笔者认为:通过特异性抗体偶联荧光分子探针检出肿瘤转移灶是荧光显像技术应用于消化外科的未来发展方向。