"健康中国"战略背景下麻醉学科建设的PEST-SWOT分析与策略建议

麻醉学是临床医学的重要组成部分, 麻醉学科是体现医疗机构综合能力的重要临床专科, 在促进现代化医院发展和保障人民健康方面具有举足轻重的作用。在"健康中国"战略背景下, 该研究通过建立PEST-SWOT分析矩阵, 从政治环境、经济环境、社会文化和技术环境四个维度分析我国麻醉学科所处的宏观环境, 对我国麻醉学科发展的内外部条件进行深入探讨, 在此基础上提出策略建议, 以期为我国麻醉学科发展提供理论依据, 进而为"健康中国"战略的实施提供有力支撑。     

翻转课堂教学法在我国护理教育教学中应用的SWOT分析

采用SWOT分析法,对翻转课堂教学法在护理教育教学中优势、劣势、外部机会和威胁四方面进行分析,旨在进一步发展完善该教学模式在护理教学中的应用提供参考。     

专业学位护理研究生培养的SWOT分析

目的探讨影响我国专业学位护理研究生培养的学生自身及其外部因素,并提出行之有效的应对策略。方法采用SWOT分析法,对学生自身的学习优势、劣势及外部机会和威胁4个方面进行分析。结果学生自身优势包括学习愿望强烈、专业基础扎实、思维活跃、学习能力强,劣势包括学习定位不准、经验不多、知识未更新、时间不足;外部机会包括学科发展需要、国家政策保障、单位提供支持、高校重视培养,威胁因素包括身份认同不到位、培养目标不具体、培养体系不成熟、师资条件不满足。结论影响我国专业学位护理研究生培养的因素涵盖学生自身与外部环境两大方面,需在自身优势与劣势及外部机遇与威胁因素统筹考虑的基础上制定相应的应对策略。     

手术室护士循证实践能力的SWOT分析

目的 探讨基于SWOT分析的河南省手术室护士循证实践能力现状及其影响因素，以期为循证实践培训提供参考。方法 采用循证实践能力评估量表对河南省二、三级综合医院的558名手术室护士进行现状调查，利用SWOT分析法评估其内部优、劣势和外部环境的机会、威胁；并进行系统总结分析，制订有效的循证实践培训策略。结果 手术室护士循证实践能力总均分为(89.25±11.18)分，其中循证实践态度均分为(50.19±7.98)分，循证实践技能均分为(19.18±2.98)分、循证实践知识均分为(19.89±2.30)分、多元线性回归分析显示，循证实践能力态度的影响因素为文献检索能力、循证的重要性、循证对临床实践的帮助、专业态度。技能的影响因素为文献检索能力、循证应用时机、循证对临床实践的帮助、专业态度。知识的影响因素为循证应用时机、最近5年发表过的文章数量、沟通能力、专业态度。结论 手术室护士循证实践能力总体水平不高，但对循证实践持有积极态度。建议管理者营造循证实践的氛围和文化，培养护士循证思维，切实提高手术室护士循证实践能力。     

Study on the correlation between early three-dimensional gait analysis and clinical efficacy after robot-assisted total knee arthroplasty

Purpose: Robot-assisted technology is a forefront of surgical innovation that improves the accuracy of total knee arthroplasty (TKA). But whether the accuracy of surgery can improve the clinical efficacy still needs further research. The purpose of this study is to perform three-dimensional (3D) analysis in the early postoperative period of patients who received robot-assisted total knee arthroplasty (RATKA), and to study the trend of changes in gait parameters ...     

社区实施出院老年人延续性护理的SWOT分析

运用SWOT即Strength（优势）、Weakness（劣势）、Opportunity（机遇）和Threat（挑战）分析法,对目前国内社区开展出院老年人社区延续性护理服务的优劣势、存在的机遇与挑战进行综合分析,并提出相应的发展策略。     

社区实施出院老年人延续性护理的SWOT分析

运用SWOT即Strength(优势)、Weakness(劣势)、Opport unity(机遇)和Threat(挑战)分析法,对目前国内社区开展出院老年人社区延续性护理服务的优劣势、存在的机遇与挑战进行综合分析,并提出相应的发展策略。     

北京市市属医院探索护理垂直管理模式的SWOT分析

目的探讨护理垂直管理实施过程中的优势、劣势、机遇和挑战,为护理垂直管理的顺利实施提供参考。方法对北京市5家实施护理垂直管理试点医院的28名护理管理者进行访谈,运用SWOT分析法和类属分析法分析访谈资料。结果实施垂直管理的优势包括促进护士绩效奖金分配的公平性,增加护理人力调配的及时性和高效性,促进护理人员培训的积极性和计划性,提升护理管理团队的协调性;劣势包括护理管理团队的人力和能力需要加强,护理绩效考核方案还有待完善和可能影响科室层面对护理的支持;机遇包括护理岗位管理的不断深入,医院领导的支持和护理学科发展的需要;威胁包括缺乏可借鉴的管理模型和部分科室主任的阻力大。结论护理垂直管理模式有利于调动护理人员的工作积极性,提高护理管理效率和工作质量。建议提高护理队伍整体实力和增加信息沟通与交流渠道等,以促进垂直管理的顺利实施。     

护理院校临终关怀教育的SWOT分析

目的 探讨我国护理类院校开展临终关怀教育的现况,为我国临终关怀教育事业发展提供参考。 方法 运用SWOT分析法,剖析我国护理类院校开展临终关怀教育的内部优势、劣势、外部机会以及威胁。 结果 我国护理类院校开展临终关怀教育的优势：满足护生群体需求,弥补临终教育空白;规范死亡教育,提高死亡应对能力。劣势：教材有待统一,教学形式略为单一;师资水平良莠不齐,教师队伍尚需建设;地域发展存在差异,人文教育培养不足。机遇：积极响应国家政策,德育发展势在必行;顺应社会老龄化趋势,培养临终关怀人才。威胁：传统文化根深蒂固;关怀发展滞后不前。 结论 我国护理类院校开展临终关怀教育优劣势共存,只有完善相关法制政策、健全临终关怀服务体系、培养高质量师资队伍,并建立具有中国特色的本土化教育模式,才能真正实现临终关怀在我国护理教育中的长远发展。     

肝细胞癌“一次性”完全射频消融的理论基础及安全实施策略

射频消融(radiofrequency ablation,RFA)已广泛应用于因多种原因不能手术切除的肝细胞癌(hepatocellular carcinoma,HCC)患者的治疗,且对于能达到肿瘤“一次性”(one-off)完全消融的患者其疗效不逊于外科手术.然而,由于现有热消融技术的局限性,肿瘤大小及所处部位的特殊性,临床医生有时无法实施“一次性”完全消融.而不完全的和多次重复的RFA是影响患者预后的重要因素之一.为达到“一次性”完全消融目的,术前准确评估肝脏肿瘤的解剖学位置,选择不同的RFA治疗方法和步骤非常重要.本文依据肝脏解剖学特征,结合肝胆外科的专业优势,系统分析探讨了肿瘤“一次性”完全消融的理论基础和安全实施策略.     

Mainly abdominal "complex" polytrauma. Considerations on surgical strategy and clinical case report

The Authors want to present un uncommon case of polytrauma managed with surgical treatment at the Trauma Center of the A. Cardarelli Hospital in Naples. Chest, abdomen, pelvis, and left lower limb have been severely injured. This case is so interesting because of the rareness of some lesions (i.e. diaphragm rupture) and the numerous lesions of internal organs (i.e. lungs, spleen, liver, pancreas, mesenterium) and of the bones (i.e. thigh-bone and pelvis). A very good outcome has been obtained for survival as well as for functionality and quality of life since we have strictly applied the rules for the management of the "complex" polytrauma.     

Palpable breast tumours: "triple diagnosis" and operative strategy. Results of a prospective study

A prospective study of 292 consecutive patients with 303 tumours was performed to appraise the combination of physical examination, mammography and fine-needle puncture (triple test) in the diagnosis of breast tumours. The diagnostic accuracy of the triple test was 100%. Because of its relative smallness, however, the series does not permit the conclusion that a benign result of triple test makes excisional biopsy unnecessary. It is emphasized that a follow-up regimen with participation of radiologists and cytologists is required. Fine-needle puncture with cytologic examination of the aspirate is recommended as a routine procedure in the diagnosis of breast tumours.     

"Removal without replacement" strategy for uncontrolled prosthetic tricuspid valve endocarditis associated with abortion sepsis

Isolated tricuspid valve (TV) endocarditis associated with abortion is a rare entity with a poor prognosis. We report the case of a 22-year-old woman with a diagnosis of isolated prosthetic TV endocarditis secondary to recurrent abortion. The patient had progressed to multiorgan failure and disseminated intravascular coagulation during her clinical course. Because of the high operative risk and uncontrolled infection, we performed an unusual surgical approach that has not previously been reported. Resection of infected valvular tissue without replacement of the prosthesis led to a rapid convalescence period and complete cure.     

An "optimal" k-needle placement strategy and its application to guiding transbronchial needle aspirations.

This article addresses the problem of finding an "optimal" strategy for placing k biopsy needles, given a large number of possible initial needle positions. We consider two variations of the problem: (1) Calculate the smallest set of needles necessary to guarantee a successful biopsy; and (2) Given a number k, calculate k needles such that the probability of a successful biopsy is maximized. Note that "needle" is used as shorthand for the parameter vector that specifies the needle placement. Both problems are formulated in terms of two general, NP-hard optimization problems. Our k-needle placement strategy can be considered as "optimal" in the sense that we are able to formulate it as a known NP-hard problem for which it is believed (NP not equal P conjecture) that no efficient algorithm exists that computes the optimal solution. In other words, our strategy is "optimal" with respect to the best approximative algorithm known for the respective NP-hard problem. For the second variation we have implemented an approximative algorithm that is guaranteed to be within a factor of approximately 0.63 of the exact solution. Given a number k, the algorithm calculates k sets of parameters, each set specifying the placement of a needle and the corresponding probability of success. The resulting probabilities show that our approach can provide valuable decision support for the physician in choosing how many needles to place and how to place them.A typical example of a biopsy where the initial needle position is known approximately is a transbronchial needle aspiration (TBNA). We demonstrate how our "optimal" needle placement strategy can be used to achieve sensor-less guidance of TBNA. The basic idea is to use a patient-specific model of the tracheobronchial tree (from CT/MR) and our model for flexible endoscopes to preoperatively estimate the unknown position of the bronchoscope. The result is a set of candidate shapes for the unknown shape of the bronchoscope before needle placement or, in other words, a (large) number of possible initial needle positions. By parameterizing the handling of the bronchoscope, including the insertion of the biopsy needle, we are able to apply our "optimal" strategy. The result is a TBNA protocol that, if executed during the procedure, prescribes how to handle the bronchoscope to maneuver the needle into the target. With the aforementioned endoscope model, we present a new way of modeling long, flexible instruments. The algorithm requires no initialization or preprocessing and calculates the workspace of an instrument based on its insertion depth and a set of internal and external constraints.     

“等待观察”：直肠癌新辅助放化疗后完全缓解治疗的新策略

毋庸置疑,直肠癌尤其是局部进展期直肠癌(LARC)的治疗策略已然发生了翻天覆地的变化。术前新辅助放化疗(NCRT)联合根治性全直肠系膜切除手术(TME)已经成为LARC的金标准治疗模式。NCRT不仅可使肿瘤缩小,降低临床分期,提高手术保肛率,而且使部分患者达到临床甚至病理完全缓解。然而,根治性手术存在手术创伤大,并发症多,以及永久性造瘘带来的痛苦。对于完全缓解的患者是否可以免于外科手术,而采用非手术"等待观察"策略,成为了近年来结直肠外科医师关注的战略问题。笔者就"等待观察"策略的定义、特点、发展史及研究现状等进行综述,并对这一新兴策略的前景提出思考。