Combat surgery: Status of tactical abbreviated surgical control

Traditionally injury care meant definitive repair following surgical exploration. However the outcome is poor because of deranged physiology in severely injured. Damage control surgery (DCS) is abbreviated initial procedure with subsequent correction of physiological imbalance, followed by definite repair.Tactical abbreviated surgical control (TASC) is application of principles of DCS techniques in the tactical environment. TASC is applied because of patient related factors (classic damage control) and limitations due to tactical reasons. Non-patient related factors only seen in tactical setting are, large numbers of patients arriving in short span, mobility of forward medical units, limitation of resources, and hostile environment. TASC involves only phase one of classical DCS. Complete correction of physiological imbalances and definitive surgery is carried out at a better equipped static hospital. TASC has shown to improve survival, extends benefit to greater number and helps to conserve precious resources. However TASC has its own limitations.     

舒适护理模式在血液透析护理中的应用探讨

目的研究探讨舒适护理模式在血液透析护理中的应用及效果。方法将2006年1月—2012年1月在该院进行血液透析的患者60例随机分为两组,对照组给予常规护理,实验组给予舒适护理,观察对比两组患者的护理效果。结果实验组患者焦虑程度降低,舒适度提高,与对照组比较,差异有统计学意义（P〈0.05）;实验组患者睡眠质量高于对照组。差异有统计学意义（P〈0.05）。结论在血液透析患者治疗期间给予舒适护理模式具有较好的效果,可以稳定患者情绪,提高睡觉质量,进而提高其生活质量。     

创建麻醉护理一体化管理模式在麻醉后恢复室的应用

目的 探讨麻醉护理一体化管理模式在麻醉后恢复室(PACU)中的应用效果.方法 选择2014年12月至2015年4月在我院接受手术且实施麻醉护理一体化管理模式的58例患者作为干预组,另外选取2013年12月至2014年11月接受手术且接受常规护理干预的患者作为对照组.比较两组患者出室和入室血压、呼吸、意识和活动力得分、两组平均交接时间、每月差错事件及护理满意评分,以及出室后并发症发生情况.结果 两组患者入室时血压、呼吸、意识和活动力得分比较差异均无统计学意义(P>0.05);出室时,干预组患者的血压、呼吸、意识和活动力得分分别为(1.8±0.5)分、(1.7±0.6)分、(1.8±0.6)分和(1.7±0.4)分,对照组分别为(1.3±0.2)分、(1.3±0.3)分、(1.3±0.4)分和(1.1±0.4)分,两组比较,干预组均高于对照组,差异均具有统计学意义(P<0.05);干预组平均交接时间、差错事件分别为(2.2±0.5)min、(4.5±0.4)次,低于对照组的(4.5±1.3)min、(12.5±3.6)次,而护理满意评分为(92.6±4.9)分,高于对照组的(79.5±4.3)分,两组比较差异均具有统计学意义(P<0.05);干预组并发症率为5.2%(3/58),明显低于对照组的20.7%(12/58),差异具有统计学意义(P<0.05).结论 麻醉护理一体化管理模式有利于PACU麻醉患者生理功能的恢复,且能减少并发症的发生,提升PACU工作效率.     

终止治疗的讨论和伦理问题

ICU的医护人员必须就许多危重患者生命支持治疗的维持或终止等问题与家属讨论。作者就这种医患交流的重要性、方式、步骤和医学伦理问题进行讨论。     

女性巨大尖锐湿疣的特殊手术方法及护理

目的应用了手术方式治疗女性巨大尖锐湿疣。方法为保护女性外阴的外形,手术从外向内进行,使用单极电凝贴于止血钳钳夹处的金属,利用电凝产生的高热,使蒂周围3 mm的皮肤组织产生高热凝固,以皮肤变黄为度,松开止血钳,确认没有出血,然后再次使用单极电凝对断端进行修整。结果手术顺利,效果良好。结论对于女性巨大尖锐湿疣的治疗,可以灵活的使用手术、电灼和光动力等方法,使患者能够最大程度保持外阴的形状和功能,使之达到康复。     

Organ donation : Intensive care issues in managing brain dead

Organ donation and transplantation is one of the most powerful and dramatic practices in modern medicine. It is the pinnacle of centuries of dreams, massive amounts of accrued knowledge and impressive technical developments. One organ donor has the potential of saving more than five lives and impacting the quality of life of many others via tissue donation. The clinical team has a responsibility to the donor families and the recipient patient to do everything possible to provide best practices supported by the best evidence. These standardized best practices should come from the published evidence which is adapted for use in the specific environment, culture, and infrastructure of the institution.     

重症监护病房患者检测降钙素原和C反应蛋白的临床意义

目的 探讨检测降钙素原(PCT)和C反应蛋白(CRP)对重症监护病房(ICU)患者细菌感染的临床意义.方法 选取2008年2月至2010年8月在ICU病房住院的67例患者,空腹抽取所有患者静脉血3ml,3 000 r/min离心分离血清备用,检测所有标本的血清PCT和CRP的浓度水平,结合细菌培养结果和临床诊断,分析血...     

儿科重症监护病房护士应对护理风险的方法及对策

本文分析儿科重症监护病房护士在工作中存在的护理风险及其原因,提出一系列的护理对策及防范措施：强化风险意识;加强与患儿及家长的沟通;提高自身修养,加强专业知识、技能的培训及健康教育的宣传;重视安全教育,强化法律知识,从而保证了护理服务质量,降低了护理风险,减少护理纠纷的发生。     

"Please, I want to go home": ethical issues raised when considering choice of place of care in palliative care

Many palliative care patients would prefer to receive care, and to die, at home. Despite this many die in institutions. In response to this, politicians and charities have adopted policies aimed at increasing the opportunities for care and death at home. The need to discuss plans for discharge with most inpatients reinforces expectations of a choice of place of care. However, many palliative patients do not have a choice of care at home. This article will explore the circumstances in which patients are unable to choose home care and consider changes in clinical practice that can help to maximise choice. We shall argue that there is a distinction between the preferences of patients and the choices actually available to them. In attempting to make this distinction we advocate consideration of the balance between the ethical principles relevant to each case.     

内镜微创切除进展､困难与挑战

自内镜黏膜下剥离术(ESD)引进国内之后,内镜切除领域得到了飞速的发展?ESD作为治疗早期胃肠道肿瘤的首选治疗得到了认可?本文对内镜切除领域的新进展进行了总结,包括ESD?隧道内镜技术?内镜全层切除技术及其对应的缝合技术,并总结和展望了面临的困难和挑战?     

1例肺动静脉瘘患者行介入栓塞治疗的护理

目的探讨肺动静脉瘘在行介入弹簧圈栓塞治疗的护理疗效。方法通过对该例肺动静脉瘘患者在术前进行充分的评估病情,制定合理的术前、术中,术后护理措施及并发症的预防,并认真实施。结果 栓塞成功,术后患者血氧饱和度由治疗前的86%上升到95%。心悸气短、头晕乏力、咯血、胸闷现象基本消失,四肢指端甲床及口唇转红晕。结论弹簧圈栓塞治疗肺动静脉瘘,是安全有效的治疗方法,手术前中后的认真观察与护理,对手术的顺利进行及恢复具有重要的意义。     

外科重症监护病房中常见病原菌分布和耐药性监测

目的 分析上海交通大学医学院附属新华医院外科重症监护病房(SICU)中常见病原菌分布及其耐药特征.方法 收集123例SICU患者各种病原学标本,分析常见病原菌分布情况并进行药敏监测.结果 共分离出497株病原菌,其中革兰阴性菌占58.1%,其次为革兰阳性菌(19.7%)和真菌(22.1%).真菌以白色假丝酵母菌(15.1%)为主.痰液标本的病原体分离率较高(278株),病原菌分布从高到低依次为鲍曼不动杆菌(20.5%)、铜绿假单胞菌(20.5%)、白色假丝酵母菌(15.8%)和大肠埃希菌(7.9%).鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低(21.0%).大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶(ESBLs)试验的阳性率分别为49.3%和40.9%,对亚胺培南高度敏感.革兰阳性菌对万古霉素和利奈唑胺敏感性最高.结论 加强SICU病原菌流行病学监测对合理使用抗菌药物,减少耐药菌株的产生有重要临床指导价值.     

外科重症监护病房内栓塞症的诊断与治疗--附4例报告及文献复习

目的 分析外科重症监护病房（surgical intensive care unit,SICU）内常见栓塞症（脂肪栓塞和羊水栓塞）的临床表现,探讨其诊断和治疗方法。方法 对我院2002年SICU确诊的4例栓塞症患者的临床资料进行回顾性分析。结果 4例患者中,男1例,女3例,年龄23～36岁,1例为左上肢、双下肢长骨骨折致脂肪栓塞,1例为左股骨骨析致脂肪栓塞,1例为剖宫产术中发生羊水栓塞、1例为催产素引产失败后发生羊水栓基。4例患者均不同程度出现意识改乏、呼吸衰竭、贫血、血小板减少,除1例病情较重死亡,其余均痊愈出院。结论 SICU内患者病情复杂,对长骨骨折及高危产妇,要警惕栓塞症的发生,如果早期诊断,及时治疗,预后良好。     

外科重症监护病房中常见病原菌分布和耐药性监测

目的 分析上海交通大学医学院附属新华医院外科重症监护病房（SICU）中常见病原菌分布及其耐药特征.方法 收集123例SICU患者各种病原学标本,分析常见病原菌分布情况并进行药敏监测.结果 共分离出497株病原菌,其中革兰阴性菌占58.1%,其次为革兰阳性菌（19.7%）和真菌（22.1%）.真菌以白色假丝酵母菌（15.1%）为主.痰液标本的病原体分离率较高（278株）,病原菌分布从高到低依次为鲍曼不动杆菌（20.5%）、铜绿假单胞菌（20.5%）、白色假丝酵母菌（15.8%）和大肠埃希菌（7.9%）.鲍曼不动杆菌对头孢哌酮/舒巴坦耐药率最低（21.0%）.大肠埃希菌和肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）试验的阳性率分别为49.3%和40.9%,对亚胺培南高度敏感.革兰阳性菌对万古霉素和利奈唑胺敏感性最高.结论 加强SICU病原菌流行病学监测对合理使用抗菌药物,减少耐药菌株的产生有重要临床指导价值.     

健康大数据在医疗卫生领域中的应用及挑战

健康大数据是医疗卫生领域中非常重要的资源,合理利用健康大数据的优势服务医疗卫生事业是大势所趋。健康大数据将在医药研发、疾病诊疗、健康危险因素分析、公共卫生应急管理、居民健康管理和精准医疗等方面发挥不可替代的作用。但是健康大数据在医疗卫生领域中的应用也面临着一些挑战,例如居民隐私数据泄漏的风险,缺少制度机制层面的联动协同,缺乏更为专业的人才队伍等问题。因此未来应在这些方面加大工作力度,保证健康大数据在医疗卫生领域的应用中发挥出更大的作用。     

外科重症监护病房病原菌感染分布及耐药性监测

目的 探讨SICU的病原菌分布及耐药特点.方法 回顾性总结2004年3月～2005年8月SICU送检的150份细菌学检查阳性标本病原菌的分布特点及其耐药性监测.结果 近80%的阳性标本来源于呼吸道.革兰氏阴性杆菌109株,占72.66%;革兰氏阳性菌31株,占20.67%;真菌10株,占6.67%.革兰氏阴性杆菌的耐药率较以前明显上升,鲍曼不动杆菌对亚胺培南的耐药率高达43.24%.万古霉素对绝大多数球菌仍保持较高的敏感性.结论 SICU要加强呼吸道管理,合理应用抗生素,坚持监测病原菌及其耐药性.     

Research and applications: Phenotyping for patient safety: algorithm development for electronic health record based automated adverse event and medical error detection in neonatal intensive care

Background

Although electronic health records (EHRs) have the potential to provide a foundation for quality and safety algorithms, few studies have measured their impact on automated adverse event (AE) and medical error (ME) detection within the neonatal intensive care unit (NICU) environment.

Objective

This paper presents two phenotyping AE and ME detection algorithms (ie, IV infiltrations, narcotic medication oversedation and dosing errors) and describes manual annotation of airway management and medication/fluid AEs from NICU EHRs.

Methods

From 753 NICU patient EHRs from 2011, we developed two automatic AE/ME detection algorithms, and manually annotated 11 classes of AEs in 3263 clinical notes. Performance of the automatic AE/ME detection algorithms was compared to trigger tool and voluntary incident reporting results. AEs in clinical notes were double annotated and consensus achieved under neonatologist supervision. Sensitivity, positive predictive value (PPV), and specificity are reported.

Results

Twelve severe IV infiltrates were detected. The algorithm identified one more infiltrate than the trigger tool and eight more than incident reporting. One narcotic oversedation was detected demonstrating 100% agreement with the trigger tool. Additionally, 17 narcotic medication MEs were detected, an increase of 16 cases over voluntary incident reporting.

Conclusions

Automated AE/ME detection algorithms provide higher sensitivity and PPV than currently used trigger tools or voluntary incident-reporting systems, including identification of potential dosing and frequency errors that current methods are unequipped to detect.     

流产后关爱随访系统实现与应用

阐述流产后关爱的重要性,介绍流产后关爱随访系统的业务流程、数据流程、实现环境及功能模块,包括患者管理、随访管理、随访统计分析和系统管理等,分析其应用效果,指出该系统有助于提高随访成功率及患者就医满意度。     

e-Measures: insight into the challenges and opportunities of automating publicly reported quality measures

Using electronic health records (EHR) to automate publicly reported quality measures is receiving increasing attention and is one of the promises of EHR implementation. Kaiser Permanente has fully or partly automated six of 13 the joint commission measure sets. We describe our experience with automation and the resulting time savings: a reduction by approximately 50% of abstractor time required for one measure set alone (surgical care improvement project). However, our experience illustrates the gap between the current and desired states of automated public quality reporting, which has important implications for measure developers, accrediting entities, EHR vendors, public/private payers, and government.