综合系统评估在医疗风险控制当中的作用

目的探讨应用综合系统评估单进行医疗风险控制的效果。方法采用自制综合系统评估单,在病人入院24小时内完成对病人各系统的评价,列出症状、异常体征及异常检查结果,并采取相应的治疗措施。如病人病情改变时,应及时进行再评估。比较应用前后医疗风险发生的机率。结果应用综合系统评估单强化医护人员对各系统疾病的干预、治疗,医疗风险事件发生率降低,差异有统计学意义(P0.05)。结论综合系统评估有利于医疗风险的控制,可加强医务人员对住院病人整体状况的把握,提升患者就医体验满意度,降低医疗风险发生率。     

临床护理路径应用于消化性溃疡患者的效果评价

随着我国公费医疗体制改革的深入,医疗质量与医疗费用问题已成为人们普遍关注的问题。如何以低廉的收费,让病人能“看得起病,看得好病”是各医疗机构、医护人员面临和思考的问题。临床护理路径(CNP)又称为临床护理程序。是为以确诊为某一病人制定的、以病人为中心的、从入院到出院一整套医疗护理整体工作计划。这种计划包含病人在预计住院日中每一天的医疗护理评估、干预、治疗措施及预期结果等,最适合预期结果相对明确、病情相对单纯的常见、多发性健康问题。我科率先提出引入CNP,以期规范临床医疗护理行为,缩短病人平均住院时间,降低病人医疗费用,加强医护合作,提高病人满意度。     

临床护理路径的研究现状

以护理程序为框架的临床护理路径（Clinicnursingpass,CNP）是病人在住院期间的护理模式,是指由医院各种背景的专家,根据某种疾病或某种手术方法,制定出的一种大家同意认可的治疗护理模式。病人由住院到出院都在模式下完成治疗,依据治疗结果来分析评估及总结每个病人的差异,以避免下一个病人住院时发生同样的失误,通过此种方式来控制医疗成本,维护并提高医疗质量。     

建立“微创临床路径”、发展微创医院

临床路径(Clinic pass，CP)是指由医院各种背景的专家，根据某种疾病或某种手术方法，制定出的一种大家同意认可的治疗模式。病人由住院到出院都在模式下完成治疗，依据治疗结果来分析评估及总结每个病人的差异，以避免下一个病人住院时发生同样的失误，通过此种方式来控制医疗成本，维护并提高医疗质量。     

危重病人比重引入对综合医院质量主成分分析评估结果的影响

目的:评估危重病人比重的引入对综合评估的影响?方法:采用主成分分析法,对医疗质量指标?效率指标和效益指标进行综合评估?结果:危重病人比重对传统主成分分析的结果产生影响?结论:在不同医院之间?同一医院不同时期的质量评估引入危重病人比重具有一定意义?     

全科医疗机构的质量保证

现代的全科医疗机构正逐渐演变成一个基层保健的管理体系，其宗旨是用最低廉的价格为病人提供良好的服务。良好的医疗服务取决于医疗单位内部的各种因素，包括成员、政策、组织、管理、资料分析处理技术以及自身的监督管理。良好的医疗保健需要有计划性，要考虑到各种情况，如为慢性病病人提供的照顾，为促进健康和预防疾病提供的保健，为急性病病人提供的迅速有效的救治。有计划的医疗保健需要团队精神，需要准确的资料来制定决策，尤其是制定目标、对象和优先照顾者以及确定标准和评估医疗组中每个成员的表现。     

做好护理工作,满足病人合理需求

在新的医学科学领域里，护理工作质量的高低，对病人的康复起着重要作用，如何做好这项工作，我们认为护士首先要了解病人，知道他们对医疗和护理的要求是什么。根据病人的要求制定护理计划，评估护理工作。为满足病人的合理需求，提高服务质量，应做到以下几点。1真心的听病人震来实践证明许多病人在表达其想法特别是提出疑问时感到有些紧张，如果医护人员专心倾听病人的叙述，就会从中得知他们合理的需求。2询问病人的愿望要了解病入的愿望，他的病友比护士更清楚。通过询问病人的愿望可以提高疗效。如果只按照已经掌握的发病机理去评估病…     

关于限制使用医疗技术临床准入的伦理缺失分析

限制使用医疗技术临床准入是医疗技术准入制度的重点内容。然而,目前我国对限制使用技术的准入研究较为滞后,特别是对其伦理评估研究更是缺乏。从伦理审查的认识缺位,评估主体及其伦理素养缺位,评估标准缺失及缺乏全过程评估等四方面对目前我国限制使用医疗技术临床准入伦理缺失的危害性进行分析,并呼吁尽快制定科学、合理、符合我国实际的伦理评估指标体系。     

小儿危重病例评分法在儿童重症监护病房中的应用

目的总结小儿危重病例评分法(PCIS)对儿童重症监护病房病人(PICU)的评估应用。方法回顾2012年1月至2012年6月宁夏医科大学总医院PICU收住168例危重病例资料,应用PCIS正确评估儿PICU的危重程度。分值>80分属非危重病人,分值71～80分属危重病人,分值≤70分属极危重病人。结果本组评分≤70分死亡8例,评分71～80分死亡5例;评分81～100分死亡1例。随着评分值的降低,病情越危重,发生多脏器损害或衰竭的器官数越多,病死率越高。结论 PCIS法能帮助对PICU患儿病情做出判断,筛选出危重病人,从而更好的制定治疗方案,对医院医疗资源的整合起到重要的指导作用。     

36例肿瘤病人护理风险管理体会

目的对肿瘤病人进行护理风险管理,达到减少护理风险,增强医疗安全保障方法对我科36例肿瘤病人采取护理风险管理措施,建立病区质控小组,加强对化疗进程的管理,建立和完善化疗护理工作制度与标准,制定和严格执行配置化疗药物操作规程等结果我36例肿瘤化疗病人无一例发生医疗意外事件结论对肿瘤病人进行护理风险管理,减少了护理风险事件的发生,保障了医疗安全.     

Current management of unstable angina

The patient with unstable angina (angina of recent onset, of changing pattern or occurring at rest) is at high risk of myocardial infarction and sudden death. Patients with simple angina of recent onset can generally be managed out of hospital. Those with progressive angina or angina at rest should be admitted to a coronary care unit, kept at bed-rest, and given propranolol and long-acting nitrates when such therapy is indicated. With these approaches the rate of infarction within 1 to 3 months after the onset of unstable angina is about 12% (as compared with 40% before 1970); the mortality in the same period is less than 2% (as compared with 17% before 1970), though during the first year it is about 17%, much higher than in patients with stable angina and in survivors of acute myocardial infarction.

Urgent aortocoronary bypass grafting has proven to be unnecessary and probably undesirable for most patients with unstable angina, and is now generally reserved for patients who continue to have angina in hospital while receiving full medical therapy. The ongoing management of patients whose angina is controlled during the acute phase remains controversial. The main options are to operate on every possible patient, to operate only on those with certain distributions of coronary artery lesions, and to operate only on those who have recurrent symptoms. Further studies are required to delineate the etiology and the Optimal management of unstable angina.

     

风险管理在护理管理中的应用效果探讨

目的研究风险管理在护理管理中的应用效果,并评价其对护理质量的影响。方法以我院在2011年3月-2013年3月收治的380例患者为研究对象,将其随机分为对照组和观察组两组,每组190例患者。对照组采用常规管理,观察组采用了风险管理,通过调查问卷、寻访的方式对两组患者的护理效果进行总结和分析,并对两组惠者的护理满意度进行比较。结果通过分析,对照组的护理满意度为,观察组的护理满意度为,观察组的护理质量和护理满意度明显优于对照组,两组比较差异有统计学意义（P〈O．05）。结论将风险管理应用到护理管理中,具有良好的效果,不仅能够有效提高护理质量,也能提高护理满意度,值得进一步推广和使用。     

Implementation of antithrombotic management in atrial fibrillation

The aim of the study was to assess the extent to which published recommendations on the antithrombotic management of atrial fibrillation had been adopted into clinical practice in a busy district general hospital, and the impact of clinical audit on subsequent management. In the initial audit, 185 consecutive patients with atrial fibrillation were studied using their case notes to identify any further clinical risk factors for stroke. A management algorithm stratified patients with atrial fibrillation into high, moderate, or low risk of stroke according to the individual stroke risk factors. For patients at high risk, the correct treatment is warfarin unless there are specific contraindications. For patients at moderate risk, the correct management is aspirin unless there are specific contraindications. Patients at low risk should receive no thromboprophylaxis. The clinical risks of stroke and thromboprophylaxis on discharge from hospital were recorded. An extensive education programme on stroke prevention in atrial fibrillation was undertaken. Six months later a further 185 consecutive patients with atrial fibrillation were audited. Overall, a large proportion (306/370; 83%) of patients were at high risk of stroke. In the initial audit, antithrombotic management was correct in 89 patients (48%). In the follow up audit, antithrombotic management was correct in 135 patients (73%) (p < 0. 00001). If this improvement in management were extrapolated to all hospital patients in the United Kingdom, approximately 1400 strokes/year could be avoided. Despite broad consensus in recent publications, antithrombotic management of atrial fibrillation remains imperfect, with many patients exposed to unnecessarily high risk of stroke.     

基于社区管理的原发性高血压患者血压控制效果的影响因素研究

目的 对重庆市双碑社区开展的社区居民高血压随访资料进行研究,了解随访效果和血压控制效果并对其影响因素进行分析,为更有效地开展高血压社区干预提供依据.方法 对双碑社区自2014年经二级以上医疗机构确诊的原发性高血压患者进行随访管理.采用问卷调查和体格检查,了解血压控制效果和影响因素.结果 纳入随访管理的高血压患者共3 362例,70％以上的高血压患者最后1次血压和平均血压都控制在正常范围内.62.4％的高血压患者的血压管理效果为优良,不良的比例为15.4％.多因素Logistic回归发现随访方式为家庭访视或门诊随访、心理调整良好、摄盐量为轻、服药规律、吸烟控制较好、饮酒控制较好、运动时间长可促进高血压管理效果良好.结论 双碑社区2014年高血压患者的管理效果良好.加强健康教育,改善患者的不良生活行为,加强心理调适,能达到更好的管理效果.     

Recent updates of management of endometrial carcinoma

Endometrial carcinoma is a low grade curable malignancy and most patients present with early disease with excellent survival. Of all female pelvic malignancies, it seems to have more advocates for different treatment plans than any other. Total extrafascial hysterectomy and bilateral salphingo-oophorectomy is the primary operative procedure. Pelvic lymhadenectomy is performed in most centres on therapeutic and prognostic grounds and to individualize adjuvant treatment. Postoperative irradiation are used to reduce pelvic and vaginal recurrences in high risk cases. Treatment planning are conservative in order to reduce patients morbidity and overtreatment while maintaining acceptable recurrence and survival rates.     

Non-operative management of perforated duodenal ulcer

We describe the selective non-operative management of 34 patients who had an initial diagnosis of perforated duodenal ulcer made on acute presentation between 1984–1994 in our district surgical unit. Diagnosis of the condition was made on clinical grounds with the aid of an erect chest X-ray which demonstrated pneumoperitoneum in 28 patients (82 per cent). Six patients (18 per cent) who did not respond to non-operative treatment required surgical intervention; 3 patients had an unsealed duodenal ulcer perforation; 2 had a perforated benign gastric ulcer and 1 patient had acute gangrenous cholecystitis. The overall mortality and morbidity rate was 3 per cent and 35 per cent respectively. There were no documented reperforations over a mean follow-up period of 27 months. While these figures are acceptable and comparable with operative intervention for this condition, we do however stress the labour intensive methods and close clinical monitoring that is required to avoid morbid sequelae.     

Hemophilic arthropathy: considerations in management

The authors evaluate nonsurgical and surgical approaches to treating patients with hemophilic arthropathy and review the functional and economic limitations imposed on treating these patients. Indications for surgery are discussed and a case study that incorporates both conservative and surgical management options is presented. While the advent of factor replacement therapy has dramatically changed the course of treatment and prognosis for patients with hemophilia, the authors argue that the economic burden of treating these patients is still very high. The authors recommend that proper conservative and surgical management options for patients with hemophilia should be based upon a thorough understanding of the disease process.     

Surgical management of constrictive pericarditis

Summary BACKGROUND: Constrictive pericarditis is a disease characterized by marked thickening and dense scarring of the pericardium with pericardial sac obliteration, or calcification of the pericardium. Without treatment this disease is characterized by high morbidity and mortality. OBJECTIVE: To review the surgical management of constructive pericarditis and the post operative challenges. METHODS: Eleven patients who had pericardiectomy for constructive pericarditis between 2000 and 2005 were studied. Data was obtained from the operating theatre register, histopathological reports and patient's case notes. RESULTS: The mean age was 33 years with a range of 14 to 53 years. There were seven males (63.6%) and four females (36.4%). Seven (63.6%) out of the eleven patients operated were treated for pulmonary tuberculosis. The cause of pericardial constriction in four patients (36.4%) was undetermined. Follow up period was between 4-59 months. The mean follow up was 17.5 months. Seven patients (63.6%) were off diuretics and had no exercise intolerance. Patients were classified using the New York Heart Association (NYHA) n (NYHA) functional and therapeutic classification in class I-V. Two patients preoperatively in class III are now in class I after surgery on low dose diuretics. One patient who had calcific constrictive pericarditis and came in class III was now in class II with diuretics after 3 years of follow up. There was no postoperative mortality. One patient was lost to follow up. CONCLUSION: Pericardiectomy is a useful procedure for constrictive pericarditis and was beneficial to all the patients in this study with an improvement in their functional capacity. Intensive peri-operative monitoring and management reduced morbidity and mortality.     

Early management of the critically injured

A plan for the early management of the critically injured patient is described with emphasis on the priorities of management of injuries to certain organ-systems. The most important priorities are the establishment and maintenance of adequate ventilation and adequate circulation. The general surgeon is best qualified to assume full responsibility for the proper care of the critically injured, of patients with multiple injuries, and of patients in traumatic shock. He must assume the risk of transfusing unmatched whole blood and of deferring non-essential radiographs. The emergency and radiology departments may have to be by-passed to save the life of the critically injured patient. The measures required to establish a clear airway, to treat complications which can impair ventilation, to manage shock and hemorrhage and the possible complications of massive transfusions of blood are reviewed.