低年资护士的护理安全信息警示管理

目的 探讨对低年资护士实施护理安全信息警示管理的效果.方法 对35名低年资护士在常规护理安全管理的同时给予安全信息警示管理,包括建立护理安全信息警示管理体系,制定并应用护理安全信息周报表,执行安全信息警示管理并反馈等.结果 实施护理安全信息警示管理前后不良事件发生率比较,差异有统计学意义(P<0.05);实施护理安全信...     

Imaging of the pelvis in the traumapatient

Pelvic trauma can be a source of significant morbidity and mortality. Early diagnosis is often made on physical examination, but radiographic imaging is essential for rapid and adequate treatment of the patient with suspected pelvic injury. Plain radiographs of the pelvis remain the benchmark of diagnosis because they are, so easily obtainable and provide early valuable information regarding pelvic injuries. Several other imaging techniques now exist for visualizing the pelvis, and the treating physician must determine which additional diagnostic studies should be obtained. Imaging of the patient with pelvic trauma should be obtained when more information is needed for diagnosis, treatment, or postoperative management. Timely but judicious use of diagnostic radiographic imaging of the pelvis should be the rule.     

日间手术全周期闭环智慧系统管理实践与成效

目的 探讨日间手术全周期闭环智慧系统对日间手术的管理效果.方法 应用智慧系统实施日间手术全周期质量闭环管理,实现预约检查手术、手术精准确认、医护患全程手术信息共享,多维度宣教知识精准推送,按时逐级完成出院随访、过程质量控制等.结果 应用智慧系统管理后,患者术前检查完成率、病情评估完成率、麻醉访视完成率、首台准时麻醉率、...     

A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury

BACKGROUND: Ultrasound (US) is commonly used for the diagnosis of hemoperitoneum after blunt abdominal trauma, but the value of US as an aid for identification of operative lesions after penetrating trauma is not well documented. The purpose of this investigation was to determine the accuracy of US for the evaluation of penetrating torso trauma and to assess the impact of this information on patient management. METHODS: We conducted a prospective cohort observational study of consecutive penetrating torso patients at a Level I trauma center. RESULTS: During the 6-month trial period, 177 victims of penetrating torso trauma were assessed by our trauma teams. Ninety-two patients had stab wounds, 84 patients had gunshot wounds, and 1 patient had a puncture wound. All 28 patients with positive US examination had an exploratory laparotomy or thoracotomy (one patient had more than one procedure), resulting in 26 therapeutic operations. There were 149 negative US examinations, but in this group, 36 patients underwent laparotomy or thoracotomy, and 28 had therapeutic operations. The overall accuracy of the US examination was therefore 85%, the sensitivity was 48%, and the specificity was 98%. There were only three patients who had their initial management altered by a positive US examination. CONCLUSION: The US examination lacks sensitivity to be used alone in determining operative intervention after gunshot or stab wounds. Rarely does US information contribute to the management of patients with penetrating abdominal injuries.     

Partners and nurses’ knowledge and representations of gout: A qualitative study

Adherence to gout treatment is poor. Partners of patients and nurses are two major communicators with gouty patients, and their perceptions of illness may affect patient behavior.ObjectiveTo explore partners’ and nurses’ knowledge and representations of gout.MethodsWe used a qualitative grounded approach with semi-structured face-to-face individual interviews with a purposive sample of hospital nurses working in rheumatology and internal medicine departments and patient partners. Interviews were audio-recorded and transcribed. All authors met regularly to discuss coding and data interpretation.ResultsOverall, 20 nurses and 12 partners participated in the interviews. Four major themes were evidenced: knowledge gaps (gout cause was unknown, unawareness of urate-lowering therapy and the possibility to cure gout, focus in gout flare and diet); lack of information and education on gout (knowledge acquired by personal experiences, nurses complained to be insufficiently educated, partners highlighted the lack of information and that general practitioners did not have time to educate patients); gout consequences and social impacts (handicapping disease, avoid social activities like dinner with friends); attitudes towards gout flare and patient management (feeling powerless during flare, negative feelings such as being ashamed leading to postpone medical seek or unconcerned about their partner disease). Nurses regretted that they had not enough time to discuss issues with patients.ConclusionPartners and nurses’ knowledge of gout is based on daily experiences. Participants were eager to learn more about gout. Nurses’ education and education programs including partners may improve gout management and patient adherence to treatment.     

麻醉风险评估和分级管理的软件开发和应用

目的开发麻醉风险评估和分级管理平台的软件,促进麻醉风险的评估和分级管理。方法系统软件采用VFP9．0关系型数据库语言和Visual Studio 2015编程,其中麻醉患者风险评估方法参照Hussman、Aust和“Lemon”等方法。结果开发了Windows环境下运行的麻醉风险评估和分级管理系统,包括患者信息库、风险评估、风险分级管理、过程考核、查询统计以及知识库6个模块。实现对手术患者风险识别和评估、分级管理、智能信息档案以及过程考核等过程进行管理。结论此系统有利于麻醉患者风险评估和分级管理,操作简单容易。     

Selection of methodology in surgical treatment of adolescent idiopathic scoliosis

Before contemplating any surgical procedure, one has to define the goals of the operative procedure. The patient should be evaluated thoroughly by physical examination and by adequate radiographs, including bending films. The surgeon should be familiar with different types of techniques and their qualities. The goals of surgery should be outlined clearly and understood between the physician and the patient. The patient should be provided with sufficient and easy-to-understand information (Table 1), and be encouraged to have an input in the decision-making process. For instance, is the goal of surgery to stop progression? To achieve cosmetic correction? To preserve maximal spinal mobility or to help improve pulmonary function? Is it important for the patient to be cast free postoperatively? Once the goal is defined, and we are aware of the abilities of each technique, then we can arrive at a realistic expectation. Again, it is of utmost importance that the surgeon select the procedure that he or she has adequate experience in performing.     

The effect of routine intraoperative transesophageal echocardiography on surgical management

OBJECTIVE: To assess the effects of routine intraoperative transesophageal echocardiography (TEE) on surgical management of patients undergoing all types of cardiac surgery. DESIGN: Prospective, observational. Setting: A single-institution, clinical investigation, university-affiliated hospital. PARTICIPANTS: Two hundred eighty-three consecutive patients undergoing cardiac surgery. INTERVENTIONS: A comprehensive TEE examination was performed in every patient after the induction of anesthesia. An appropriate surgical plan was then developed. A focused TEE examination was also performed at the conclusion of surgery. Whether or not TEE findings represented new information and whether or not this new information altered surgical management was documented. MEASUREMENTS AND MAIN RESULTS: There were 106 new TEE findings in 87 patients (31%). Half of the new findings involved the mitral valve, and a quarter involved the tricuspid valve. The new TEE information altered surgical management 77 ways in 71 patients (25%). Half of the altered surgical managements involved the mitral valve, and a third involved the tricuspid valve. In 8 patients (3%), TEE information influenced decisions regarding use/nonuse of cardiopulmonary bypass (CPB). In 2 patients, TEE examination after the separation from CPB prompted reinitiation of CPB. In 1 patient, TEE examination after the induction of general anesthesia prompted cancellation of surgery. CONCLUSIONS: The routine use of TEE during cardiac surgery revealed new cardiac pathology in 1 of every 3 patients and led to altered surgical management in 1 of every 4 patients. TEE information also influenced decisions regarding use/nonuse of CPB in 3% of patients. Thus, the authors suggest that intraoperative TEE should be used routinely in all patients undergoing cardiac surgery.     

Informed consent for gastric cancer surgery

Gastric cancer patients must have sufficient information on their prognosis and the risks and benefits associated with different therapeutic options before giving informed consent for treatment. The clinical stage of the cancer should be explained, along with the possibility of stage migration after surgery. The procedure proposed should be compared with other therapies including best supportive care, with explanations of postoperative prognosis, actual morbidity and mortality rates at the individual institution, and aftereffects. The surgeon should also explain measures to prevent and treat aftereffects, including dietary restrictions, reflux, dumping syndrome, and adhesive bowel obstruction. Because some patients refuse blood transfusions on religious grounds, the consent to undergo transfusion should be obtained separately from that to undergo surgery. Resected tissue is considered to be personal information, and consent must be obtained for its use in subsequent research after histopathologic examination. Adjuvant chemotherapy using S-1 is a standard treatment option in advanced gastric cancer of stage II or III, for which patients should make an informed choice after sufficient explanations of its efficacy and adverse effects.     

General assessment of the upper limb

Clinical examination of the upper limb of a spastic patient is a lengthy and somewhat complicated procedure that is best performed together with all the practitioners involved in the child's care. It should be repeated before any decision is made regarding treatment. Standard procedures in surgery of the upper limb in cerebral palsy are not appropriate, as the clinical picture is different for each individual patient. Surgery should be aimed at correcting spasticity, muscle/joint contracture, and motor deficit as required. All these elements therefore must have been assessed carefully before treatment. Finally, clinical examination detects all local and general contraindications to surgery and selects the appropriate candidates.     

Advanced Hysteroscopic Surgery Training

Hysteroscopic surgery is pivotal in management of many gynecological pathologies. The skills required for performing advanced hysteroscopic surgery (AHS), eg, transcervical hysteroscopic endometrial resection (TCRE), hysteroscopic polypectomy and myomectomy in the management of menorrhagia, hysteroscopic septulysis in fertility-related gynecological problems and hysteroscopic removal of chronically retained products of conception and excision of intramural ectopic pregnancy ought to be practiced by contemporary gynecological surgeons in their day-to-day clinical practice. AHS is a minimally invasive procedure that preserves the uterus in most cases. Whilst the outcome is of paramount importance, proper training should be adopted and followed through so that doctors, nurses, and institutions may deliver the highest standard of patient care.     

Fatal Fulminant Pancreatitis After Laparoscopic Gastric Bypass Surgery

Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction. Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early detection and management of severe complications.     

产科护士维护患者安全的护理行为研究

目的了解产科护士维护患者安全的护理行为现状,为实施针对性管理提供参考。方法采用自行设计的护理人员维护患者安全护理行为问卷对122名产科护士进行调查。结果 8个维度自评得分3.40±1.03~4.70±0.67,其中正确识别患者得分最高,鼓励患者及家属参与照护得分最低;34个条目中排序前5的为执行侵入性操作前主动沟通与确认并有书面记录、为出院患者提供治疗药物服药指导、交接或移动患者后立即检查并确认留置管道正常等(得分4.76±0.62~4.86±0.49),排序后5的为鼓励患者及其家属与医护人员主动沟通、鼓励患者及其家属询问、提醒专业人员洗手等(得分3.08±1.02~4.01±0.97)。结论产科护士维护患者安全的护理行为处于中等偏上水平,但鼓励患者及其家属参与照护等行为不足,其他方面亦有较大提升空间。护理管理者应加大管理力度,提升产科护士维护患者安全护理行为水平,确保患者治疗安全。     

Laparoscopic partial gastrectomy for the treatment of gastropleural fistula.

Gastropleural fistulas (GPF) are uncommon and can occur as a consequence of prior pulmonary surgery, trauma, or malignancy. Conservative management usually fails, requiring gastrectomy and even thoracotomy in these often debilitated patients. We present a patient with GPF confirmed by upper endoscopy and radiographic contrast examination, who underwent a laparoscopic partial gastrectomy and closure of the fistula. To our knowledge, this is the first such report in the English language literature. Laparoscopic treatment of GPF may be associated with less early morbidity and should be considered as the initial procedure of choice.     

Management of haemorrhoidal disease

Except for complications, therapeutic strategy for hemorrhoidal disease depends on patient complaint and data from clinical examination. Management is mostly progressive and first aims at releasing symptoms rather than achieving anatomic resilience. In patients with haemorrhoids responsible for insignificant symptoms and with no alteration of quality of life, no treatment is mandatory. Patient complaint, either related to bleeding or prolapse, must prone active management. Medical treatment must be offered as a primary approach in the majority of patients with non-complicated hemorrhoidal disease, followed if necessary by office-based procedure. Surgical treatment is indicated when office-based procedures proved ineffective or immediately after medical treatment failed in patients with Grade IV haemorrhoids. In case of local or general complication, or associated proctologic disease, surgical management is most often required.     

Case management: A new practice model for ET nurses

An examination of wound, ostomy, and continence nursing practice provides ideas for improving patient care and for role development of the ET nurse. During this period of rapid health care reform, opportunities to expand ET nursing practice must be explored. For many ET nurses, care of the patient with an ostomy remains a primary focus. The fitting of prosthetic equipment and patient education concerning ostomy care may not, however, be enough to demonstrate the impact of ET nursing care on the outcome of patients with an ostomy. Caring for the patient undergoing gastrointestinal surgery by means of a case management model is a new option for ET nurses. Nurse case managers focus on the patient and the impact of illness from admission until discharge. They are accountable for coordinating the multidisciplinary team who cares for the patient and for the evaluation of outcomes. ET nurses must evaluate the outcomes of their care to demonstrate the continued need for our specialty practice. This article describes the efforts of ET nurses at a tertiary care center in the Midwest to develop a case management system for patients undergoing gastrointestinal surgery within their practice. The process of developing a critical pathway, or care map, is also described.     

Primary rhabdomyosarcoma of urethra in a 5-year-old girl: case report and literature review

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, while RMS from the urinary tract has rarely been reported. Aspects of the manifestation, diagnosis, and treatment of these tumors are discussed in the case of a girl with rapidly progressive RMS from the urethral tract. She was treated with a two-stage surgical procedure and chemotherapy. At the latest follow-up visit at 18 months after treatment, the patient had no evidence of disease on clinical examination or imaging studies. The present case underscores that careful history, physical examination, and laboratory tests should be performed, in additional to using adequate tissue for routine pathologic examination, before making the diagnosis. A combined approach to treating RMS using multidrug chemotherapy and surgery has markedly improved survival.     

46例胰十二指肠切除术的护理体会

目的 总结46例胰十二指肠切除术后患者的护理。方法 收集2014年9月至2017年1月我科46例胰十二指肠切除（Whipple术）患者的术后护理资料,包括一般护理、腹部症状及体征、管道护理、并发症的观察与护理、心理护理等。结果 46例胰十二指肠切除患者中33例术后无并发症发生,康复出院。12例术后患者发生并发症,通过干预治疗,好转出院,一例患者因多种器官疾病放弃治疗。结论 规范或标准化护理、早期发现问题、医护沟通畅通三是Whipple术的围手术期护理的重要节点。     

Preliminary results on the safety and efficacy of the OssaTron for treatment of plantar fasciitis

The OssaTron may be another alternative for management of plantar fasciitis (heel pain syndrome) after failure of non-operative management and prior to surgical management. This study evaluated primarily the safety and early preliminary efficacy of the OssaTron in treatment of patients with plantar fasciitis unresponsive to non-operative management. Twenty heels of 20 patients were treated with 1000 extracorporeal shockwaves from the OssaTron to the affected heel after administration of a heel block. The patients were followed for one year. Each patient was evaluated by roentgenogram, KinCom, range of motion and physical examination, including evaluation of point tenderness by means of a palpometer and according to a 10-cm visual analog scale. The control was the contralateral heel. Patients also performed self evaluation by means of patient activities of daily living questionnaire and pain reported by a 10-cm visual analog scale. There were no complications or adverse effects attributed to the procedure of orthotripsy. Of the 20 patients treated, 18 were improved or pain-free. Eighteen of the 20 subjects treated stated that they would undergo the procedure again instead of surgery. Based on these results, we concluded that orthotripsy is a safe and effective method of treating heel pain syndrome that has been unresponsive to nonoperative management.     

Interest of thyroïdectomy in the management of thyroglossal duct cysts

PURPOSE OF STUDY: To discuss the authors' experience with thyroglossal duct (TD) carcinoma and expose the interest of the thyroidectomy in the management of this entity. PATIENTS AND METHODS: A retrospective review of all patients with the diagnosis of TD operated on from 1985 to 2002 was performed. RESULTS: Four cases of papillary TD carcinoma were identified. Two patients were treated by a Sistrunk procedure associated with total thyroidectomy. One patient needed a thyroidectomy fifteen years after the initial management of the papillary thyroglossal duct carcinoma. The last patient had a medical treatment, with no evidence of complication after eleven years of follow up. CONCLUSION: A microscopic focus of papillary carcinoma, without cyst wall invasion, can be managed by a Sistrunk procedure, with the need for long-term follow up. Treatment of all other thyroglossal duct papillary carcinomas should include thyroidectomy followed by radioactive iodine treatment.