《NCCN直肠癌临床实践指南》外科原则十年变迁及临床意义

2005年《NCCN直肠癌临床实践指南》专家组关于直肠癌的外科原则共有4项推荐,包括主刀医师术前亲自行内镜检查,切除原发肿瘤、保证足够切缘,切除肿瘤淋巴引流区以及尽可能保留器官结构的完整性.截至2015年,外科原则推荐意见共进行了4次更新,但是,始终要求术者应亲自进行内镜检查,以保证术者清晰掌握肿瘤范围、位置,并对手术方式选择、能否保留肛门做出合理的判断考量.回顾十年间《NCCN直肠癌临床实践指南》关于外科原则的推荐意见,专家组始终坚持以“追求R0切除和尽量保留器官结构的完整性”为基本原则的宏观理念.     

Patients’ preferences regarding the delivery of health care in a hand surgical practice

Background

The Patient Protection and Affordable Care Act of 2010 includes patient satisfaction scores in the calculation of reimbursement for services provided. The Medicare and Medicaid Electronic Health Care Record Incentive Program mandate that physicians provide electronic communication with patients. Little data exists regarding patient preferences that might guide the physician adhering to these guidelines. We performed a survey study to examine patients’ attitudes regarding the delivery of their health care.

Methods

We provided an anonymous survey to all outpatient hand surgery patients within a 1-month period at our level I academic center. The survey was structured to ascertain patients’ attitudes toward outpatient wait times as well as delivery of patient-specific healthcare-related information. One-hundred and ninety-six surveys were available for review.

Results

Of the 196 patients surveyed, 106 (54 %) were between the ages of 45 and 64. Patients aged 25 to 44 were the least willing to wait for an initial outpatient appointment. The majority of patients in all age groups demonstrated unwillingness to wait more than 1 week for evaluation of a new problem. One hundred and forty patients (71 %) were willing to wait longer for an appointment with an upper extremity specialist rather than have an earlier appointment with a non-upper extremity specialist. Wait times of 30 min after arrival in the office were acceptable to 174 patients (89 %) while 40 patients (20 %) were willing to wait an hour or more. Patients preferred a typed handout detailing their specific problem as opposed to referral to a website or an e-mail containing information.

Conclusions

The results of our study indicate that patients prefer typed information as opposed to e-mail or websites regarding their health care. Our study also suggests that patients are willing to endure longer wait times if they can be given a sooner appointment, and most prefer a specialist for their problems. These results will provide some guidance to the physician regarding what patients find most appealing.     

张掖医学高等专科学校改建3年来科研工作的实践与反思

张掖医学高等专科学校改建3年来，各项科研工作发展较快，科研力量得到加强，科研成果数量也有较大幅度的增加。纵向来看，科研工作发展速度较快，但从横向上比较，与其他同类学校相比还存在着很大的差距，最突出的差距是以课题为代表的集体科研成果数量少，档次不高。总体可以概括为：有成绩，但是差距不小；有潜力，但是发掘不够；有优势，但是整合不足。因此，有必要反思学校改建3年来的科研工作，正视挑战，调整思路，切实落实科研强校战略，全面推进科研工作，努力实现“教学立校、科研强校”。     

浅谈如何做好骨科实习教学

在骨科实习教学过程中，从培养高尚的职业道德，加强骨科基本功训练，拓展全面科学的临床思维，引导实习生正确对待就业与考研等几个方面着手，提高骨科实习质量，达到培养目标。     

病案管理的探索与实践

随着社会法制意识的增强,病案管理工作在医院管理中更凸显出它的重要性。只有充分认识病案在当今社会中的法律地位和作用,才能使所有参与完成病案的医务人员、病案管理人员和使用者能够自觉维护病案的真实性、完整性和科学性,自觉维护患者、医务人员和医疗机构的合法权益。     

实习护生自我防护意识与锐器伤相关性的调查分析

目的了解护生锐器伤的发生与自我防护意识是否存在相关性。方法采用自行设计的问卷调查表，对在我院实习的护生随机抽取100名进行回顾性调查，并进行相关性分析。结果锐器伤在护生中是比较普遍的，其中各种针剌伤占45．9％，安瓿玻璃割伤占41．8％，而用纱布包裹拆安瓿占25，6％，戴手套采血占14．3％，发生锐器伤后向老师汇报占15，3％。结论护生自我防护意识薄弱，护生自我防护意识与锐器伤存在相关性。     

以问题为中心的教学法在临床教学中的应用

以问题为中心的教学方法（Problem—based learning，PBL）在培养学生独立解决问题能力、创造性思维及主动学习能力方面起着重要作用。如何尽量发挥以问题为中心的教学方法在临床教学中的应用，是我国临床教育工作者应探讨的问题。